Inspection on 09/02/09 for Cwello Lodge

This inspection was carried out on 9th February 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

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Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Cwello Lodge 17 Cobbett Road Southampton Hampshire SO18 1HJ     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: Janet Ktomi     Date: 0 9 0 2 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 35 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 35 Information about the care home Name of care home: Address: Cwello Lodge 17 Cobbett Road Southampton Hampshire SO18 1HJ 02380559628 02380559628 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Auckland Care Ltd Name of registered manager (if applicable) Mr Christopher Paul Carr Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users to be accommodated is 5. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning disability (LD). Date of last inspection Brief description of the care home Cwello Lodge is a registered residential care home able to provide care and accommodation for up to five younger adults with learning disabilities. The home is not suitable for people with a physical disability. The home is a large detatched house which has been extended to provide all single bedrooms with ensuite WC and wash basin. There is a bathroom on the ground floor and two shower rooms on the first floor. There is a lounge/dining room and large separate kitichen. There is also an office on the first floor. To the rear is an enclosed Care Homes for Adults (18-65 years) Page 4 of 35 care home 5 Over 65 0 5 Brief description of the care home garden with patio and lawn area. Car parking is in the road outside the home. The home is owned by Aukland Care Ltd. At the time of the unannounced inspection visit the homes registered manager Mr C Carr was managing another home owned by Aukland Care and Cwello Lodge was being managed by the deputy manager who was in the process of registering as the manager for Cwello Lodge. The homes weekly fees range between 800 and 1300 pounds dependant on assessed needs of the person. Care Homes for Adults (18-65 years) Page 5 of 35 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 contains information gained prior to and during a visit to the home undertaken on the 9th February 2009. All core standards and some additional standards were assessed. This was the first inspection of the home that was registered in September 2008. The home has been rated as providing good outcomes for people who live there. This is the maximum rating that a new service can achieve on its first inspection. The visit to the home was undertaken by one inspector and lasted approximately five and a half hours commencing at 1 pm and being completed at 6.30 p.m. The inspector was able to spend time with the person in charge who is in the process Care Homes for Adults (18-65 years) Page 6 of 35 of registering with the commission as the homes manager and staff on duty and was provided with free access to all communal areas of the home, documentation requested and people who live at the home. Information from the Annual Quality Assurance Assessment (AQAA) completed by the person in charge and surveys received from people who live at the home, staff and external professionals is also considered. The Responsible Individual briefly visited the home during the inspection visit and provided information about the homes fees following the inspection. During the visit to the home the inspector was able to meet with and talk to people who live at the home. 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 35 Care Homes for Adults (18-65 years) Page 9 of 35 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 35 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. The home would only admit new people whose needs could be met at the home and who were compatible with the people already living there. Evidence: The inspector discussed the homes admission procedure with the person in charge and viewed two completed pre-admission assessments. The inspector also spoke with care staff and a person who lives at the home about new service users and the admission process. The inspector spoke with social care external professionals following the inspection visit and two comment cards were received from care managers. Since the home opened in September 2008 four people have been admitted. A fifth person is due to move into the home soon after the inspection visit. The home is in the process of completing work to provide a further two bedrooms. The manager is aware that these will need to be registered with the commission as the home is currently only registered to provide accommodation for up to a maximum of five people. Care Homes for Adults (18-65 years) Page 11 of 35 Evidence: The pre admission assessments for two people living at the home were viewed. The person in charge had visited the people with one of the providers and completed a comprehensive assessment of their needs. Information had also been gained from professionals involved in their care including care managers and community nurses. Peoples relatives were also involved in the assessment and identifying of peoples needs. Copies of care manager assessments were seen in peoples care plan files. Information gained during assessment had been used to formulate care/support plans. There was also evidence that reviews had been undertaken approximately one month after people had moved into the home involving the person and other relevant people. Information from pre-admision assessments was included in care plans and risk assessments. The inspector spoke with one person living at the home about the process for their moving in. The person confirmed that the person in charge had visited her and that she had visited the home on several occasions before moving in. The person also stated that she was aware that another person was due to move into the home and that although she had not yet met them, as she had been out at the time of his previous visit, she would be meeting him. There was a list of visits undertaken by people prior to their moving in seen in care plans. The person the inspector spoke with confirmed that they had received written information about the home and had information in their room about about the home. The person in charge confirmed that everyone had a copy of the service users guide and that this had been read to them. The service users guide is not yet in a suitable format for all people living at the home and the the home should consider how information could be provided in a more suitable format for the people who live at the home such as pictorial or via audio tape/video etc. Comment cards were received from two of the people who live at the home both stated they were asked if they wanted to move to this home. Additional comments being I came for lots of visits. Both stated they had received enough information about the home before they moved in so they could decide if it was the right place for them. One added the statement I would like to stay here, I dont want to move. Two comment cards were received from care managers one stated usually and one always to a question about the services assessment arrangements and if they ensured that accurate information is gathered and that the right service is planned and given to individuals. Care managers added additional comments in respect of assessments stating thorough assessments carried out before my client moved to Cwello Lodge in October 2008, the other saying the home has been opened recently, the home manager and staff have shown great efforts to obtain accurate information from previous providers for the service users I work with. Care Homes for Adults (18-65 years) Page 12 of 35 Evidence: Care staff confirmed that they had enough received enough information about new people moving into the home. The person in charge stated that consideration was given as to compatibility with existing people when considering whether to offer a home to a new person. None of the people living at the home are self funding. The inspector observed copies of contracts provided to their funding authorities. The fees for the home vary depending on the level of a persons assessed needs. Some people receive additional 1-1 support and there was evidence that they were receiving this. Care Homes for Adults (18-65 years) Page 13 of 35 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 the home are at the centre of the homes care planning system and actively involved in their development. Staff are committed to supporting people to lead purposeful and fulfilling lives as independently as possible. People who live at the home make their own informed decisions and have the right to take risks in their daily lives. Evidence: Two care plans were viewed. Risk assessments and the ways in which risks should be managed were seen in care plans. The inspector spoke with staff and the people who live at the home about care plans. The inspector also discussed how decisions are made and observed how people who live at the home are encouraged and supported to be active and independent. The two care plans viewed were person centred and followed a person centred format. Care plans had been reviewed every month and had been signed by the person whose Care Homes for Adults (18-65 years) Page 14 of 35 Evidence: plan it was. Care plans contained information about, and risk management plans in respect of, health needs as well as personal care, social and independence skills training. The home uses a key worker system. Each care plan contained risk assessments relevant to the needs identified and incorporated into the persons care plan. Management of risk positively addressed safety issues whilst aiming for improved outcomes for people using the service in terms of skills development and independence. Two care managers completed comment cards and stated always to a question about whether the service responds to individual needs of people, one added individualised planning. When asked what the service does well one care manager added the comment proactive with person centred approach to care plans. The person in charge identified on the homes AQAA that there are plans to make care plans and other information for people who live at the home in a pictorial format. Four staff completed comment cards all felt that the ways of passing information about people worked well, we always pass on information and use handover book every day, another stating the team is always kept informed of any information needed by the manager and information is passed on about issues at handover. Observation during the inspection visit and discussions with people living at the home confirmed that they are able to make decisions and that these are respected and acted upon by the home. Throughout the inspection visit people were observed making suggestions and their views being sought by the person in charge and staff. People confirmed they are involved in shopping (as occurred on the day of the inspection visit) and decisions about the menus. The person in charge stated that when information needs to be shared or views sought this is done on an individual basis and would be recorded in the persons care plan. People are able to choose what they spend their personal money on and bedrooms were personalised reflecting their occupants interests. Records of what people had spent their money on confirmed that people are supported to make choices about their lives and what they do. The support people receive in relation to their personal finances is recorded in care plans and varies between the people living at the home depending on the level of support required. The inspector viewed the arrangements in respect of personal finances and the procedures and records are appropriate and well maintained. The home has either organised or is organising a social services advocate to be responsible for peoples money with the home supporting people with small Care Homes for Adults (18-65 years) Page 15 of 35 Evidence: amounts of personal spending money. Copies of how money has been spent with and on behalf of people is provided to the advocate. External health professionals and staff identified in comment cards that there are confidentiality issues with a lack of privacy for staff performing handover in the kitchen, confidential information maybe heard by other service users and/or a discussion about behaviors. Another identifying it would be good for the home to have access to a quiet room where issues can be discussed without other service users hearing. Care plans and confidential information is kept secure. Care Homes for Adults (18-65 years) Page 16 of 35 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported to live the lifestyle they choose. Evidence: Information in care plans, comment cards and other records viewed is considered along with discussions held during the inspection with care staff, the person in charge and with people who live at the home. Everybody has an individual weekly programme of activities that includes a variety of day services, college and leisure activities, intended to help develop and maintain life skills and provides opportunities for socialisation away from the home. A list of regular weekly activities was seen in the care plans viewed. Care plans also contained records of what activities either in the home or in the community people had participated in. Discussions with care staff and people who live at the home confirmed that they enjoy Care Homes for Adults (18-65 years) Page 17 of 35 Evidence: these activities and had been involved in the development of their individual activity plans. During the unannounced visit by the inspector to their home two people were at home with others arriving home later in the afternoon having been out shopping and for lunch with the person in charge and a carer. Comment cards were returned from two service users one said always and one usually that they make decisions about what they do each day. One person added I go to day centre, we talk about trips with staff and they sort them out, we talk about trips at meetings. Both people who returned comment cards stated they could do what they wanted during the day, in the evening and at weekends. I go to day service in the week, I have other trips on the weekend, I like that staff take me to church and trampoline which I choose. Similar comments were expressed to the inspector when she spoke with people who live at the home. Staff also commented on what they thought the service did well the service provides a very good service to their clients. We ensure all our service users have independence and community integration. We also value individual choice. External health professionals felt that the home supported individuals to live the life they choose, as far as im aware taking into account the clients wishes and choices, through pcp and daily choice service user are supported to make choices regarding lifestyles. They have a good understanding of the paramitters of choice, capacity of each individual for certain decisions and their duty of care. Within their bedrooms people have a variety of home entertainment equipment such as TVs and music systems. During the inspection visit people were noted to be able to spend their time as they wished, moving about the home independently. The home is located in a residential area with easy access to local services. Staffing levels are sufficient to enable people to access community activities. Whilst viewing financial records the inspector saw evidence of money spent on outings and personal items. People are involved in assisting care staff with food shopping in the local shops, use local leisure centres, the local library, parks and use local health facilities. The home has a good sized rear garden and the person in charged described plans for the spring and how people who live a the home will be encouraged to be involved in growing some of their own vegetables and helping with the care of the garden. Two comment cards were received from people who live at the home who stated that they could do what they wanted at all times and that activities were provided. Two care managers returned comment cards and added additional comments about Care Homes for Adults (18-65 years) Page 18 of 35 Evidence: what the service does well stating it was very pro-active with supporting service users to do activities of their choice, encourage service users to enjoy their own home and encourage service users to take responsibility for their own actions. The home has a house car capable of transporting everyone living at the home. The manager stated that the home pays for all costs relating to the house car. The inspector discussed holidays with the person in charge who stated that the home was paying for a holiday for the people who live there and they were looking at options as to where people would like to go. People informed the inspector that they could have friends visit them at the home and that they were supported by the home to visit family and friends. People attend local clubs and church activities where they are able to meet existing friends and make new friends. The homes routines tend to be organised around the people who live there with meal times flexible to meet peoples individual preferences and routines. Discussions with the people who live at the home confirmed that all had done different activities on the day of the inspection visit. As well as external activities people are encourage to undertake domestic tasks and the home has a range of craft and activities equipment which was shown to the inspector. The home does not employ separate catering staff so care staff take turns to cook each day. People who live at the home are encouraged to participate in food preparation with risk assessments in place in respects of some aspects of food preparation. Information in care plans stated if people require special diets and what support they need at meal times. Records showed that meals are varied and nutritious. People stated that they liked the meals at the home. Two of the people at the home had helped staff with the weeks food shopping and putting items away in the kitchen on the day of the inspection visit. Care Homes for Adults (18-65 years) Page 19 of 35 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People receive personal care and support in the way they prefer and their health needs are met. Staff have received training in respect of medication. Medication Administration Records do not evidence that medication has been administered as prescribed. Evidence: Information about personal and health care needs and that provided was viewed in care plans. Comment cards and discussions were held with the people who live at the home and staff. Comment cards from care managers and health professionals are also considered. The arrangements for the storage and administration of medication were viewed with any related records. Two comment cards were received form external health professionals which were positive about the service confirming that the home always seeks advice and acts upon it to manage and improve individuals health adding I have received appropriate communication from the service requiring advice regarding a service user, advice always acted on. Another health professional stating all staff at Cwello (manager and Care Homes for Adults (18-65 years) Page 20 of 35 Evidence: support staff) have contacted me to gain advice on physical and mental health issues as well as behaviour and emotional. staff have acted appropriately on all information given and have reviewed the progress and success of information/intervention When asked on the comment cards whether individuals health care needs are met by the care service both stated yes, adding all staff have met the needs of the service user I work with in full. I have not had any concerns about the needs of other residents who appear to be also have theirs met. The other stating yes requested recording charts, these are completed. requested service user sees GP, this was done quickly and reported back to me. When asked in comment cards if they felt care staff have the right skills and experience to support peoples social and health care needs both health professionals stated always brilliant staff team, very motivated, kind, experienced and always working their best for the service users, the staff are very reactive in insuring that individuals are supported and that their needs are met, they use differing approaches with individuals depending on their needs, wishes and preferences. And when asked does the service respond to differing needs of individuals - both responded always as far as Im concerned I have no cause for concern, no concerns. Comment cards from two care managers answered always to the question are health care needs properly monitored and attended to by the care services. Additional comments being the home has been very pro-active to monitor and attend to health needs of service users I work with, service user fully supported to attend medical appointments, all registration completed with GP. The home operates a key worker system. Male and female staff are employed so choice would be available if support were required. The home has one bathroom on the ground floor and two shower rooms each with a WC on the first floor. Care staff stated that the bathing facilities were appropriate for the people living at the home. The staff have been consistent since the home opened and staff have got to know the people who live at the home and stated they would recognise if someone was not their usual self and may be unwell. People living at the home are registered with local GPs and support is provided from care staff to make and attend appointments. Care plans contained records that indicated that people are able to see chiropodists, Dentists, opticians and doctors when required. Information about health needs is recorded in care plans. People are encouraged and supported to lead healthy lifestyles. At the time of this unannounced inspection all medication was found to be stored Care Homes for Adults (18-65 years) Page 21 of 35 Evidence: correctly. The medication administration records were viewed and these contained a number of gaps where they had been fully completed. Medication coming into the home is recorded on the Medication Administration Records. The home uses a predispensed system for tablets with liquid medication dispensed at the time of administration. The inspector checked the blister packs against the medication administration records and identified that in one case a tablet had been signed as given but was still in the blister pack and in other cases these had not been signed as given but were also not in the blister pack or with medication that was waiting to be returned tot he pharmacist as it had been removed from the blister pack and then refused by the person. Some tablets cannot be placed into blister packs, however it was not possible to audit these to determine if they had been administered as recorded on the medication administration records as there was no date on the box to indicate when this was opened and commenced in use. The inspector found a bottle of liquid bowel medication in the medication trolley for a named person however the home could not locate a medication administration sheet for this person which they stated was not kept with the other medication administration records but kept with the care plans. It was therefore not possible to determine if people had received the medication as prescribed. Care plans contained risk assessments as to peoples abilities to self administer their medication. These showed that none of the people living at the home were able to self medicate therefore all medication is administered by care staff who have received training. There was information in care plans about medication people were receiving and guidance about as required medication. The home has acted to ensure the privacy and dignity of a person who dislikes and removes curtains from her bedroom by placing a special window film over the glass which allows light in and people to see out but does not permit people outside to look into the persons room. External health professionals both felt that the home always respects peoples privacy and dignity. Stating from what I have witnessed and through discussions with staff the whole team is respectful of privacy and dignity, the other saying as far as Im aware when visiting I have not see anything which has caused me concern. Care Homes for Adults (18-65 years) Page 22 of 35 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. People at the home are able to complain and should be protected from abuse. Evidence: The home has a complaints policy which is made available to people or their representatives. There is also information as to how to complain available around the home. The complaints policy should ensure that all complaints are appropriately investigated within twenty-eight days. The home maintains a complaints book and has received no complaints since it opened in September 2008. No complaints have been received at the Commission in respect of Cwello Lodge. One care manager stated on a comment card that at a recent review, a family member reported that she raised some concerns about a member of staffs attitude. She felt satisfied with the actions taken. Throughout the inspectors visit people who live at the home were seen responding verbally and non-verbally to staff, making requests and appeared comfortable around staff. Staff have a good understanding of the people who live at the home and should be in a position to realise if people were unhappy. Staff spoken with were aware of the procedure they should follow should a person or their representative make a complaint. All staff who completed comment cards stated that they were aware of what to do if a service user or relative raised a complaint one adding yes, I would talk to them and hear them out and help them about the concern and hand over the Care Homes for Adults (18-65 years) Page 23 of 35 Evidence: concerns to the manager as soon as possible. Service users stated on comment cards that they knew how to complain. Most people attend external activities such as college and day services so would also be able to report concerns to them. The home has a safeguarding policy and the person in charge was aware of the local procedures for safeguarding. Staff spoken with during the inspection were aware of the adult protection policy and procedures and clear about their responsibilities to report issues of concern without delay. The manager and staff confirmed that they have received safeguarding training as part of their induction and certificates were seen in staff files. The providers are frequently at the home and staff or service users would also be able to report concerns to them. No concerns in respect of safeguarding were raised in any comment cards received from people who live at the home, staff, care managers or health professionals. The home supports some people who have behaviours that may present challenges. Staff have not yet received training in respect of challenging behaviour but the home is working closely with members of the community team to ensure peoples behaviours are managed. The home responded appropriately shortly following the inspection when an incident occurred notifying relevant professionals and the commission. The personal finances and employment procedures followed should ensure that people are protected from abuse. Care Homes for Adults (18-65 years) Page 24 of 35 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. People live in a comfortable homely house suitable for their individual and collective needs. Evidence: The inspector viewed the communal areas of the home and some bedrooms. Information in the AQAA and registration report completed in September 2008 are also considered. People and staff talked about the home and comments in comment cards received are also considered. The home is located in a residential area of Bitterne on the outskirts of Southampton within walking distance of local shops and facilities. The home is a large older house that has been completely redecorated and modernised prior to registration in September 2008. The registration report started that certificates for all services and equipment were seen as part of the registration processes. The home undertakes weekly checks of the fire detection equipment, the records of which were viewed during the inspection visit. The inspector viewed the homes communal rooms and a staff member showed the inspector the bathrooms and bedrooms including the vacant room and two Care Homes for Adults (18-65 years) Page 25 of 35 Evidence: unregistered rooms that the maintenance man was in the process of refurbishing. The person in charge was aware of the need to register these rooms before admitting people to them. The home is safe, well maintained and at the time of the unannounced inspection clean and free from any unpleasant odours. Care staff undertake cleaning tasks and encourage the people who live at the home to participate. One person who lives at the home stated on a comment card the bath is dirty after I have used it so I have to clean it after I have bathed with staff help. The home meets peoples needs in a homely and domestic way. Bedrooms are all single with communal areas, lounge dining room and kitchen appropriate for the people who live at the home. The home has an enclosed rear garden, with patio area and lawn. The home does not have parking available for visitors or staff, however parking is available in the road outside the home. The home does not have a staff room and at present staff on sleepin duties do so in the vacant bedroom. It was not clear where they would sleep when the home is fully occupied. External professionals identified that the home does not have a private room for meetings or staff handovers which are done in the kitchen and therefore personal information can be overheard by other service users or visitors. The home has an office on the first floor for the manager and the Responsible Individual. Everybody has their own single bedroom, which have ensuite facilities of a WC and washbasin. Bedrooms seen were pleasantly decorated and individually personalised. Personal home entertainment equipment such as televisions and music centres were seen in bedrooms. Two bedrooms are on the ground floor and the remaining bedrooms are on the first floor. The home is not suitable for people with a physical disability. The home has two shower rooms on the first floor and a bathroom on the ground floor. These are appropriate for the people who currently live at the home. The registration report confirmed that thermostatic valves are fitted to all water outlets to prevent the risk of very hot water. Radiators are covered to reduce risks to people. The homes laundry is situated in a small room located off the hall and kept locked when staff are not present. The equipment is domestic and appropriate for the number and needs of the people who live at the home. Care staff confirmed that they have adequate supplies of disposable gloves, aprons and any other infection control equipment required. Substances hazardous to health and items hazardous to health eg kitchen knives, were stored securely. Care Homes for Adults (18-65 years) Page 26 of 35 Care Homes for Adults (18-65 years) Page 27 of 35 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported by a consistent staff team, provided in sufficient numbers and with the necessary skills to meet their individual and collective needs. Evidence: The inspector viewed information in staff files about recruitment, staff training and supervision. Information from comment cards from people who live at the home, staff and external professionals is also considered. Observations and discussions with people, the person in charge and staff during the inspection are also included. Interactions observed during the visit indicated that people and staff have a warm friendly relationship with people feeling able to express themselves. Comment cards received from the people who live at the home stated that staff treat them well and act on what they say. Four comment cards were completed by care staff, all were positive confirming that training is provided, that there are generally enough staff to meet peoples needs and that communication between staff is good. Two comment cards were received from visiting health professionals who stated the staff at Cwello Lodge are enthusiastic and always keen to adapt their approach to meet service users needs, it is refreshing to work with a team so so committed to improve Care Homes for Adults (18-65 years) Page 28 of 35 Evidence: the care for their residents. Additional statements from care managers on comment cards about what service does well being managing some of the difficult times some of the service users may have in calm consistent manner. Another care manager commented staff work well as a team, and the staff have shown enthusiasm and motivation to meet service users needs well, good understanding of non-verbal communication of the service users. The person in charge stated that there are eight permanent care staff and her employed at the home. Staff rotas and discussions with staff confirmed there are always at least two staff on duty with the manager extra to these numbers. Two staff are provided at night, one awake and one asleep on call. Staff spoken with felt that the staffing levels and arrangements were appropriate to meet the peoples needs and that activities relating to social and leisure are possible during the evenings and weekends. Evidence in peoples files confirmed that people are able to enjoy a variety of external activities with the current staffing levels. People who live at the home confirmed to the inspector and on comment cards that they are able to do what they want at evenings and weekends. The home has not needed to use agency staff as staff cover each others annual leave and occasional sickness. The home was registered in September 2008 and all staff have been recruited since that time. The person in charge described the homes recruitment procedures and records for two staff on duty on the day of the inspection visit were viewed. The procedures in place and records seen would indicate that a thorough recruitment and checking process is in place that should ensure that unsuitable people are not employed at the home. Many of the staff had been employed before the home had anyone living there so it had not been possible to include service users in the initial recruitment process. The home is now recruiting additional staff and the manager stated that people living at the home had been included in deciding the qualities of the people they wanted to support them and would be involved in the selection of new staff. Interviews would be held at the home and people would have the opportunity to meet applicants and their views would be considered. Four staff returned comment cards and all confirmed that all pre-employment checks had been carried out before commencing employment. They all also confirmed they had received an induction which covered everything they needed to know the job when they started. Adding I think I got the induction very well and effectively, I was given all the information I needed to start and was able to ask any questions I had about the job. The inspector noted that the form sent out for references does not include a date and the person in charge stated that this would be added to the form. The person in charge Care Homes for Adults (18-65 years) Page 29 of 35 Evidence: had recorded on an index form the date references had been received. All other information corresponded so the inspector accepts that these dates are correct. The person in charge described the homes induction procedures and these include all new staff working supernumerary until they are deemed competent and also have undertaken essential training. Care staff stated on comment cards that their induction had provided them with the skills they needed. The person in charge stated that two of the eight care staff have at least an NVQ level 2 in care and five further care staff are undertaking this qualification either at level 2 or 3. Care staff confirmed to the inspector that they have undertaken all mandatory training. Comment cards returned by care staff stated that they received all the necessary training and that they felt they had the necessary skills and experience to meet peoples needs. Although all staff have completed mandatory training none have as yet undertaken additional training relevant to the specific needs of the people living at the home such as autism or managing challenging behaviour. Care staff stated that the person in charge supports them well when there are incidents. The person in charge stated that the person centred planning coordinator for Southampton is to provide some training for staff. Care staff confirmed that they felt well supervised by the person in charge and that they regularly had opportunities for supervision. Records of supervision were seen in staff files. Staff comment cards also identified that staff meetings are held. All care staff felt they received the necessary support and regularly met with the manager to discuss how they are working the manager is very helpful in situations out of our control, she advises us on the best way to tackle a situation,manager has one to one meetings with staff on regular basis to discuss how we are working and we have team meetings about running of the home and service users. Care Homes for Adults (18-65 years) Page 30 of 35 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home benefit from a service that is well run in their best interests. Evidence: When the home was first registered the Responsible Individual was registered as the homes registered manager. The Responsible Individual has informed the commission that they will now be managing another of their homes and that the deputy manager at Cwello Lodge will become the homes registered manager. This was the person in charge during the inspection visit and it was clear from discussions with staff and people who live at the home that the deputy manager has been acting as the homes manager and that they clearly see her as the manager. This was also the impression the inspector obtained. The Responsible Individual visited the home for a short period during the inspection but did not remain and left the person in charge to continue with the inspection. The person in charge confirmed to the inspector that she has an NVQ level 4 in Care and has almost completed the Registered Managers Award (RMA). The manager Care Homes for Adults (18-65 years) Page 31 of 35 Evidence: confirmed that she also attends update courses to maintain her skills and knowledge. The manager is supported by the Responsible Individual. The person in charge completed the homes Annual Quality Assurance Assessment that was returned to the commission within the required timescales. This was completed to a good standard and contained relevant information. The person in charge stated that she is to do the train the trainer for infection control and is already a train the trainer for autism. Positve comments about the person in charge were made on staff comment cards including our manager is so great, im thankful that I work with her she treats the staff and service users very well. She is very supportive to the staff carrying out our duties to gain knowledge and give high quality servive and care to out residents,yes im happy with my boss and feel able to talk to her anytime I need and have an honest chat about anything The evidence, form surveys completed, care records and observation indicates that people are able to make decisions and supported to live the lifestyles they choose. A representative of the provider undertakes a monthly visit to the home (Regulation 26 visits) with the written reports of these visits being seen during the inspection visit. The home has service users meetings and staff meetings on a monthly basis. Reviews in peoples care plans indicated that external professionals are involved in reviews. The home has only been registered since September 2008 however the person in charge is already considering how formal quality assurance including questionnaires for external stakeholders should be managed. Throughout the inspection visit a number of records were viewed. These have been identified in the relevant section of this report. Records were well maintained and appropriately stored. There were no concerns in respect of health and safety identified during the inspection visit. Staff have undertaken training, all items and substances hazardous to health were securely stored and people stated that they felt safe living at the home. No concerns were raised by external professionals in comment cards received. Care Homes for Adults (18-65 years) Page 32 of 35 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 33 of 35 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 Care Homes for Adults (18-65 years) Page 34 of 35 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. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 35 of 35 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!