Inspection on 30/10/08 for Hunters Lodge

This inspection was carried out on 30th October 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Hunters Lodge 01/11/07

Hunters Lodge 14/06/06

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

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Polesworth Group 64 Long Street

Polesworth Group 68 Long Street

10 Whitfield Avenue

Extracts from inspection reports are licensed from CQC, this page was updated on 13/03/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Hunters Lodge Hunters Lodge Bryngwym Manor Wormelow Hereford Herefordshire HR2 8EQ     The quality rating for this care home is:   one star adequate 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: Christina Lavelle     Date: 0 3 1 1 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: · · · · Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 33 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 33 Information about the care home Name of care home: Address: Hunters Lodge Bryngwym Manor Hunters Lodge Wormelow Hereford Herefordshire HR2 8EQ 01981541352 01981540762 hunterslodgehome@tiscali.co,.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Karen Anne Hall Type of registration: Number of places registered: Voyage Ltd care home 10 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: Service users may also have acquired brain injuries, some physical disabilities, a sensory impairment and/or associated mental health needs. Date of last inspection Brief description of the care home Voyage the provider has run services for people with learning disabilities and a range of other challenging and complex needs and behaviours since 1987. Hunters Lodge provides accommodation and personal care for ten adults. People using the service may need care due to learning disabilities, mental disorder, sensory impairment and physical disabilities (including an acquired brain injury). People living at the home often have complex needs and may use challenging behaviours. Since the last inspection in November 2007 the registered manger has left. Ms Ann Morgan was appointed as manager in June, but is not registered yet. The home is in the village of Wormelow, about seven miles from Hereford city centre. There is a local shop/post Care Homes for Adults (18-65 years) Page 4 of 33 Over 65 0 10 Brief description of the care home office and a pub in walking distance and the home also has two vehicles. The building is set in lovely, large grounds and has an internal courtyard. The accommodation is all ground floor and the premises adapted for people with mobility difficulties who may be wheelchair users. Bedrooms are all single with en-suite facilities that include a shower wet room or bath. One bedroom is a self-contained flatlet that could offer more independent living to its occupant. The house has a large sitting room, separate dining room, kitchen, lobby and utility room for everyone living there to use. There are two offices, a staff sleep in room, storage areas and a training/meeting room on the first floor. Information about the service is provided in a statement of purpose and service users guide. The guide is available from the home and Voyage. The fee level and any extra costs are set out in service agreements. These are based on the individual needs of each person using the service and are agreed with them, their family or advocate (if appropriate) and their funding authority, before they move in. Care Homes for Adults (18-65 years) Page 5 of 33 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate 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 is a key inspection of the service provided by Hunters Lodge. This means that all the Standards that can be most important to people living in care homes are assessed. As part of this inspection we, the commission, visited the home twice and spent about ten hours there. The first visit was made without telling staff or the people living there beforehand. It was agreed that they should be referred to as residents in this report. We spoke with four residents about their experience of the home and their lifestyle. Two care staff were interviewed about the service and their role, training and support. The way the home is run and plans to improve the service were discussed with the new manager. Surveys had been completed by nine residents and one social worker, which asked their views of the home. Feedback received is referred to in this report. Care Homes for Adults (18-65 years) Page 6 of 33 The manager had completed an AQAA (annual quality assurance assessment) before our visit. This asks managers to say what their service does well, could do better and about their plans to improve the service. Some relevant records were checked, such as residents care plans and staff files and parts of the building were visited. All other information received by the commission about or from the home since the last inspection is also considered. This includes two complaints and several events that had affected the safety and welfare of residents (these are called notifications). What the care home does well: What has improved since the last inspection? What they could do better: Residents care, health plans and risk assessments need reviewing and updating to show their current needs and risks and focus on their personal goals. Staff can then support them to achieve their goals, develop skills and manage identified risks better. Care Homes for Adults (18-65 years) Page 8 of 33 Progress to introduce care plans in a more suitable way for residents should continue. They could then understand and be more involved in planning their own care. It would better ensure residents specialist health related and behavioural needs are met and managed if they had more input from appropriate health care professionals. Some parts of the building that all the residents use need to be redecorated and have new carpets and fittings to make the home look nicer and be more homely. Staff need training on the complex needs of people using the service such as mental health, autism, communication and moving and handling. This would help them to understand and know how to meet residents needs better and/or manage them safely. Progress to address the lack of management support and leadership should continue so that the support of staff and residents, and so the quality of service, improves. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 33 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 33 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents can be confident the home could support them. This is because a full assessment would be made of their needs and the home would know their wishes from involving them and/or their representatives in their needs assessment and admission. Evidence: There have not been any new residents since the last inspection. However it is evident from discussion with the manager, and the homes assessment and admission policy and procedures, that new people would not be admitted to the home until a thorough assessment of their needs had been undertaken. The manager confirms they would always obtain relevant information about prospective residents and visit them at their current residence to meet them, assess their needs and give them information about Hunters Lodge. Introductory visits to the home would then be arranged, whenever feasible including an overnight stay. A trial stay at the home would follow when the views of, and their compatibility with, existing Care Homes for Adults (18-65 years) Page 11 of 33 Evidence: residents would be considered. A review meeting would be held at the end of their trial stay before the decision is made about the suitability of the placement and a contract in respect of the service agreed by all parties involved. Families and significant other people and the homes staff would be fully involved in these processes. Care Homes for Adults (18-65 years) Page 12 of 33 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The needs and goals of residents may not be met because their plans do not reflect their changing needs and personal goals. Residents can make some decisions in their lives and daily routines because staff promote their individuality and choices. Evidence: Each resident has a plan of their care that covers relevant areas of need with limited background information. Plans include their preferred routines, some likes and dislikes, risk assessments, health related records and an activity schedule. Most peoples plans had not been reviewed and updated for over a year and so they may not accurately reflect their current needs and the support they need from staff. Individuals risk assessments had also not been reviewed and updated recently. In view that some relate to management of behaviours that can be challenging and/or could result in self harm this needs to be addressed as a priority. Although the manager said that the incidence of such behaviours has reduced since the risk Care Homes for Adults (18-65 years) Page 13 of 33 Evidence: assessments were carried out they still should reflect the current situation and provide clear guidance to staff about how they should manage any possible risks and challenging behaviours consistently. The home has recently started to use a care planning format that is more person centred. This means that residents will be more involved in drawing up their own plans and identifying personal goals they want to achieve. Whilst this is a positive development only one persons plan had been fully set up in this way so far. It should also be ensured that they can each have a copy of their own plan if they wish and so plans need to be in a suitable format they can understand. When reviewed plans should then be updated to specify actions taken to meet their individual goals, any progress made and outcomes. As part of the care planning process it is important that staff make efforts to communicate with residents to help them know and understand their needs and wishes. In respect of one person this means that staff need to have specific training, which the home had undertaken to provide. This training is still being sought however and should be arranged as soon as possible. Plans should always refer to residents particular needs in relation to such as gender and disability. They should also reflect any requirements made by their placing authorities to meet their needs. However one person is supposed to receive individual staff support for a certain number of hours a week, but it is not specified how this time is allocated. Copies of residents service agreements were not available at the home for the manager to check such requirements. A social worker comments in their survey that opportunities and attention for my client has not been as reflected in original contracted hours. This should be monitored and adhered to as far less 1 to 1 has been provided. Care staff are allocated to particular residents as their keyworker and it is good they have the opportunity to spend some individual time with their allocated people to discuss their views, lives and goals. It is planned to further develop the keyworker role and as residents spoken with know and like their keyworkers this should benefit them. Efforts are being made to involve residents more in making their own decisions and choices. Regular residents meetings are held when they can express their views on aspects of day-to-day living, activities and such as the homes decor and social events. The plan to introduce service user satisfaction questionnaires, and take necessary action as a result, should also enable people to have more control of their lives. Care Homes for Adults (18-65 years) Page 14 of 33 Care Homes for Adults (18-65 years) Page 15 of 33 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are treated as individuals and take part in activities that meet their personal interests and go out in the community. They are encouraged to be independent and lead their chosen lifestyle. Staff also support residents to maintain links with their family, friends and representatives and the home provides healthy meals they like. Evidence: The manager and staff clearly recognise that residents should be enabled to develop their social, emotional and independent living skills. Although some people take part in few regular activities because of their particular difficulties, efforts are being made to seek and continue to offer them educational and social/leisure opportunities and to encourage them to go out and integrate more in the wider community. Plans include individuals interests and hobbies and each person has a weekly activities Care Homes for Adults (18-65 years) Page 16 of 33 Evidence: schedule. As part of the development of person centred planning their plans could better identify their goals and efforts being made to achieve them. The manager expects that activity take up sheets are completed, which will be helpful when reviewing progress. Residents are supported to keep in touch with their families through phone calls and visits and the home provides transport if necessary. Some people have personal relationships that staff support and help them to maintain and develop friendships. The manager has recently contacted an advocacy service to obtain independent support for people with limited external contacts and expressed commitment to promoting family and other peoples involvement. This is good as one social worker comments in their surrvey that communication is not as good as it could be between staff and more effort could be made to keep social workers, family and others more informed. It is positive that a specific activities co-ordinator has recently been appointed. It is planned that they will set up an activities folder for each resident and enable more evening activities. In addition some residents are being helped to set up and follow a life skills programme that they will keep and work on themselves with their keyworkers. These cover such as self care, cooking, travelling, literacy and managing their own finances. Those people able to go out to the local shop and pub alone. More in-house activities are being introduced and the homes has two vehicles for outings and holidays. Voyage provide an activities allowance and residents pay for some specific activities such as horse riding, although staff report that activities can be limited due to budget. Residents are encouraged to be involved in the domestic routines of the home and the gardening and shopping etc. They take responsibility for cleaning their own bedrooms and laundry etc. if they are able to. Efforts are also being made by staff to involve them more in cooking and they are all help to choose a weekly menu. Regarding food at the home menus seen show a variety of main meals, including fish, meat, pasta and rice dishes. Healthy options such as salads, home made soups and jacket potatoes are available for lunches. Staff say they try to promote a wholesome diet with fresh vegetables etc. and residents are encouraged to help themselves to fresh fruit. People spoken to all say they like the food and one person is being supported to lose weight and lead a more active lifestyle at their request. Care Homes for Adults (18-65 years) Page 17 of 33 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents receive necessary support, in the way they prefer, with their personal care. Their physical, mental and/or behavioural needs may not all be met because procedures in place for staff to follow have not been agreed and reviewed appropriately. Residents medicines are being managed safely in the home by staff on their behalf. Evidence: Residents access health care services from the homes local GP surgery. Staff also support them to have an annual health care check and attend regular appointments with health care professionals, such as dentists and opticians, out in the community. In view that Hunters Lodge provides a service for people who have complex needs its statement of purpose says that their company psychologist assesses each persons psychological status, with follow up visits to ensure regular observation and reviews. Although most residents have mental health and/or behavioural difficulties they are currently receiving limited input from health care specialists. The manager has recently had to request that they all have an assessment by the companys psychologist. Care Homes for Adults (18-65 years) Page 18 of 33 Evidence: Residents behaviour management plans and intervention protocols seen have not been reviewed for at least a year and/or set up and agreed with relevant professionals, as expected. Specialist input needs to be sought to make sure that residents emotional and psychological needs are being met properly. Residents may also have physical disabilities and so the accomodation is all on the ground floor, and ramps, aids, adaptations and equipment are provided. Some staff report however that they have not had moving and handling training, as the homes annual quality assurance assessment says they do, and this should be addressed. Plans outline support each person needs with their personal care and their preferred routines but should include more detail of any specific input needed in relation to such as continence management. Staff appropriately encourage people to be independent and to take responsibility for their own personal hygiene as much as they can. The new person centred plan format includes a section called My Health. Those seen (and to be completed) should include detailed information about individuals health and conditions. Plans should also include specific guidance to staff about what action they may need to take in respect of peoples physical and emotional state and behaviours, as some just state that staff need to monitor these aspects. Records are completed for everyone when any health care input is obtained and/or appointments attended with the reason, outcomes and any further action required. These records should be dated and signed by the staff members involved. An appropriate medication policy is provided that is accessible to staff. Some aspects of this policy and procedures have been reviewed and amended, as was required following the last inspection when a commission pharmacist inspector inspected the homes medication management. Relevant medication records were checked during this visits and were being maintained appropriately. There are secure storage arrangements for medication in the home and medicines and external skin preparations are kept separately as they should be. The deputy manager is delegated responsibility for medication kept at Hunters Lodge and confirmed that all other issues raised in the pharmacists inspection report have since been actioned. Staff who administer medication have undertaken a formal training process in relation to safe handling of medicines. Refresher training was also recently arranged for two staff due to administration errors that were appropriately notified to the Commission. One residents plan shows they administer one of their medications and it is good that the home recognises peoples rights to self-administer their medicines if they are able Care Homes for Adults (18-65 years) Page 19 of 33 Evidence: to and enable them to do so safely. Care Homes for Adults (18-65 years) Page 20 of 33 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can express their views and if they have concerns about the service they know how to complain and feel confident they will be listened to and dealt with. There are also systems in place to safeguard them, although they would be better protected when risk assessments and protocols in respect of behaviour management are reviewed. Evidence: The service has a complaints procedure that is also available in a format that is easy to understand. A copy of this has been given to each resident and their family. They are also given cards called letting us know what you think to encourage people to raise issues or concerns directly with Voyage if they wish. The home keeps a record of complaints made with details of their investigations, actions taken and response to complainants. Residents are encouraged to express their views and all those who completed surveys confirm they know who to speak to if they are not happy and how to make a complaint. Most surveys confirm that staff always listen and act on what they say and two residents also said that they feel able to talk to the new manager. Residents meetings are now being held regularly with notes taken and action points. Voyage are planning to develop a national forum for people using their services to allow them to more input into service development. Care Homes for Adults (18-65 years) Page 21 of 33 Evidence: Voyage provides policies and procedures for safeguarding adults and whistle blowing. The home also has a copy of local multi-agency procedures for adult protection. Staff receive training on these procedures and also how to recognise abuse as part of their induction and through an in-house interactive training session. It is positive that further training is also being arranged through an external accredited trainer and that the manager is ensuring that all staff go through all these polices and procedures again and sign a checklist to confirm that they have read and understand them. Staff also receive training to help them to manage behaviours that are aggressive and/or challenging better. Two complaints about the service have been brought to the attention of the commission since the last inspection. The first involved a number of matters, which included a lack of management support, staff conduct, low staff morale and restraint policies being used inappropriately. This complaint was also made to Voyage and they carried out an investigation. Staff were interviewed and meetings held to openly discuss the issues raised and whistle blowing processes. Although there was no evidence that staff morale and practice had directly effected the safety and welfare of residents it was clear that management issues were having an adverse effect on the home and this is discussed in more detail in the Conduct and Management section of this report. A positive outcome of this investigation was that most staff have since attended training on non-violent crisis intervention. The second complaint alleged neglect of personal care and protection from health and safety hazards in respect of one resident. The complaint was made to Voyage and a copy was sent to us. The matter was discussed appropriately with us and the complaint was referred to the local authority as a safeguarding issue. The manager attended a strategy meeting and was responsive to the process, agreeing to take necessary steps to monitor and review all the issues raised. The action taken has also helped to ensure that the resident now feels more able to raise concerns directly with home managers. Care Homes for Adults (18-65 years) Page 22 of 33 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Hunters Lodge have a safe and reasonably well maintained home, which is comfortable, pleasant and kept clean to promote good infection control. Evidence: Hunters Lodge has a rural location in the village of Wormelow and is within lovely and extensive grounds. The home is about seven miles from Hereford city centre. There is also a pub and shop within walking distance and it is on a bus route. Residents accomodation is all situated on the ground floor and the house and garden are accessible to wheelchair users. Aids and equipment are provided to meet the needs of some individuals. One social worker comments in a survey that the home provides a remote setting in a calm pleasant area, which has been very therapeutic for my client. The overall impression of the home is comfortable and the sitting and dining rooms are well furnished. The decor in the corridors is rather shabby however and the carpets are stained. It is good therefore that the manager says that rectifying this, and buying new window blinds, is part of the homes upgrading plan for the coming year. Since the last inspection one bedroom has been competely refurbished due to damp, the Care Homes for Adults (18-65 years) Page 23 of 33 Evidence: homes roof has been repaired and its parking area extended. Those areas of the building visited were found to be clean, warm and fresh smelling. Most residents confirm in their surveys that the home is always clean and fresh. Staff have cleaning schedules to follow and they involve residents in household tasks. The AQAA states that the home has an infection control policy and procedures and that arrangements are in place for the disposal of soiled waste. It was previously confirmed that staff are provided with disposable gloves and aprons and it was seen that liquid soap and paper towels are available in the communal bathrooms. This should all help staff to promote good hygiene and reduce any risk of infection in the home. Care Homes for Adults (18-65 years) Page 24 of 33 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are being supported by sufficient, qualified staff on duty at all times. They can be confident in staff because checks are carried out to make sure they are suitable. Residents could be better supported if staff receive more training to help them understand and know how to manage their specialist needs. They should benefit from the increased support and supervision staff now have from the manager. Evidence: Staffing levels include at least six care staff on duty daily between 8.00am and 8.00pm; three from 8.00 until 9.00pm and two waking night staff. A new staff member has recently been appointed to work a few evenings to facilitate activities and this will provide more scope for people to go out. Although there has been a fairly high staff turnover at the home since the last inspection, and there are still two vacancies, a recruitment drive is ongoing. The homes permanent and relief rather than agency staff are able to cover the home, which is better for consistency of care. There are still two staff teams who work long days on opposite shifts, but it is good that some care staff and seniors now work across both shifts, the new manager having recognised the potential for conflict due to different ways of working. The manager was not aware of any one to one staffing Care Homes for Adults (18-65 years) Page 25 of 33 Evidence: specified in individuals funding authority contracts and so could not respond to a social workers comment that such an agreement was not being adhered to. Most staff have achieved an NVQ (National Vocational Qualification) in social care. Whilst this reflects positively on their commitment and competence residents could benefit if staff receive more training relating to the specialist needs of people using the service such as mental health, sensory impairment and autism. In the AQAA the manager describes training that will be arranged, which involves in-house instruction on the role of keyworkers, writing reports and risk assessments. This should also be helpful as part of the development of a more person centred approach. The homes training matrix, which shows the training undertaken and planned for the staff team needs updating and the manager says it is planned to deal with this as a priority. Regarding staff recruitment the homes AQAA and previous inspection confirm that Voyage operate robust policies and procedures and new staff are not confirmed in post until the companys Human Resource Team have checked these have been followed. The AQAA and staff in their surveys confirm that an enhanced criminal records bureau (CRB) check and two written references (one from their last employer) are always taken up. However copies of the actual checks and references are not kept at the home but at Voyages head office. Although there are checklists in staff records confirming satisfcatory checks have been taken up those seen had not been signed and verified by a registered person, as expected. The manager agreed to ensure that copies are available in the home and/or that she sees them and signs the checklists once she is registered. Voyage provides a comprehensive induction programme for new staff, which is accredited. The AQAA states they will also undertake an LDQ (Learning Disability Qualification), although some staff still need to do so. One new staff member was interviewed and felt that their induction had been very good. It had included two weeks of shadow shifts and opportunity to read and understand health and safety and all other relevant policies and procedures. New staff also have to complete a satisfactory probationary period before their appointment is confirmed. The manager has taken steps to ensure all staff receive regular supervision and annual appraisals, which had not been happening for a while due to the absence of a manager. The deputy and seniors have also had training on supervision so that they can be involved in the process more. This helps to identify individuals training and developmental needs, as well as those of the staff team. Staff report they feel better supported and that communication, team working and morale have all improved. Care Homes for Adults (18-65 years) Page 26 of 33 Care Homes for Adults (18-65 years) Page 27 of 33 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents should be able to have more confidence in the service when management arrangements have stabilised. There are ways the home reviews its practice so that the service runs well and continues to develop. This should be based on the views of residents so the service improves for their benefit. The home environment is safe for people because good health and safety practices are carried out. Evidence: The new manager (Ms Ann Morgan) was appointed by Voyage in June, although she has not yet submitted an application to the commission for registration. Ms Morgan has relevant experience and training and in due course the AQAA says she will undertake the companys management development programme. Ms Morgan appears committed to developing a more individualised service and is offering both residents and staff appropriate support and encouragement. The previous manager was suspended for several months before being dismissed in January 2008 on the grounds of gross misconduct. Whilst this managers conduct did Care Homes for Adults (18-65 years) Page 28 of 33 Evidence: not have a direct impact on residents safety and welfare the lack of leadership clearly has had an adverse effect on such as the review and update of residents care plans and risk assessments, their activities, specialist input and staff support, supervision and training. Additional management input Voyage had told the commission that they would provide to support the home and deputy manager during the absence of a registered manager did not transpire. Management arrangements now include the deputy manager having more time to spend working directly with staff and residents. Three senior staff take responsibility of leading shifts, allocating care staff tasks, taking shift handovers etc. They will also be involved in individual staff supervision and monitoring keyworkers role and monthly care plan reports. Staff say that team meetings are being held more regularly, communication is more open and their input and suggestions are valued and taken up. The manager is aware of the need and is taking steps to arrange further training to improve staff knowledge in respect of residents special needs and to promote person centred care and safeguarding. Voyage operate a formal system to review and assure service quality. This includes their required monthly visits when relevant aspects are checked and/or audited and some people at the home are interviewed. Voyage employs a regional quality assurance manager and they carry out an annual service review when a development plan is set up with actions specified to improve the service. The AQAA gives a reasonable picture of the current service, but whilst it is acknowledged that the manager is still quite new, it needs to better reflect the areas that need to improve. Voyages annual service development plan should highlight these areas, and also incorporate the views of residents and relevant stakeholders. This could be obtained from residents meetings and there are plans to develop a service user questionnaire and a national service user forum. Regarding health and safety staff receive training in core areas of fire safety, first aid, food hygiene and infection control, although they should also complete moving and handling training. The AQAA and previous inspection confirm that Voyage provide comprehensive polices and procedures for staff to follow in their working practices to help them maintain and promote the safety and welfare of people within the home environment. This includes necessary risk assessments in place, checks on the fire safety and water systems/equipment and regular servicing of gas installations and heating. Care Homes for Adults (18-65 years) Page 29 of 33 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 30 of 33 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 Regulation 13(4) c. Risk 31/01/2009 assessments must be carried out for each resident and management plans put in place if necessary, in consultation and agreed with relevant professionals. Those plans already in place must be reviewed and updated. This is so that staff can ensure that any possible risks are minimised and manage any risks consistently to keep people safe whilst also promoting their independence. 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 6 A system should be put in place to ensure the plans of people living at the home are reviewed and updated more regularly and as their needs change. Reviews should involve the individual and relevant other people such as Care Homes for Adults (18-65 years) Page 31 of 33 their family, advocate and professionals (if they agree). This is so their plans reflect their current needs and personal goals and how they can be supported to meet them. Specific requirements in respect of communication should also be addressed so that people can better express their own needs, wishes and goals and make choices. 2 18 People living at the home should receive physical support from staff who are suitably trained to help them move and transfer safely. Their preferences and needs in this respect should also be recorded in their plans for staff to follow. The home should ensure that residents physical and emotional health care needs are assessed and recognised with the input of specialist health care professionals and that up to date procedures are in place for staff to follow. Staff should receive more training relating to the disabilities and specific conditions of people using the service such as mental health, autism, sensory impairment, communication methods and moving and handling. This is to give the staff team the knowledge and skills to enable them to meet residents needs and deal with their behaviours better. 3 19 4 32 Care Homes for Adults (18-65 years) Page 32 of 33 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) 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. 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