Inspection on 19/03/09 for Meadow Lodge

This inspection was carried out on 19th March 2009.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Meadow Lodge 04/02/08

Meadow Lodge 14/08/06

Meadow Lodge 13/12/05

Meadow Lodge 02/08/05

Meadow Lodge 01/12/04

Meadow Lodge 26/07/04

Meadow Lodge 30/03/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Meadow Lodge Sadlers Mead Monkton Park Chippenham Wiltshire SN15 3PE     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: Alison Duffy     Date: 2 6 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 36 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 36 Information about the care home Name of care home: Address: Meadow Lodge Sadlers Mead Monkton Park Chippenham Wiltshire SN15 3PE 01249656136 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Wiltshire County Council care home 4 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is 4. The registered person may provide the following category of care only: Care home providing personal care- Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: Learning disabilityCode LD Date of last inspection Brief description of the care home Meadow Lodge is situated in a quiet residential area on the outskirts of Chippenham. The home provides respite care for up to four people with a learning disability. People take part in activities and training sessions, as they would do, if they were at their permanent home. The service is owned and managed by Wiltshire County Council. The staff team also provide care for people in Derriads, which is part of the Chippenham Respite Service. There is 24 hour staff cover to provide support for people using the Care Homes for Adults (18-65 years) Page 4 of 36 Over 65 0 4 Brief description of the care home service. Meadow Lodge has a lounge, dining room and a domestic style kitchen. There are four single bedrooms. One bedroom is on the ground floor and has ensuite facilities. There is a large, secluded garden at the rear of the house. There is ample parking to the front of the building. Care Homes for Adults (18-65 years) Page 5 of 36 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 key inspection took place over a period of two days. The first day was on the 19th March between 3.15pm and 8.15pm. The second day was on the 26th March 2009 between 10am and 4pm. On the first day of our visit, support workers supported us with the information we required. The second day was arranged to meet with the acting manager, Ms Newman. Mr Streeter, service manager was also present. We met with people who use the service in the communal areas. We observed the evening meal and interactions between staff and people using the service. We talked to staff on duty and toured the accommodation. We looked at care planning documentation, staff training records and health and safety documentation. We looked at the medication administration systems. Care Homes for Adults (18-65 years) Page 6 of 36 We sent the service an Annual Quality Assurance Assessment (AQAA) to complete. This is an assessment of how well they are performing. It gave us information about the services future plans. Information from the AQAA is detailed within this report. All key standards were assessed on this inspection and observation, discussions and viewing of documentation gave evidence whether each standard had been met. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the experiences of people using the service. What the care home does well: What has improved since the last inspection? What they could do better: While people are assessed before being offered a service, the home should get up to date information, before each respite stay. Risk assessments must demonstrate sufficient detail to minimise the potential risk. Consideration should be given to an ongoing refurbishment plan in order to develop the environment. Staff deployment should be reviewed so that the skill mix and experience of staff and staffing levels are conducive to peoples needs. There must be documentation in the home to evidence a robust recruitment procedure. All fire safety checks must be regularly undertaken and be clearly documented within Care Homes for Adults (18-65 years) Page 8 of 36 the fire log book. All staff must receive regular fire instruction training. 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 printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 36 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 36 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are assessed before they are initially offered a service yet to ensure the placement remains suitable, an up to assessment is needed. Evidence: At the last inspection, we saw that the Statement of Purpose was well-written and readily available to people. However, the content did not fully meet with Schedule 1 of the Care Homes Regulations 2001. We made a requirement to address this. Ms Newman told us that the document had been reviewed. It had also been further reviewed to incorporate the recent changes in the registered manager. During our visit, an up to date copy of the Statement of Purpose could not be located. Mr Streeter confirmed that the changes had been made and the document was saved on the computer. It was agreed that a copy would be sent to the Commission. We have not received this so are unable to confirm that the requirement has been addressed. Within the AQAA, under the heading do well, it states provide a quality care setting that caters for many individual needs including complex and challenging behaviour. Due to factors such as current staffing levels and the size and layout of the service, Care Homes for Adults (18-65 years) Page 11 of 36 Evidence: we advise that ways to manage challenging behaviour, are clearly identified within the Statement of Purpose. Ms Newman said that generally, those people with more complex needs, have their respite care at the other respite care centre in Chippenham. On the day of our visit, two people were being admitted for their period of respite care. Within the services quality assurance system, it was identified that a copy of the Service Users guide would be placed in each persons room. We did not see evidence of this. Ms Newman told us that all new users of the service would be given a copy of the document, before their admission. Ms Newman said if people had been regularly staying at the service, they would not be repeatedly given the documentation. Ms Newman told us that placing agencies assess all prospective users of the service. She said that care managers are very aware of the needs, which can be met within the home. Ms Newman told us that if a person were deemed suitable, the care manager would discuss the persons individual needs with the registered manager. The person would be encouraged to visit the service and meet staff and other people using the service. The manager would receive a documented assessment stating the persons needs. Following this, a decision to offer a placement would be agreed. Ms Newman told us that the majority of people using the service have done so for many years. They are therefore well known to the staff team. We looked at the files of the two people being admitted on the day of our visit. A recent assessment had not been completed. Ms Newman told us that there was an understanding that relatives would contact the service, if there had been any changes to the persons care needs. Ms Newman told us that both people had been coming to the service for a long time and there was regular discussion with family members. No changes had been reported upon. We advised that a formal system be developed so that staff actively seek an up to date assessment of the person before their admission. Ms Newman agreed to do this. Care Homes for Adults (18-65 years) Page 12 of 36 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. Peoples needs and aspirations will be met more effectively through the intended new care-planning format. People are encouraged to make decisions within their daily lives. Clearer documentation in relation to risk management would ensure people are further safeguarded. Evidence: At previous inspections, we saw that some care plans did not contain accurate, up to date information. We made a requirement to address this. At the key inspection in February 2008, we saw that some progress had been made. At this inspection, the care plans were up to date and contained a range of information. Topics covered included health and personal care, eating and drinking, hobbies and interests, culture, religion and communication. Important aspects of the persons life such as family, friends and pets, were identified. Mr Streeter told us that he had identified that the existing care plan format could be improved upon. As a result, new care plans were being introduced. Mr Streeter told Care Homes for Adults (18-65 years) Page 13 of 36 Evidence: us, the new system was to be more streamlined and more person centred. It would be more concise and direct staff to issues, which were most paramount. Mr Streeter told us that a new summary format was also in the process of being developed. This format, known as a grab and run form was intended to give key information at times, such as a hospital admission. We saw that the existing care plans were lengthy and key issues were not easy to find. The plans had a page for each topic, which were not always required. We agreed that streamlining the formats would be beneficial. Despite the care plans being lengthy, we suggested that some information within the care plans could be expanded upon. For example, within the section about the community, it was recorded sometimes go out in the van, sometimes train, never alone. We suggested that the persons preferences of what they enjoyed doing and the support they required should be added. Within the section identifying the management of personal monies, it was recorded like money kept in tin, can have it when I want to buy something. We said further detail identifying the persons ability to manage his/her own money could be expanded upon. We saw that there was a section on personal relationships. In one care plan, documentation stated I have a boy/girlfriend. Staff told us that this relationship was fully supported within the service. There was no evidence of this within the care plan. Within the care plan format, what I like to do and hopes and dreams were identified. One plan stated that the person would like to start horse riding again. It was not apparent if this goal had been reached. In terms of hopes and dreams, it was stated I hope I do not get poorly again and go to hospital. Other aspirations were not evident. One person told us that they liked to go to bed late. They liked to watch television. They told us they had to get up early for their day service. At weekends, they said they liked to get up later. The persons preferences were shown in their care plan. There was a section detailing peoples preferred daily routines. Staff told us that people are able to choose when they get up and go to bed yet day services sometimes control this. One staff member told us we try to make people feel at home, as much as we can. Some people have been coming a long time so they come in and just get on with what they want to do. We saw that people were asked what they wanted to do during the evening. People were offered choices of what they wanted to drink and what they wanted for their dessert. We did not see people choose what they wanted for their main evening meal. We saw that one person was receiving support to unpack their belongings. They were asked where they would like each item stored. Ms Newman and staff told us that people are encouraged to make decisions, as far as they are able. Some people may need support to do this. Within care planning Care Homes for Adults (18-65 years) Page 14 of 36 Evidence: information, we saw that one person was able to choose, if they were offered two alternatives. We saw that there were regular residents meetings to encourage people to give their views. The meeting agenda and minutes were completed in pictorial formats to enable easier understanding. We recommended that enlarging the pictures might be of benefit for some people. At previous inspections, we made a requirement that all risk assessments must be regularly reviewed and up to date. At the inspection in February 2008, we saw that the requirement had been partly met. During this inspection, the care plans we looked at contained a range of risk assessments. All had been updated. We said however, that the assessments contained insufficient detail to minimise the potential risk. Ms Newman explained how the risk assessments had been undertaken. This made the information clearer yet further clarity would ensure greater safeguards for people. Risk assessments relating to those people with epilepsy had been undertaken. Care Homes for Adults (18-65 years) Page 15 of 36 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have access to a range of social activity both in house and within the local community. People are supported to follow their preferred routines. Meal provision is good and based on fresh produce, healthy eating and peoples preferences. Evidence: Staff told us that people are supported to continue with the daily routines that they have at their permanent homes. This may include attending day services. One person told us that they did keep fit and drawing at their day service. They said they met their friends. Staff told us that other activities undertaken include cooking, life skills, art and craft and discussion groups. Transport is provided to take people to their day services. The service also has its own transport to be used, as required. Staff told us that not all staff are able to drive the homes vehicle. If there are no drivers on duty, staff told us that people are supported to walk within the local vicinity or use public Care Homes for Adults (18-65 years) Page 16 of 36 Evidence: transport. Staff told us that some people have stay back days. This enables people to remain at Meadow Lodge and choose what they want to do. People may choose to have a lazy day such as staying in bed and then spend time in the garden. Alternatively, people can choose to go out either shopping, for a meal or to the park. People are supported to go to local clubs. They may also attend social events, which the clubs have organised. At weekends, staff told us that external activity is encouraged. It is expected with the better weather approaching, that people will be supported to go out more. One person told us that they go bowling and play crazy golf. Staff confirmed that trips to the cinema, bowling and to the pub are regularly undertaken. This was confirmed within peoples daily notes. One member of staff said we try to get out as much as we can. We saw that a trip to a fast food restaurant had recently been undertaken. People are supported to go to church if they wish. Within one care plan, we saw that a persons goal was to access the community more. It was not evident, if this had been achieved. Staff told us that people are supported to maintain contact with their family and friends, as they wish. We saw that one person was concerned that they had forgotten something they thought had been packed. Staff asked the person if they wanted to telephone their parent. They were given support to do this. Staff told us that they always keep relatives informed of any aspect such as an incident or poor health. We saw various examples of people expressing themselves and making decisions. One person pulled the curtains when it was beginning to get dark. They cleared the table after the meal and then vacuumed the dining room floor. We saw that they assisted another person by creating a space for them to sit down. During the evening meal, they helped the person load their spoon with their dessert and offered them a serviette. Another person took their cup to the kitchen to be washed up. People chose where they wanted to sit. After the evening meal, one person played on their games console in the lounge. Another person did a jigsaw at the dining room table. Another person did some drawing and looked at some books. People then had a beauty session, which included a foot spa, a hand massage and manicure. We saw that people were able to spend time where they wanted to. This involved people watching television in their own room. Staff told us that people are able to participate within housekeeping tasks if they want to. They said some people like to help and some people like to watch. Others are not interested in housekeeping tasks and do not get involved. Staff said this was Care Homes for Adults (18-65 years) Page 17 of 36 Evidence: respected. Staff told us that some people like to assist with small aspects of the services shopping. One person showed us their daily diary. They saw their care plan and said me. They said they helped to develop their care plan. The person placed their diary in the care plan. We saw that the diary was used as an information sharing format for the staff at Meadow Lodge, staff at the day service and family members. The person told us that they carry it and then give it to staff. We saw that staff engaged well with people using the service. There were positive, attentive interactions. During the evening meal, staff ate with people using the service. People were included in all conversations. There were discussions about what people had undertaken during the day and what they wanted to do for the evening. Other topics included families, holidays and hobbies. We saw that people were sensitively prompted to eat and given support, when required. Staff told us that people are able to choose what they have to eat during their stay. At breakfast time, people are shown a choice of cereals, which they can select from. People can also have toast if they wish. Staff told us that people generally take a packed lunch to their day service. They said that some people are able to prepare their own lunch box. We saw one staff member prepare a sandwich for the persons lunch the following day. They asked the person what they wanted. They chose cheese salad, which was made with a selection of fresh ingredients. The evening meal consisted of a stir-fry. This looked colourful and was well presented. One person had cottage pie due to their dietary needs. People said that they enjoyed the meal. One person smiled when they were asked if the meal was good. People had a choice of fresh fruit or yoghurt for their dessert. They chose yoghurt. One person pushed their yoghurt away when it was offered to them. A staff member explained that they wanted the yogurt in a dish. This was undertaken and the person readily ate the dessert. We saw that having yoghurt in a dish was detailed within the persons care plan. We saw there was a good variety of fresh fruit and vegetables available. Staff told us that they aim to cook all meals from scratch. They said there was an emphasis on healthy eating although peoples preferences were respected. Care Homes for Adults (18-65 years) Page 18 of 36 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People receive the personal support they require and have access to health care intervention as needed. Policies and procedures are in place to ensure the safe handling of medication. Evidence: We saw that details of peoples preferred daily care routines were included in their care plans. We saw that one person was asked if they would like their shower at night or in the morning. Their request was followed. Staff told us that the organisation has a policy whereby male staff do not support female users with any form of personal care. The policy is based on safeguarding practice, not peoples individual choices. Staff said they recognised the reasons for the policy, yet felt at times it was restrictive. We saw that during our visit, there were three female people using the service. There was one female member of staff and a male staff member. This meant the female staff member supported all three people with their personal care routines. We said greater consideration should be given to the gender of staff and their deployment. This is discussed later in the staffing section of this report. Staff told us that a key worker system is in operation. They said the allocation of key workers is currently being reviewed. Ms Newman said that once completed, she planned to discuss the key Care Homes for Adults (18-65 years) Page 19 of 36 Evidence: worker role with staff. She said this would aid further development. One staff member told us that due to the nature of the service, ensuring key workers were on duty when the persons respite stay was taking place, was a challenge. They said the implementation of co-workers was a potential solution. As Meadow Lodge is a respite care service, family members predominantly meet peoples health care needs. Care plans identified any predominant health care conditions and contact details of any involved health care professionals. Staff told us that if a person became ill, they would gain the required assistance. They would also inform family members, as a matter of course. They said that if unwell, the person could remain at Meadow Lodge if they wanted to. They could also choose to return to their permanent home early. Staff told us that if a person was unwell or did not want to go to their day service, there would be adequate staff to support them at Meadow Lodge. Mr Streeter, told us that an in depth, up to date action plan, which records and plans future work with other care practitioners regarding peoples health care needs, is being developed. Mr Streeter told us that he hoped this format would be in place by the end of April 2009. At the last inspection, we made a requirement to ensure that people with epilepsy have a risk assessment and care plan. This has been addressed. Potential triggers and signs of a possible seizure were identified. An updated epilepsy management profile was also in place. At the last inspection, we made a requirement to ensure that documentation was devised to evidence the safe transportation of medication. This had been undertaken. Staff told us that all medication was counted and documented when it arrived in to the home. This process was repeated when a person went home. An audit trail was apparent. During our visit, a minimal amount of medication was stored within the service. We saw that the medication administration record was signed appropriately. Another member of staff had signed any hand written instruction. Ms Newman said that only staff trained to do so, administer medication. She said regular competency checks are undertaken. Staff told us that they had received up dated medication training. Policies and procedures regarding medication administration were available for staff reference. We saw that there was a letter on one persons file from a GP. This identified authorisation for using a medication, as required. There was also information about pain relief. Another care plan showed that a GP had been contacted to confirm the Care Homes for Adults (18-65 years) Page 20 of 36 Evidence: details of a persons prescribed medication. Care Homes for Adults (18-65 years) Page 21 of 36 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are encouraged to raise any concern they may have. Systems are in place to safeguard people from abuse yet regular adult protection refresher training for staff would further enhance this. Evidence: The home has policies and procedures in place to enable people to raise any concerns or complaints, which they may have. The procedure forms part of the Statement of Purpose and is given out as a matter of course, to all new people using the service. Staff told us that people are generally reliant on others to support them with making a complaint. They said that family members are generally strong advocates and would raise any concern on peoples behalf, as needed. One member of staff said they would try to resolve the matter, if they received a complaint. They would also inform Ms Newman or a senior manager within the organisation. Mr Streeter told us, to minimise potential concerns from escalation, staff now telephone family members after each persons respite stay. Relatives then have the opportunity to discuss any issues, which may have arisen. Mr Streeter told us that any concerns would be immediately addressed and resolved appropriately. At the last inspection, we saw that complaints had been logged yet it was not clear if procedures had been followed, to ensure an adequate outcome. We made a requirement to address this. Ms Newman told us that there had not been any recent Care Homes for Adults (18-65 years) Page 22 of 36 Evidence: complaints. It was therefore not possible to assess the actual complaint process being followed. We saw within the AQAA that logging complaints was acknowledged as something the service could do better. We saw that working more closely with the organisations Customer Service Lead was planned, as a means of developing the management of complaints. We saw that there was a copy of Wiltshire and Swindons safeguarding procedures, No Secrets on the notice board in the office. Ms Newman told us that she believed all staff had received their own copy of the document. We advised that Ms Newman should check this and ask staff to document receipt of the information. We saw that the full policy and procedure for the Protection of Vulnerable Adults is on file but is dated 2001. We advised Ms Newman that an updated version must be gained. At the last inspection, we made a requirement that all staff must receive training in adult protection. Ms Newman told us that this had been addressed. She said the majority of staff had completed Wiltshire Councils Safeguarding training course. However, we saw within training documentation that a training officer had stipulated POVA is not a subject (unlike First Aid) that needs an official update. If it is felt that staff are forgetting what constitutes abuse then a session, perhaps as part of a team meeting, looking at No Secrets could cover it. Everything on a course is covered in that booklet. We said formalised refresher training on a regular basis is recommended. We asked staff a hypothetical question about abuse and what they would do if an allegation was made to them. They told us that they would immediately inform a member of the management team. They said they had a responsibility to do this. One member of staff spoke of the whistle blowing procedure, which they had experience of. They raised the challenges faced by those concerned within the process. Mr Streeter acknowledged this and agreed that any such process, often impacted upon the whole staff team. Care Homes for Adults (18-65 years) Page 23 of 36 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. The environment would be enhanced through an on going redecoration and refurbishment programme. A review of cleaning schedules would help to ensure peoples bedrooms are cleaned to a better standard. Evidence: Meadow Lodge is located within a quiet cul-de-sac in a residential area of Chippenham. It is in keeping of the neighbourhood and is accessible for people with a physical disability. Communal areas consist of a lounge and adjoining dining room. The dining room has patio doors leading to the rear garden. The kitchen has a large hatch so that people in the dining room are able to watch what is going on in the kitchen. We saw that all areas were comfortable, homely and domestic in style. One member of staff was refurbishing some stools in the dining room with material to match the curtains. Staff told us that people are able to use the communal areas, as they wish. People are also able to spend time alone in their own rooms. There is a bedroom on the ground floor with an en-suite shower room. At the last inspection, we made a requirement to cover the hot water pipes in the shower. We saw that this has been addressed. On the first floor, there are three single bedrooms Care Homes for Adults (18-65 years) Page 24 of 36 Evidence: and a bathroom. Staff told us that people generally like to stay in the same room for each respite stay. Ms Newman told us that there are plans to make the rooms more personalised and individual in style. This will include people choosing their own bedding for when they stay. We saw that towels were folded and placed on peoples beds ready for their arrival. Ms Newman told us that name plates for peoples bedroom doors are also planned. We saw that bedrooms in particular would benefit from redecoration. Redecoration was identified within the AQAA, as an improvement for the next twelve months. We saw that some of the walls were marked and some windowsills were stained through signs of damp. The carpet in the downstairs bedroom was stained and would benefit from replacement. Mechanical devices were fitted to all bedroom doors. These enabled the doors to be kept open yet be automatically closed if the fire alarm was activated. Within the bathroom, the window was frosted yet a blind or curtains had not been fitted. Ms Newman told us that this would be addressed. We saw that the ceiling in the bathroom was stained and the grab rail, to aid peoples mobility near the bath, would benefit from replacement. Mr Streeter and Ms Newman both agreed that the environment would benefit from being freshened up through redecoration. They said that all areas would be addressed on a rolling programme. Staff told us that the environment is usually cleaned when people are at their day service. We saw that cleaning schedules were in need of review, as the downstairs bedroom was in need of vacuuming. Some furniture within the upstairs bedrooms was dusty. We saw that all cleaning substances were stored securely. Ms Newman told us that the laundry was sufficient to meet peoples needs. We saw that its location within the service ensured that soiled items were not carried through communal areas. Care Homes for Adults (18-65 years) Page 25 of 36 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. Greater focus on peoples needs when developing the staffing roster would ensure an appropriate level of support is maintained. Documentation does not evidence a robust recruitment procedure. Staff have access to a range of training in order to assist them with meeting peoples needs. Evidence: At the last inspection, we saw that one member of staff often supported people during the day yet two staff members provided support at night. We said that this needed to be clarified with clear risk assessments in place. We said the assessments should identify whether two members of staff needed to undertake sleeping in provision. We saw that a lone working risk assessment had been completed yet staff told us that lone working is no longer undertaken. They said there is a minimum of two members of staff on duty when people are at the service. At night two members of staff continue to sleep in. If people are out during the day, there is always a member of staff on duty. This is to ensure adequate staff availability if a person is unwell and wishes to return from their day service. Staff told us that there is always a manager on call for emergencies or advice, as required. The staff team generally work across the two respite care services in Chippenham. At present, the service continues to be reliant on agency and bank staff. Staff told us that the team of bank staff generally work in other services within the organisation. Ms Newman told us that a recruitment Care Homes for Adults (18-65 years) Page 26 of 36 Evidence: drive is taking place and it is hoped that successful applicants will be found. She said in particular, senior staff and night staff are required. We looked at the files of the three most recently appointed staff. The information on file was minimal and did not evidence a robust recruitment procedure. Ms Newman told us that all recruitment processes are undertaken centrally within the organisations Human Resources Department. Records demonstrating the recruitment process are not maintained within the home. We said that a checklist was required to evidence key information regarding the recruitment process. This must include details such as the persons start date, whether references were acceptable and the date of their receipt. There must also be evidence of a POVAFirst check and a Criminal Record Bureaus check to ensure the persons suitability to work with vulnerable people. We said the checklist must identify the date, the number and the outcome of the checks. As stated earlier in this report, on the evening of our visit, there were three female people using the service. There was one female member of staff and one male. As the male staff member could not support people with their personal care routines, they were restricted in the amount of work they completed. They were also new to the service, so did not know people well. Understandably, they were not aware of peoples individual communication methods. As two people had been admitted to the service that afternoon, the more experienced staff member was responsible for checking in peoples medication and personal monies. The second member of staff was involved in countersigning the records. During this time we saw that people were unsupported. People were content to follow their preferred interests yet there was one interaction, between two people, which had the potential for escalation. Staff were not in the vicinity to be aware of this. In addition to checking in the medication and personal monies, a large amount of time was spent doing the washing up from the evening meal. Staff told us that they felt the time could be better spent through spending quality time with people. Mr Streeter told us that this had been acknowledged and a dishwasher was to be purchased. We saw that interactions between people were positive and attentive. People were given time and encouraged to communicate their views. One person was supported to focus upon what was being said to them through using their name. For example, the staff member said does XX want to look at a book? Would XX like XX (staff member) to get you one? We saw that people were relaxed and comfortable in their activities. One person made a drawing of the staff on duty. The picture was positive with all people shown to be smiling. We asked one staff member their view on the positive aspects of the service. They Care Homes for Adults (18-65 years) Page 27 of 36 Evidence: said the staff really care about people and want to do the best for them, which is lovely. We saw that staff had placed some chocolates and a card on a persons bed for their birthday. We asked one person about the staff. They said theyre good. Shes nice. They smiled and then laughed. We saw that a staff training matrix had been completed. Staff told us that they had good access to training opportunities. One staff member said they had recently completed a course at a local hospice regarding death, dying and bereavement. They had also completed a questionnaire regarding adult protection. Another staff member told us that they could ask for training in any aspect, which would benefit the service. They said they had recently completed New Steps. They explained this was a training course aimed at more mature members of staff, giving consideration to the individuals future and aspirations. Ms Newman told us that staff training is given clear focus. She said eight staff currently have a National Vocational Qualification (NVQ) level 3 in care. One member of staff has NVQ level 2 and two staff members have just commenced their award, level 2. Ms Newman told us that all new staff would be expected to commence their NVQ after a period of structured induction. Ms Newman told us that some staff were waiting for certificates to demonstrate the training they had recently undertaken. One staff file showed that a newly appointed staff member had completed manual handling, medication, first aid, food hygiene and fire safety training. Within other files, there were certificates to demonstrate training in peg feeding, health and safety, infection control and the protection of vulnerable adults. Ms Newman told us that further training in manual handling, infection control, challenging behaviour and makaton (a communication system) was planned. Care Homes for Adults (18-65 years) Page 28 of 36 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. The acting manager has a clear desire to develop the service. Greater focus on gaining and incorporating peoples views would further enhance service provision. Fire safety systems need to be more robustly applied to ensure peoples protection. Evidence: At the beginning of March 2009, Mr Pearson, the registered manager left the services employment. Ms Newman undertook the role of acting manager. Ms Newman told us that the position of registered manager was being advertised. The successful applicant would then submit an application to us, as the regulatory body, to become the registered manager. Ms Newman told us that the organisation plans to undertake this process without delay, to ensure continuity. The registered manager is responsible for two respite care services. Both services are in Chippenham. Ms Newman told us that historically, the manager spent the majority of their time at the other service. Ms Newman is addressing this, with her time being more equally shared between both services. Care Homes for Adults (18-65 years) Page 29 of 36 Evidence: Ms Newman told us that she has successfully completed a management course and has recently commenced NVQ level 4. Ms Newman told us that the service has been through a period of change, which had affected staff morale. Staff told us that particular attention had been given to ensuring this had not impacted upon people using the service. Ms Newman told us that staff had worked hard to improve the service and ensure good outcomes for people. She said that progress was being made to recruit staff. Once fully staffed, there would be greater definition of roles. Standardisation of documentation and team building were also being given priority. We saw that the organisations learning disability services, quality auditing tool was in use. This detailed a number of quality frameworks the service was working within. There was little evidence however that peoples views had recently been considered, as part of the system. We saw that a number of targets for development had been set. These included ensuring a service users guide was located in each room and that health and safety would form part of each staff meeting. There was no evidence that the targets had been reviewed, to ascertain if they had been met. At the last inspection, we made a requirement to ensure that reports undertaken as a result of the monthly regulation 26 visits, be sent to us. This has been undertaken. We looked at the fire log book and saw that the documentation was disorganised. Due to this, the fire safety checks were difficult to find. We recommended that the information be streamlined with out of date information filed appropriately. Documentation highlighted the need for monthly in house fire training and yearly external training. The completion of the training was not evidenced. The fire safety equipment, the emergency lighting and the means of escape were not regularly checked. Not all staff had received up to date fire instruction. Fire drills had taken place yet documentation was not always dated. The fire risk assessment had been reviewed yet evacuation procedures needed clarity. There was evidence of external contractors servicing the fire alarm systems yet not the fire extinguishers. Ms Newman told us that the certificate was probably filed at the other respite care service. She agreed that the whole file needed to be reviewed. There was a fire plan on the back of each persons door. Ms Newman had identified that these could be made more user friendly. We saw that all portable electrical appliances had been tested as required. There was a record of fridge and freezer temperatures yet the designated kitchen diary had not always been completed. As good practice, we saw that food was covered and dated appropriately in the fridge. We saw that there were a number of risk assessments in place. These included first aid, slips and falls and contractors in the building. Ms Care Homes for Adults (18-65 years) Page 30 of 36 Evidence: Newman told us that she was aware that some areas needed further assessment. These included travelling in the services vehicle and accessing the community. Care Homes for Adults (18-65 years) Page 31 of 36 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 1 4Schedule 1 The home must have a Statement of Purpose which complies with Schedule 1. 30/04/2008 2 22 22 The recording of complaints must show that the policy has been followed. 30/03/2008 Care Homes for Adults (18-65 years) Page 32 of 36 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 1 4 You must have a Statement 31/05/2009 of Purpose, which complies with Schedule 1. This was identified at the last inspection but a Statement of Purpose could not be located to ascertain that adjustments had been made to the document. To ensure people have accurate information to enable them to make an informed decision about whether they wish to use the service. 2 2 14 You must ensure that up to date information about a person is formally gained before they are admitted to the service. To ensure that the persons needs can continue to be met within the service. 31/05/2009 Care Homes for Adults (18-65 years) Page 33 of 36 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 3 9 13 You must ensure that 30/06/2009 control measures within risk assessments minimise any potential risks to individuals. So that people are safeguarded from harm. 4 34 19 You must ensure that a clear, robust recruitment process is evidenced within the service. To ensure people are safeguarded from harm. 31/05/2009 5 42 13 You must ensure that staff receive regular fire instruction. So that staff have the knowledge to act effectively in the event of a fire. 31/05/2009 6 42 13 You must ensure that 31/05/2009 adequate fire safety systems are in place and fully documented. So that people are adequately safeguarded. 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 You should ensure that peoples hopes and aspirations are further expanded upon and monitored within care planning Page 34 of 36 Care Homes for Adults (18-65 years) 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 documentation. 2 6 You should ensure greater detail is applied to care plans to ensure staff have sufficient information to meet peoples needs. You should ensure staff deployment in terms of gender, meets the needs of people using the service. You should ensure that an up to date Safeguarding procedures are available within the service. You should ensure that staff sign to evidence they have received, read and understood No Secrets documentation. You should ensure that all staff receive regular formal adult protection refresher training. You should ensure that a blind or curtains are fitted to the upstairs bathroom window. You should ensure that a programme of refurbishment is undertaken which includes the redecoration of peoples bedrooms. You must ensure that cleaning schedules are reviewed to ensure the service is cleaned to infection control standards. You should give consideration to peoples needs, the tasks to be undertaken and the staff members level of experience, when completing the staffing roster. You should ensure that all targets identified within the services quality assurance system are monitored and confirmed when completed. You should ensure that peoples views are an integral part of the services quality assurance system. You should ensure that a record is maintained of the dates all fire drills have taken place. 3 18 4 23 5 6 23 23 7 8 24 24 9 10 30 32 11 39 12 13 39 42 Care Homes for Adults (18-65 years) Page 35 of 36 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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