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Inspection on 04/11/08 for Beech Lodge - Deaf-initely Independent

Also see our care home review for Beech Lodge - Deaf-initely Independent for more information

This inspection was carried out on 4th November 2008.

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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The service continues to provide a warm, friendly secure environment where service users can be supported and exercise independence to a degree they are comfortable with. The service ensures that there are activities and life experiences to meet all needs and extend individual horizons, in line with expressed wishes and agreed plans of care that are regularly reviewed. Staff showed skill and commitment in ensuring that individuals are heeded and needs are met. Throughout, an easy-going friendly atmosphere was observed, with much good-natured banter and affection. Residents were generally out-going, confident, and supportive of each other. Residents indicated, throughout their signing, that they enjoyed living here, and enjoyed good, positive relations with the staff and each other. A visiting professional commented on the `lovely atmosphere` adding `I love coming here.` Visiting family members said they really appreciated the efforts of the staff and the service as a whole. Comments included `happy and contented` and `they do an excellent job`.

What has improved since the last inspection?

At the last inspection, there was a risk that a proliferation of staff notices in communal areas detracted from the homeliness of the home. These have been reduced to a bare minimum.

What the care home could do better:

Most of the residents have been at the home for a number of years. So have most of the staff. Consequently, staff are generally very aware of the needs and wishes of residents, and how to meet them. Possibly because of this, individual risk assessments are in some cases lacking in detail and consequently of little use to anyone seeking to support that individual without prior knowledge of them. More detail in individual risk assessments will ensure that any specific individual risks, and how they are best managed, will be clear to everyone involved in the care of that person.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Beech Lodge - Deaf-initely Independent 28 Warwick New Road Leamington Spa Warwickshire CV32 5JJ     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: Martin Brown     Date: 0 4 1 1 2 0 0 8 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. the things that people have said are important to them: They reflect 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 28 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 28 Information about the care home Name of care home: Address: Beech Lodge - Deaf-initely Independent 28 Warwick New Road Leamington Spa Warwickshire CV32 5JJ 01926337743 01926337743 di@leamspa282.freeserve.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mr T A Wood Type of registration: Number of places registered: Deaf-initely Independent care home 8 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability physical disability sensory impairment Additional conditions: All service users must have a learning disability and a hearing disability. The home may also provide care for one person over the age of 65 who is named in the application for variation dated 28th October 2005. Date of last inspection Brief description of the care home Beech Lodge is a parent led voluntary organisation that provides 24-hour personal care for eight adults who are deaf and also have a learning disability. It is a large detached property, formerly a hotel. It is on a busy main road, near to a college of further education, shops and parks. It has gardens to the front and a tarmac drive leading to a large space for cars and a small courtyard garden at the rear and an enclosed garden to the side. On ground floor level there is a hall, a spacious lounge, a large dining room, an equally large communal kitchen/dining room and two staff Care Homes for Adults (18-65 years) Page 4 of 28 Over 65 0 0 0 8 8 8 Brief description of the care home offices. Leading to the rear of the building there is a short flight of steps into the back corridor. Here there are two bedrooms with en-suite facilities, suitable for people with physical disabilities. The staff sleeping-in room is situated in the same area. A large, new laundry has been created. The corridor ends in a back door straight out onto the tarmac parking area. There is a double garage and a walled courtyard garden with barbecue. There are large, dry cellars at the bottom of a flight of stairs. On the first floor there are two bedrooms with en-suite facilities for residents and another staff office. There is a flight of stairs leading to the top floor. There is a small seating area on the landing and a door leads through to a lobby with four more bedrooms off this, with en-suite bathrooms. There is a small, shared kitchen off the lobby that is suitable for making snacks and drinks. Fees per person per week range from £788.75 to £946.10. There are extra charges in respect of transport, holidays, activities and equipment. Care Homes for Adults (18-65 years) Page 5 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This report has been made using evidence that has been accumulated by the Commission for Social Care Inspection. This includes information provided by the home, questionnaires returned by residents and relatives, and a visit to the home. Eight surveys were returned. These were all positive. They were all filled in without comment. In most cases, the boxes appeared ticked in by the same hand. The Annual Quality Assurance Assessment was completed and returned by the service, and gave clear details of how the service continued to work to support the people who live at the home. The inspection visit was unannounced, took place on 4th November 2008, between Care Homes for Adults (18-65 years) Page 6 of 28 1.30pm and 8pm, and was combined with an inspection of the organisations adjacent home, Chestnut Lodge. An interpreter was present for three hours of the inspection to assist the inspector in talking with residents. All the residents communicate through signing. All residents were seen over the course of the inspection, as were the staff and management on duty. Two parents were spoken with, as well as a visiting professional. A tour of the premises was made, relevant documentation was looked at, staff and residents spoken with, and observations of the home in action were made. All staff, management and residents were welcoming, helpful, and friendly throughout. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details 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 8 of 28 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Potential residents can be confident that the service would fully assess their needs to ensure that these could be amply met, and that they would have all the information and support needed to make an informed decision about where to live. Evidence: There have been no new admissions in the past twelve months. Most of the residents at Beech Lodge have been living there for nearly ten years. Those spoken with expressed no regrets at having moved there. One person had said that they had found it difficult at first not living with their parents but that they were happy now. Relatives spoken with said they had never any regrets about their loved ones moving to the home. There is a clearly set out Statement of Purpose and guide to the home which sets out its aims and how it is run for the people living there. This includes clear statements of residents entitlements. Relatives spoken with said how the home had impressed from the outset with its open and friendly approach. Care Homes for Adults (18-65 years) Page 10 of 28 Evidence: Management advised that assessments for any future admission would continue to involve lengthy introductions and trial visits and stays. This is particularly important as many of the admissions to the service have been from outside the immediate locality and all recognised the big step it was for many people. Care Homes for Adults (18-65 years) Page 11 of 28 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can be confident that their assessed and changing needs are reflected in their individual plans, that they are helped to make decisions about their lives, and supported to take risks. Residents would be more confident that individual risks are always handled appropriately if they are always recorded in sufficient detail. Evidence: All residents have detailed care plans that include copies of regular reviews. Relatives and relevant social workers are invited to reviews, and the manager advised that these can also become something of a social event for individuals, especially where relatives and social workers have travelled some distance to attend. Reviews were taking place on the day of the inspection, attended by relatives and social workers. One social worker was happy to renew acquaintance with some residents not seen for a while. An outside professional commented very positively on the service, saying that it encouraged choice and that issues of residential care and independence were always Care Homes for Adults (18-65 years) Page 12 of 28 Evidence: raised at reviews and that residents and relatives were always fully involved and kept informed. This was evident in copies of reviews and care plans looked at. A sample of two care plans were looked at in Beech Lodge. Both showed up to date reviews, and guidance and information in a clear accessible manner. Individual plans showed evidence of user involvement and agreement. Information concerning what help people needed, what they liked doing, and what daily activities they undertook, were all supported by comments from staff and from residents themselves. Reviews, care files, discussion with staff and residents, as well as observation of interactions within the home, showed residents being supported and encouraged to make decisions about their lives, whether it was what meal to choose, whether to go out, where to work or what to do in the day. One person had an individual plan which showed how the person had been supported through a bereavement, followed up by very appreciative comments from a relative. Residents are supported to take risks as part of an independent lifestyle. There were lots of good examples of this taking place, with staff supporting residents to go out, and to be independent around the house. Risks were assessed, but in some cases, details of how they were managed were rather brief, with staff support often being written in, with little other detail of how a risk was managed. In one instance, staff support when outside involved physical support on one arm, but this was not detailed on the risk assessment. The manager agreed that risk assessments should be reviewed to ensure that they contained enough detail. It was clear, from discussion with staff, and observations of interactions, that they were clear on how particular risks were managed, and were very able at ensuring this. The manager agreed that because staff were so competent and knowledgeable of residents abilities and support needs, that sometimes these may not be recorded as explicitly as might be otherwise expected. It was also noted that many of the risks, especially the routine ones, were covered in individual guidance relating to daily routines. For example, one risk merely noted an allergy to certain products, but details of the allergic reaction were provided in the morning routine guidance. Care Homes for Adults (18-65 years) Page 13 of 28 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from support in a wide range of activities, both in groups and individually, to meet their individual needs and wishes. Staff support enables residents to enjoy busy, valued lives, as well as maintaining family and other contacts. Evidence: A full schedule of activities for staff was seen, showing how staff are deployed to support residents throughout the week. Activities detailed for service users include a variety of college courses, games nights, outings to pubs and clubs, horse riding and swimming for those who have those interests. A timetable shows a busy schedule of college activities. One person has supported employment. All those signed with showed satisfaction with their variety of activities and social life. One person was looking forward to going shopping the Care Homes for Adults (18-65 years) Page 14 of 28 Evidence: following day. Residents have enjoyed a variety of holidays over the past year, and were happy to discuss these. Staff advised that residents have had some individual holidays to meet particular needs, but also enjoy the security and contact of holidays taken as a larger group. One staff commented that things are always going on and this chimed with signings by residents, who were all enthusiastic about the variety of activities. Residents are supported to maintain family contacts. The staff support in this regard is particularly important where families live some distance away. In some instances, staff provide transportation to accommodate contact. A visiting professional commented that the home is very supportive of families and encourages their support. A menu showed a choice of healthy meals continued to be provided. A meal was taken in Chestnut Lodge, and discussed in that report. Residents were seen to be enjoying drinks and fruit during the inspection. Care staff take turns to prepare meals and encourage residents to help as much as they are able and comfortable with. Care Homes for Adults (18-65 years) Page 15 of 28 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents continue to receive personal, emotional and health care support in line with their own needs and wishes and in appropriate ways by staff who understand what those needs are. The updating of medication dispensing, under the guidance of a local pharmacist, should ensure that this continues to be done in a safe manner that allows for optimum independence by residents. Evidence: The most immediate and obvious support need residents have is for staff to be able to understand and respond to them. This was evident, with staff communicating well with residents. A very good rapport between staff and residents was noted, with much good-natured signing banter between staff and more independent residents, and with staff able to reassure and support those who have higher support needs. One person was very tactile, and this was catered for with lots of varying fabrics. One resident has a dual sensory impairment. Other residents signed positively and supportively regarding this person. Staff use finger signing to communicate with her, which she responded to. She was less responsive to the interpreter, as someone she Care Homes for Adults (18-65 years) Page 16 of 28 Evidence: was unfamiliar with, and was much happier with the familiar touch of staff whom she recognised and felt comfortable with, and was able to sign some of her likes, including shopping. A rail has been put on the stairs, enabling her to go from her chosen chair in the lounge to her en suite room independently. Individual records showed health care needs being met with regular appointments with health professionals made as needed. Medication was looked at. This was being dispensed via dosset boxes. Management had recently had a visit from a pharmacy advisor and now realised this system was unacceptable. They were due to change over to a blister system of daily administration at the start of the following week. Contact with the pharmacy advisor confirmed this to be the case. Confirmation from the home of the change was received the following week. It was good to see the service being able to respond so promptly to professional advice in order to ensure that they complied with pharmacy standards. The pharmacy advisor said that any additional training requested would be forthcoming. All Medication Administration Record Sheets records checked tallied with existing stocks of medication, showing dispensing to be done accurately. The pharmacist also noted that the service did not have a controlled medication cabinet, nor a medication fridge. They were advised to obtain these for any potential use, although it was recognised that no resident had needs that required these currently, neither was it foreseen that such a use would occur. They were advised that any use of eye drops, or some antibiotics, may entail secure refridgerated storage. Management were later able to advise that secure refridgerated storage, and secure controlled medication storage was in place, to meet any future eventuality. A number of residents continue to self-administer, with suitable checks and risk assessments in place to facilitate this. Care Homes for Adults (18-65 years) Page 17 of 28 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can be confident that their views are listened to and acted upon, and that they are protected from abuse by the policies and procedures of the service, and by the open, transparent, atmosphere at the home. Evidence: No complaints have been received by us concerning this service. Surveys returned were positive, with no areas of concern or complaint. Surveys showed that residents would go to key workers or the manager in the first instance if they were not happy about something. The service advised that it has received no complaints, and therefore its complaints book is empty. No resident indicated throughout the inspection that they had anything that concerned them. Residents have contacts with families, signing social workers, and /or an advocate who visits the home regularly, but is not officially linked to the service. Finances were checked for one resident and seen to be properly and accurately recorded. Monies for this person tallied with records of this money. An incident was recorded of one person losing their wallet, but this had been recovered, and was regarded as a one off incident, rather than a specific recurring risk. The manager advised that they do random checks on monies kept for service users, with a random audit taking place by the outside person who is paid to do regular visits on behalf of Care Homes for Adults (18-65 years) Page 18 of 28 Evidence: the registered provider. There are appropriate policies and procedures in place to help protect residents against abuse. Full and ongoing training for staff ensures that they are aware of them. Staff spoken with showed a good knowledge of appropriate action to safeguard residents, and discussed knowledgeably the particular vulnerabilities of various residents, and how, for example, body charts are used where appropriate, and how any concerns would be flagged up, with management, or the Board of Trustees in line with agreed procedures. Care Homes for Adults (18-65 years) Page 19 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents continue to benefit from a clean, well-maintained environment that is obviously lived in, and subject to a continuing programme of refurbishment and upgrading to take account of wear and tear and also to improve surroundings. Evidence: The home was clean and tidy during this unannounced inspection. It is subject to repair and maintenance, with attention being given to areas that require it most urgently. Rather than being pristine and spotless throughout, it shows signs of being lived in, as one might expect from a home for nearly a dozen people of various ages. The home has spacious communal areas and spacious bedrooms. Some of these were seen, and are furnished and decorated in accordance with the needs and wishes of residents, and reflected their individual likes and personalities. The manager advised that there is an ongoing programme of renovation of bedrooms and the replacement of carpets. Walls are decorated with vibrant pictures, and artworks created jointly by staff and residents. Residents have a choice of sitting rooms, with one, on the day of the inspection, tending to be a quieter television lounge, with the joint dining room and lounge being a little livelier, with residents making their choice as to which they Care Homes for Adults (18-65 years) Page 20 of 28 Evidence: preferred. There were no unpleasant odours evident and the bathrooms and toilets that were seen were all clean and tidy. There is a large laundry, which was clean and well ordered, to meet the needs of the residents. The kitchen is large and well laid out for safe and easy use by residents as well as by staff. Care Homes for Adults (18-65 years) Page 21 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents continue to benefit from a properly recruited and well trained staff team who provide excellent support in enhancing their quality of life and helping them further develop life skills. Evidence: Staff were observed throughout to be engaging with residents in a warm and positive manner, providing support when needed. There were obviously a very good rapport between individual staff and residents. Communication was excellent, with much goodnatured banter and shows of affection between residents and staff. Staff were all seen to be proficient in sign language. Where touch signing is required for one resident, staff were seen to communicate clearly and sympathetically, to make themselves understood, and to understand the resident. There were sufficient staff on duty to meet the needs of residents. Discussion with staff and management, and signing from residents, showed that staffing is flexible enough to cater for specific activities, whether these be in the day or the evening. Staff in discussion showed a good awareness of individual needs and how to meet them, and this was confirmed by observation of interactions. Care Homes for Adults (18-65 years) Page 22 of 28 Evidence: Records demonstrated that recruitment procedures are sound and include all necessary checks, including references Criminal Record Bureau checks. The practice of residents engaging with potential staff prior to appointment, so that their views on the staff are taken into account, continues. Details of training for staff was seen to cover relevant areas. Staff spoken with all said the training was excellent. As well as gaining high levels of proficiency in signing, staff were working to further National Vocational Qualification qualifications, as well as having training in mandatory areas such as first aid and adult protection and safeguarding. The home was able to provide extensive training details demonstrating comprehensive staff training in mandatory and relevant areas. Staff were able to demonstrate in discussion their knowledge and training, and observations of staff interacting with service users showed they had a good knowledge of their needs and how to meet them. There was no indication of any residents being frustrated by an inability to make their needs known to staff. Rotas and observations on the day showed that there were sufficient staff on duty to meet the needs of residents. Staff advised that staffing was made available to cover specific outings and events. Care Homes for Adults (18-65 years) Page 23 of 28 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from a well run home in which their health safety and welfare is promoted. Their views and the views of significant others inform the development of the service. Changes planned within the service should ultimately be of benefit to individual residents. Evidence: The service has regular monthly visits by an outside consultant, who provides a report on their findings. These are constructively critical and highlight suggested areas for improvement, as well as highlighting good practice. The report for the previous month was seen. This reflected the positive nature of the service, and highlighted areas for action which had been acted on. The service continues to have the services of an independent advocate who is available to support individual residents who may not have, for whatever reason, outside support from relatives. This person also continues to chair regular residents meetings. A visiting professional spoke positively of the way individual residents are involved and Care Homes for Adults (18-65 years) Page 24 of 28 Evidence: consulted in issues affecting them. The Annual Quality Assurance Assessment returned by the service indicated that good health and safety is maintained within the home. No evidence was noted during the inspection of anything within the environment conflicting with this. The management recognised that there is a diversity of age, as well as ability, within the service, with ages now ranging from 21 to 67. This has been accommodated to some degree, with residents who are younger, more active and more independent, tending to live in the sister home, whilst Beech Lodge tends to have people who need more support. This is a tendency, not a rule, with one person who is very independent in many ways choosing to remain at Beech Lodge. There is considerable cross over between the two homes, with residents free to drop in from one to the other, up until early evening or dark at least, when the security of the premises becomes a greater consideration. Management, looking to the future, are considering providing a new, separate service for those older residents who may not share the outlook of younger, more active residents. It is also considering applying to unite the two current homes under one registration, whilst still encouraging them to run with a similar degree of separateness. The management provided a diagram of the proposed new organisational structure, which will form part of their request for a change in registration. Care Homes for Adults (18-65 years) Page 25 of 28 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 26 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 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 9 The service should review all risk assessments to ensure that the management of all individual risks is sufficiently detailed as to provide clear guidance to all staff. This will help ensure that residents are always supported in a clear and consistent way at all time in activities that may entail a significant element of risk. Care Homes for Adults (18-65 years) Page 27 of 28 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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