Inspection on 03/03/09 for Hales Lodge

This inspection was carried out on 3rd March 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Hales Lodge 09/03/07

Hales Lodge 25/01/06

Hales Lodge 08/08/05

Hales Lodge 28/02/05

Hales Lodge 14/06/04

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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: Hales Lodge Somerton Road Winterton On Sea Great Yarmouth Norfolk NR29 4AW     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: Judith Last     Date: 0 3 0 3 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 34 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.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 34 Information about the care home Name of care home: Address: Hales Lodge Somerton Road Winterton On Sea Great Yarmouth Norfolk NR29 4AW 01493393271 P/F01493393271 H2022@mencap.org.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Royal Mencap Society Name of registered manager (if applicable) Mrs Beverley Jane Pitt Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability physical disability Additional conditions: All service users have a learning disability; all or some may also have a physical disability Total number of service users not to exceed 8 Date of last inspection Brief description of the care home Hales Lodge is a purpose built care home providing care and accommodation for up to eight adults with learning and physical disabilities. The home is divided into two single storey bungalows interconnected by a corridor. Residents share all facilities. Specialist equipment is in place to ensure that residents are able to receive the most appropriate care. All residents have single accommodation and there is a good range of communal space. Care Homes for Adults (18-65 years) Page 4 of 34 care home 8 Over 65 0 0 8 8 Brief description of the care home Fees for the service range from £731 to £1,400 per month and are individually assessed, according to peoples needs and dependency. There are additional charges for hairdressing, chiropody and personal spending. People share the cost of the vehicle according to the amount they use it, and mileage is charged at 20p per mile for social outings. There is no charge for transport to medical appointments. People also pay rent. At the time of the visit the home was full. The manager says that information, including inspection reports, is made available for discussion during residents meetings and keyworker meetings. Care Homes for Adults (18-65 years) Page 5 of 34 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: Before we went to Hales Lodge we looked at all the information we had about it. This included things the manager sent us, and letters from people living or working in the home. One relative also told us what they thought about it. We visited the home without telling the manager first. We were there for just over 6 hours. We spent time looking at and listening to what was going on. We looked at records. We tried to find out from these and from talking, how well people were being supported in their daily lives. Care Homes for Adults (18-65 years) Page 6 of 34 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.cqc.org.uk. You can get Care Homes for Adults (18-65 years) Page 7 of 34 printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 34 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 34 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. People would have their needs assessed so they could be sure the home would be able to meet them if they decided to move in. Evidence: The process for assessing the needs of prospective service users looks at their personal and health care needs, as well as social needs and how people communicate. Assessments seen show a full range of information is gathered before people move in (except in an emergency). This means that people could be sure their needs would be addressed if they were accepted for admission to the home. Staff tell us that they gather knowledge about peoples communication as they start to work with them. They say sometimes this can be difficult because people may have no speech or speech impediments but that as you get to know people you get to be more confident you are understanding them. The information is used to update assessments. Care Homes for Adults (18-65 years) Page 10 of 34 Evidence: The manager takes into account information provided by other professionals or people who know the prospective resident well to make sure she has a full picture of peoples needs. There has been one admission to the home since our last visit, made on an emergency basis. There is information about the persons needs and about any risks to which they may be exposed. This information has been added to as the staff team have got to know the person to build up a fuller picture of their needs and how to meet them. Equipment needed to safely move and handle people is clearly assessed and documented. Guidance is then developed in the care plans seen showing what is to be used and how. The manager tells us the service has been successful in securing additional funding where this has been needed to support people effectively, and that she takes into account the impact of new admissions on existing residents. The admissions process provides for a trial period and visits so that people can decide if the home suits them. Care Homes for Adults (18-65 years) Page 11 of 34 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. Staff work hard to try and ensure people are involved in decisions about their lives and in planning the care and support they are to receive. Evidence: We looked at support plans for three of the people who live in the home. These set out clearly what staff need to do to support people effectively in their daily lives. Pictures and photos are used to make the information clear for staff and to try and help people understand the information themselves despite their communication difficulties. The manager has also tried to incorporate information about goals that are developed around peoples day care activities. There is evidence in support plans that peoples families (where they have involvement) help to plan their care. One person has a circle of support to help where their family is not involved. This shows consultation with others who are Care Homes for Adults (18-65 years) Page 12 of 34 Evidence: important to the person and can support them in setting out their needs. The manager says there are plans to try and develop a similar system for a second person to support them more effectively in the decision making process. A relative who is actively involved says that service users are all treated as individuals and their needs are met to the best of the staffs ability. They feel that the home always gives the person the support they expect and have agreed and gives them enough information to help them support the person with making decisions. There is a system in place with new forms to use where people find it difficult to make decisions and where these might need to be taken for them in their best interests. This reflects consideration of the Mental Capacity Act and peoples rights. Records show one person has had an independent advocate involved to help make decisions in their best interests. This helps to show how individual decisions are made, when they are made by others, and why. Five staff wrote to us. 20 feel that they usually have enough information about the needs of people they support. One commented that due to a period of staff shortages during the year information was not necessarily updated as quickly as it should have been. 80 feel that they always have enough information about peoples needs and one added that new plans are always completed and available. Records show that key information - for example about changes to risk- has been updated promptly so staff know how to support people safely. Communication difficulties mean it is difficult for people to participate in the development of policies and procedures but one person is supported to be involved with interviews for prospective staff members. It was difficult for us to communicate with people during our visit so we listened to and looked at what was going on. We heard staff talking with people and being clear about their responses. They took time to understand what people were trying to say and gave them time to answer questions. They also make use of photographs and pictures and one person has a communication aid. This means that staff try to encourage people to make their views, choices and decisions known. Care Homes for Adults (18-65 years) Page 13 of 34 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. People living in the home are able to experience a range of activities and opportunities to enhance their lifestyle. They are supported to maintain contact with family and friends. Evidence: One persons records clearly show that they have had the opportunity to attend college. There is a progress review of their attendance on their file and information about a course in dance and communication. A staff member told us about acting on other suggestions for example, exploring options for a course in flower arranging for the person. Daily records show peoples opportunities to go out into the local community and to make sure of the facilities there. For example this has included going out for meals, Care Homes for Adults (18-65 years) Page 14 of 34 Evidence: the cinema and theatre. The manager has been successful in negotiating additional funding and this has allowed for increased staffing levels in the afternoon and evening to help increase social opportunities for people. A staff member says that they felt people were accepted in their local community and attended coffee mornings that they all use local shops. They say [persons name] goes to church on Sunday. Everyone uses some sort of local facility. Records support this. One staff member says that they believe the manager is committed to getting people new opportunities. A relative feels that the home always supports the person to live the life they choose. Records from discussions with keyworkers show people are asked about holidays and that some have been planned for this year. The home has a new bus and the manager says this can take three wheelchairs to that it is easier for people to go out and about. When we last visited, one person was practising using an electric scooter and has now passed their driving test making it easier for them to use the local community. Records show family members are encouraged to maintain contact with the home and to attend social events or residents meetings where this may help people express their views. This confirms what the manager says in information she sent to us. A staff member says that they try to take into account service users views about their family and that they would look as someones communication or behaviour for example withdrawing to see whether they are happy with contact. Records also show one person was supported to write to a friend and invite them to the home for a meal. While we were visiting a staff member helped to set up a cordless telephone connection with a headset and mouthpiece that people could use. We saw one person who will be involved in using this choosing photographs from the computer that would be printed off to go alongside the big push buttons so they could make their own telephone calls. This shows the home not only supports people to maintain contact but also uses technology to increase peoples independence and tries to involve them in making decisions about using it. One staff member confirmed to us what the manager says about a person who is encouraged to choose menus from around the world and to help shop and prepare what they have chosen. Everyone living in the home needs supervision or support with their meals. There is clear guidance where this involves preparation of food to minimise the risk of choking. Care Homes for Adults (18-65 years) Page 15 of 34 Evidence: Additional guidance shows that food items are to be prepared or pureed separately so people are able to benefit from experiencing different tastes, colours and smells. The manager says that they had hoped to get menu books in place sooner (but staffing difficulties made this a lower priority). She hopes to progress this now staffing difficulties are resolved so that it will be easier for people to make choices about what they would like to eat. There are dining areas at both ends of the home. One of the kitchen/diner areas has not been adapted as the manager hoped and told us about two years ago. This means areas are cramped should residents wish to watch or join in meal preparation for example, as well as when people are being assisted with their meals. The manager says she has been trying to pursue this but has not yet had a decision from Mencap about funding the improvements she considers necessary. Care Homes for Adults (18-65 years) Page 16 of 34 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. The health and personal care people are given is based upon individual need and delivered in a way that takes into account their dignity. However, medicines are not always audited and managed robustly and safely. Evidence: The home provides support to people with complex needs arising from physical as well as learning disabilities. Individual plans clearly set out how people are to be supported with their personal care. This includes arrangements for bathing and the equipment to be used (such as hoists). There is a track hoist in one bathroom and in one persons bedroom making it easier and safer to move and handle them. While we were present we heard staff encouraging and supporting someone in using the toilet, making sure that they closed the door. This helps show staff encourage respect for peoples dignity and privacy. Records also show that there is some flexibility of routine with people being able to decide what they want to do and when, including getting up and going to bed. They Care Homes for Adults (18-65 years) Page 17 of 34 Evidence: are guided by staff because of the need to get up at a reasonable time for planned day time activities. We saw that one person had wanted to have their hair coloured and we saw that this had happened. We asked them about this and whether they liked it, and they smiled and nodded. This shows staff take into account peoples preferences and choices about their appearance and also what might be appropriate for their age and promoting self esteem. Records show that people are referred for professional advice about their health, including from neurologist, dietitian, physiotherapists and speech therapists about any intervention that might be needed. The assessment for one person for example, showed that the physiotherapist had said they needed a tray on their wheelchair to aid with positioning them properly. However, this has not been clearly cross-referenced in the care plan to help make sure staff are aware of the importance of it in promoting the persons wellbeing (although observation and daily notes show staff do understand what they need to do). The manager acknowledges in information sent to us that they could do better in ensuring records are always updated effectively. She feels staff shortages have made this difficult, giving fewer opportunities for keyworker meetings to take place over the last year. This is confirmed in records seen about these meetings. The manager has committed herself in writing to improving this in the future so we have not made a recommendation. The staff team have continued work on health plans for everyone living in the home. These set out health conditions people have and details about the professionals involved in helping keep people well. Individual support plans reflect information in the health plans, for example to do with eating, drinking, nutrition, continence and oral hygiene, setting out what staff need to do to support people effectively and safely. Records show that health concerns are referred promptly and that any tests that have been required are followed up to see what the results have been and whether any changes to peoples care is needed. This helps show that peoples health and wellbeing is promoted. We looked at the way medication was managed and spoke to staff about their training. Medicines are stored safely in a locked cabinet. There were no omissions of signatures from the record charts in use, showing that regular medication was being given appropriately. One staff member confirmed they had training in the handling of medicines by distance learning and had also completed training delivered by a pharmacy. They said they also had an assessment of their competence before being signed off as able to administer medicines safely. This means there are measures in Care Homes for Adults (18-65 years) Page 18 of 34 Evidence: place to help ensure staff are able to administer medicines safely. There is guidance for staff about the use of medication prescribed for occasional use to control specific conditions. In each case we saw information in daily records showing that the administration was clearly justified. This means that this medication is being used as prescribed to keep people well if their condition warrants it. The manager says there have been two errors in medication administration in 12 months. In each case they had been reported and advice taken about the welfare of service users. She told us about these as she is supposed to do and about the actions she is taking to make sure mistakes are less likely. However, there are concerns that medicines not in blister packs, or given to day services or family members when the person is away from the home, cannot be audited properly. This is because balances sent out and returned are not clearly recorded. This compromises the ability of the management team to check that these medicines are being recorded and administered accurately. Guidance for staff recognises that people have the right to refuse medication and that staff need to respect this. It shows what further advice or action will be taken. This means decisions will be respected but also that they would be followed up to make sure they were informed decisions and were in the persons best interests. Care Homes for Adults (18-65 years) Page 19 of 34 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 are supported to express their concerns and these are responded to robustly. There are measures in place to help protect people from abuse. Evidence: People living in the home would need help to make a complaint. They are given simplified information about how to do this. All of the staff who wrote to us say that they know what to do if a person (or their representative) has concerns about the home. The complaints record shows staff helped one person to make a complaint. This shows that staff understand what they need to do, speak out and take peoples concerns seriously. A relative wrote to us that the home has always responded appropriately if they have needed to raise any concerns and that they know how to make a complaint if they need to. They go on to add that I have never had any reason to complain about any of the staff or anything in Hales Lodge and weve never had a bad word to say about Hales Lodge. These things mean we think that any concerns about the service would be taken seriously and addressed but that people are very satisfied with the service they receive. Care Homes for Adults (18-65 years) Page 20 of 34 Evidence: The manager says staff have regular training in safeguarding vulnerable people and this is confirmed by staff we spoke to as well as training records. Records also show the staff team have worked with the safeguarding team in Norfolk to ensure people are protected from abuse. The manager ensures that staff are checked to make sure they are not unsuitable to work with vulnerable adults and tries to ensure that inexperienced staff always work with others who know people well, to ensure people are protected. Care Homes for Adults (18-65 years) Page 21 of 34 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in an environment that is homely and hygienic. However, access to facilities is currently compromised and identified risks have not been addressed by the organisation. Evidence: The home is situated not far from the centre of the village of Winterton so people do not have far to travel to access local facilities. Staff recognise that sometimes this is difficult for people with physical disabilities. All accommodation at Hales Lodge is on the ground floor and accessible to people with physical disabilities. Aids are provided, such as hoists, including two ceiling track hoists, to help people access the facilities in their home safely. Furnishings are domestic in quality and homely. However, parts of the home are in need of redecoration and the manager has particularly identified the communal lounges. The kitchen area at one end of the home is similarly awaiting refurbishment so that facilities are improved and less crowded for people. She is negotiating this with Mencaps Assets management department so that necessary action can be taken. Care Homes for Adults (18-65 years) Page 22 of 34 Evidence: Some service users room have been redecorated and carpets replaced. There are regular checks on fire safety in the home. However, risks identified in the fire risk assessment have not all been addressed. The manager has pursued this but has not been successful in ensuring funding is available for taking all the actions considered necessary. This includes the fitting of an additional call point and upgrading to glass in a fire door. These things have been considered necessary in order that staff can raise the alarm easily should a fire break out, and that any fire would be properly contained. The manager reports that one bath is currently out of order. Two people cannot be supported safely in the other bathroom based on risk assessments seen, and so are having to have a shower in the other facility. Staff say these people cannot speak for themselves but that their behaviour does not indicate that they dislike showers. However, this represents a reduction in facilities available to people and means that two people are not able to make a positive choice about using the bath or shower. There is guidance for staff about how to control infection and we saw that they have access to protective equipment to help minimise the risk of spreading infection (gloves etc). The washing machine has a sluicing facility to help with this as well. Since our last visit, a member of staff has been recruited to help with cleaning the home and so make a better environment for people living there as well as freeing care staff from some of the domestic responsibilities they had previously. Another staff member has received training in infection control from Great Yarmouth and Waveney Health Trust and is certificated as competent to be the named person for linking with them about the control of infection in the home. The home has been awarded 5 stars for food safety by the local environmental health department, meaning that practices are considered good in promoting peoples protection from food contamination. These things mean there are measures in place to help reduce the risk of harm from infection, and to help minimise the risk of its spread should infection break out. Care Homes for Adults (18-65 years) Page 23 of 34 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are competent and skilled with access to training that helps them understand and meet peoples needs effectively. However, staffing issues during last year compromised the ability of the staff team to meet peoples needs. Evidence: The manager says in information she sent to us, that almost half of the staff have National Vocational Qualifications in care. This helps provide them with the underpinning knowledge they need to support people effectively. One of the two staff we spoke was working towards this and says that the home is brilliant at training. Another told us that training is good. All of the staff who wrote to us feel that they are being given training that is relevant, keeps them up to date and helps them to understand peoples needs. A relative also says they feel staff always have the right skills and experience they need to support people effectively. One staff member commented to us that there are regular training updates. Staff feel their induction was helpful in giving them an understanding of their roles and one staff member told us that they felt there were no holes in giving them the information they needed to support people properly. We know that the manager is finding it difficult to ensure that induction is delivered to new staff in a prompt and Care Homes for Adults (18-65 years) Page 24 of 34 Evidence: timely way as so many new staff have been starting over recent months, following the lifting of the recruitment freeze. Longer standing staff members have also found this difficult and one says this is still putting pressure on the longer serving members of the team having so many new staff all starting in a short period of time. However, comments from staff show that they feel they are given the information they need and can ask colleagues if they are unsure. These things mean that staff have access to training to develop and enhance their skills and to help them understand and respond to peoples needs. We have concerns about what happened with staffing levels during the last year. We were not told about these at the time. It is clear from the managers own reports to her line managers that she considered the situation to be serious. She had secured additional funding from purchasers during the year because of the complexity of peoples needs but had not been able to recruit to meet these. Evidence shows that Mrs Pitt informed her managers in June that staffing was below safe working levels and in July she considered staffing to be in a crisis state. The manager had to use agency staff to increase staffing levels. She tried to ensure that regular staff were used but their experience with the client group meant that there were some tasks they could not safely perform. They needed considerable supervision from permanent staff members. Staff have made comments to us about this showing that staff had put themselves out to cover shifts knowing that we were not offering the quality of the service that we wanted to. Mrs Pitt was not successful in securing permission from Mencap to recruit during the summer despite her concerns about supporting people properly and safely. We know that there are now more staff working in the home because the recruitment freeze is over and our interviews with staff showed that morale is recovering. We looked at recruitment files for staff newly taken on and saw that an appropriate range of checks was made before people start work to ensure that people were fit for the work they were to perform and did not present a risk to vulnerable people. The manager says it is sometimes difficult for her to fulfil her legal obligations to ensure everything is in place as personnel files are not sent to her until new staff members are ready to start work. Care Homes for Adults (18-65 years) Page 25 of 34 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager runs the home in an open and transparent way and takes other peoples views into account. Peoples safety is generally promoted although further improvement is needed. Evidence: Mrs Pitt has a lot of experience in work with people with learning difficulties and complex needs. We know from previous visits that she has the necessary qualifications to support her in understanding her role and running the home effectively. She participates in periodic training to update her knowledge and the training matrix shows that courses are made available in various aspects of management. She is supported by a deputy manager. Staff we spoke to feel that the manager is supportive and does her best to promote the welfare of service users and of the staff team. They say they feel she did all she could to try and address staffing difficulties last year, with more senior managers in the organisation. Care Homes for Adults (18-65 years) Page 26 of 34 Evidence: One person says that the management team will push for what is needed on behalf of people living in the home and that they are open with them about issues. One told us, We know she tries to sort things out and that the management team try to get things organised if training is needed. We asked if the management team were open to suggestions for different ways of working and to look at staff ideas and were told staff are able to raise things and to put suggestions forward for discussion in staff meetings. There is an equal opportunities policy within the organisation. The manager told us in information she sent what the service tried to to to promote equality and diversity. Her focus in the information is on overcoming barriers caused by physical disabilities by looking at equipment that might be needed, and addressing difficulties people have in expressing themselves by looking at new ways of communicating with them. There are regular audits about the quality of the service. The manager completes compliance reports for line managers setting out what problems and issues there are which need addressing, and where improvements need to be made. These show that she has clearly flagged up where there are issues such as staffing and health and safety requirements. People have opportunities to express their views about the service and to make suggestions for improvement in residents meetings. Relatives are also able to attend these and minutes show this. Relatives are also surveyed for suggestions about improvements that could be made. There is an ongoing improvement plan in place which is updated as changes are made. The home is also monitored by an area services manager who reports on the quality of it to the organisation. These visits provide for discussion with staff and people living in the home so their views are taken into account. Records show that a range of health and safety issues is checked every month. Staff completing the assessments sign the record to show what they have looked at. We saw that there are servicing arrangements in place for equipment to make sure that it remains safe for use. Information in the managers reports shows that she felt safety had been compromised during the recruitment freeze when staffing levels fell significantly. There are outstanding issues that have not been addressed about the safety of the home in the event of fire. These are documented risks and although the organisation Care Homes for Adults (18-65 years) Page 27 of 34 Evidence: has addressed some of the issues, others remain outstanding and having been identified as hazards they need to be addressed so that risks to peoples safety in the event of a fire are minimised so far as practicable. There is clear guidance for staff about evacuating the premises in the event of fire, call points are tested regularly and fire detection and fire fighting equipment is serviced regularly to make sure it will work effectively if it is needed. Care Homes for Adults (18-65 years) Page 28 of 34 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 29 of 34 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 20 13 Medicines sent out from the home or received into it and not in blister packs must be recorded accurately. If this does not happen it will not be possible to check that medicines are being given as they are prescribed. It will not be possible to see whether these medicines have gone missing. Regulation 13(2) of the Care Homes Regulations 2001 requires proper arrangements for the recording.... of medicines received into the care home. 22/05/2009 2 24 13 Identified shortfalls in fire safety measures must be addressed. If this is not done people will be exposed to avoidable risk 30/06/2009 Care Homes for Adults (18-65 years) Page 30 of 34 in the event of fire. Fire may not be properly contained so giving staff time to help people leave the home safely. Regulation 13(4) of the Care Homes Regulations 2001 says that all parts of the home so far as reasonably practicable shall be free from hazards to the safety of service users. It also says that unnecessary risks to the health and safety of service users must be identified and, so far as possible, eliminated. 3 27 23 The bath currently out of use must be repaired or replaced. This is to ensure peoples access to existing facilities is not reduced and people. This is so everyone who wishes, can have a bath in safety. Regulation 23(2)(j) of the Care Homes Regulations 2001, requires that there are sufficient numbers of baths and showers. 4 33 18 Where the manager identifies staffing levels are below safe working levels, remedial action must be taken promptly to ensure staffing levels are adequate. 15/05/2009 31/07/2009 Care Homes for Adults (18-65 years) Page 31 of 34 If staffing is not maintained with adequate numbers, skills and competence, people are at risk of not having their needs met. People will be at increased risk to their safety. Regulation 18(1) of the Care Homes Regulations 2001 requires that the registered person takes into account the size of the home, statement of purpose and number and needs of service users, and then ensures that at all times there are suitably qualified, competent and experienced staff working in the home in sufficient numbers as appropriate for the health and welfare of service users. 5 33 37 The registered persons must 15/05/2009 tell us when the welfare of service users is affected, including where this is caused by reduced staffing levels. We need to be sure that the situation at the home is safe and that peoples welfare is being promoted. We need to know what is happening and what the providers of the service are doing about it. We need to know that the Care Homes for Adults (18-65 years) Page 32 of 34 people responsible are not placing service users or staff at undue risk. People living in the home have complex needs and must have staff working with them who understand this and are competent to deal with them. Regulation 37 of the Care Homes Regulations 2001 requires that the Commission is notified without delay of any event in the care home which adversely affects the wellbeing or safety of any service user. 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 34 The manager should be given early access to personnel information so she can satisfy herself (in accordance with the law) that all the necessary information has been obtained or clarified if need be. 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