Inspection on 30/11/09 for The Lodge, Exmouth

This inspection was carried out on 30th November 2009.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

The Lodge, Exmouth 29/11/06

The Lodge, Exmouth 01/12/05

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 17/02/2010.

Key inspection report Care homes for adults (18-65 years) Name: Address: The Lodge, Exmouth 207 Exeter Road Exmouth Devon EX8 3DZ     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Michelle Oliver     Date: 3 0 1 1 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. 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. Care Homes for Adults (18-65 years) Page 2 of 32 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). 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 CQC 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 32 Information about the care home Name of care home: Address: The Lodge, Exmouth 207 Exeter Road Exmouth Devon EX8 3DZ 01395276457 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Deborah.Brown@DevonPtnrs.nhs.uk Premier Living (Devon Partnership NHS Trust) care home 4 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The age range category is 18 to 40 years. The registered manager must obtain the Registered Manager?s Award by the 30th November 2006. Date of last inspection Brief description of the care home The Lodge provides personal care and support for up to four residents with a learning disability. The home is operated by Trust Residential Services. Although the house is on two levels, all accommodation is on the ground level. The second floor is not accessible. There are four en-suite bedrooms, a large kitchen / dining room, a lounge and an office / sleep in room. There is a large pleasant garden to the rear of the property. The home is decorated and furnished to good standard creating a warm and homely atmosphere. Care Homes for Adults (18-65 years) Page 4 of 32 Over 65 0 4 Brief description of the care home Information received prior to the inspection indicated that current fees are #2670. Currently there are no additional charges for any services. The manager provides the most recent CSCI inspection report to service users and their relatives during the admission process. Subsequent reports are made available and explained to service users on request. Care Homes for Adults (18-65 years) Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This unannounced inspection took place over 4.5 hours on Monday 30th November 2009. During the inspection all those living at The Lodge were case tracked. This involves looking at peoples individual plans of care, and speaking with the person and staff who care for them. This enables the Commission to better understand the experience of everyone living at the home. As part of the inspection process the Care Quality Commission likes to ask as many people as possible for their opinion on how the home is run. We sent questionnaires out to all people living at the home, 3 health and social care professionals (including GPs and care managers) and 5 staff. At the time of writing the report, no responses had been received from people living at the home, 2 health and social care professionals and 5 staff. Their comments and views have been included in this report Care Homes for Adults (18-65 years) Page 6 of 32 and helped us to make a judgement about the service provided. People living at the home have limited verbal communication skills, and as we are not skilled in their other methods of communication it was difficult for us to have any meaningful communication with these people. However, the interaction between the people living at the home and those who care for them was closely observed. We also spoke with 4 staff and the deputy manager General information about fees and fair terms of contracts can be accessed from the Office of Fair Trading web site at /www.oft.gov.uk . Care Homes for Adults (18-65 years) Page 7 of 32 What the care home does well: The Commission has bben told that Premier Living service will come to an end in 2010. A project group will work with all individuals to find out what is important to them, where they want to live and how they want to be supported. The project team has talked to all of those supported by Premier Living and their families. Comprehensive plans have been formulated at The Lodge to ensure that as much information as possible has been gathered. This is to ensure that when people move from the service it will be to a place which will have the information on which to assess whether their health and social care needs can be met. The staff team work hard to encourage and support people to live their lives as they wish. The atmosphere is warm, friendly and fun. It is clear there are good relationships between staff and the people living in the home. We saw staff being caring and respectful, offering choices and supporting people in a kind manner. People living in the home lead an active life, using local and surrounding communities to obtain social and educational facilities.The meals at the home provide a varied diet and take into account peoples likes and dislikes. Relatives are welcomed at the home and there appears to be good communication with families. Relatives are encouraged to be involved and participate in the care planning and reviewing process. Concerns and complaints are taken seriously and people are protected from abuse or harm by well informed staff and good reporting procedures. Peoples finances are protected by rigorous systems. People are supported by a team of staff who are competent, qualified and well supervised. The health, safety and welfare of people living at the home is promoted and protected. Comments made by staff at the home, in response to what does the home do well include The Lodge has been and always will be until we close, a friendly and homely environment for our service users, due to the management and all the staff team working hard to keep it this way. Day trips and eating out are common place for our service users, which they enjoy immensely. The staff and management all work well together, which only enhances the homely atmosphere and makes it easy for new members of the staff team to integrate quickly and Care for the residents and meet their needs and very friendly staff create a welcoming atmosphere. Very caring and friendly happy relationship between staff and residents. The records kept in the home help staff assess, understand and monitor peoples needs and risks. Good policies, procedures and practices ensure people and staff are kept safe, this includes good recruitment, health, safety and financial practices. Good systems are in place to assess and monitor all practices, seek views of people, Care Homes for Adults (18-65 years) Page 8 of 32 staff and outside professionals on a day to day basis,to ensure the home is run in the best interests of the people living there. What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details 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 32 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 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People considering making The Lawns their home will benefit from the assurance that their aspirations and needs can and will be met at the home before a decision to live there is made. Evidence: We were told that a comprehensive detailed assessment of peoples needs was undertaken to ensure the home were able to meet their individual needs before a decision was made for them to make The Lodge their home. The service does not have a specific format for assessing peoples needs before they move in, but the manager makes sure that comprehensive information is gathered to enable the home to assess whether the individuals needs can be fully met by the environment and competence of the staff at The Lodge. Before coming to live at The Lodge individuals would be given a copy of the homes Statement of Purpose and a Service User Guide which details how the home is run at present and what they can expect from the home. Care Homes for Adults (18-65 years) Page 11 of 32 Evidence: Due to the communication difficulties of the people living at the Lodge at the time of this inspection they were unable to talk about their move to the home. However, throughout the time we spent at The Lodge all the people living there were relaxed and appeared settled. Each person living at the Lodge has been provided with Terms and Conditions of occupancy, which ensures that those living at the home or their representatives know what services will be provided within the fee structure. Staff said they felt the information provided before someone moved in helped them to understand their needs. Care Homes for Adults (18-65 years) Page 12 of 32 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home can be confident that they will be involved in decisions about their lives, in the planning of their individual care and that their wishes and needs are considered when plans are completed. Evidence: All people living at The Lawns have individual comprehensive plans of care based on an assessment of need. They include detailed information about their individual health and social care needs and what actions staff are to follow to ensure each need or goal is met and monitored. They include reference to equality and diversity and focus on the individuals strengths and personal preferences. Other information includes, for example, who or what is important to them, how they keep safe, their goals and aspirations, skills and abilities and how they make choices in their lives. People living at The Lodge have limited communication skills and limited understandings of care plans and are therefore unable to easily contribute to their Care Homes for Adults (18-65 years) Page 13 of 32 Evidence: formulation or reviews. It was clear through observations made that the staff team work hard to meet peoples needs and have a good knowledge and understanding of the care plans and any associated risks. All plans of care looked at included detailed information in relation to all aspects of individuals care and how best these needs can be met by the individual and staff at the home. The plans provide short term goals, how they will be met, assessments of risk and good monitoring. Daily records are kept of all areas of need, including health care appointments, activities, and achievement of the goals in care plans. Staff support and enable people living at the home to take responsible assessed risks and care plans include assessments of risks that may cause danger to the individual or make it unsafe for them to do certain things. Assessments of potential risks to individuals through general health, needs or activities, are undertaken and clear action required to be taken to minimise or reduce any risks is recorded. During this inspection we spoke to several members of staff all of whom had excellent knowledge and understanding of the needs of all living at The Lodge and who were committed to supporting people to lead purposeful and fulfilling lives as independently as possible. We saw staff communicating well will all people living at the home, being kind, affectionate and respectful. The completion of Person Centred Plans and service Designs has brought a lot of clarity into how the people wish to live, be supported and cared for in the future. We have been told that the service will continue to work on developing the Person Centred Plans as appropriate and continue to work in a progressive way while they are still operating. The ethos of The Lodge is to ensure that all those living at the home are enabled and supported to make decisions in all areas of their lives. All decisions made on behalf of individuals living at The Lodge are agreed and discussed with relatives and care managers, particularly those that may infringe upon individuals freedom of movement or privacy. Good records of such decision making processes are recorded and reviewed regularly. Staff confirmed there is a high level of staff training at the home, directed at the needs of people living at The Lodge, thereby ensuring their needs are met appropriately. Care Homes for Adults (18-65 years) Page 14 of 32 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 who live at The Lodge can be confident that they will be supported to make choices about their lifestyles, will be provided with choices of well balanced meals and will be treated respectfully and consulted in all decisions about their lives. Evidence: All staff spoken to during this inspection confirmed that people living at The Lodge live their lives as they wish and undertake meaningful activities when they choose. When we arrived at The Lodge we were greeted by a support worker. One person was enjoying breakfast in the homely, warm kitchen, another was having a lie in and another had gone into the town with a support worker. One person was not well and we were asked by staff not to visit this person. The atmosphere was comfortable and happy and a lot of laughter and affection was seen throughout the inspection. People Care Homes for Adults (18-65 years) Page 15 of 32 Evidence: moved around the home with no restrictions, although there was always a support worker close by if needed. We were told that staff at The Lodge enable people to experience a wide range of leisure activities and support them to continue with existing activities. Staff also provide opportunities for them to be involved in the local community, have access to vehicles, are given a choice of external activities brought into the home, provide the support for people to have annual holidays of their individual choices and to go on day trips. We saw well maintained records of activities undertaken by all people living at The Lodge. Recent outings include a trip to Crealy Park, Woodlands, rugby matches, a visit to Exeter for the switching on of the Christmas lights and one person went to Birmingham to see Tom Jones and Dolly Parton. We were told that people living at the home take part in planned activities and in whatever they choose to do. Individual care plans included information about people enjoyed doing and daily records confirmed the activities that people take part in are their own choices. The Lodge has 2 vehicles, which are used to take people out. One of the vehicles is a people carrier and provides seating for 7 people and the other is a 4 seater car. Activities are not limited to just during the day, we were told that people go out to during the evening to clubs or to the cinema. People living at The Lodge are encouraged and supported to maintain close contact with their families and it is clear when looking at care plans that this is achieved. Visitors are welcome at the home at any time and people living at The Lodge are supported to welcome visitors in private or in a chosen communal area. Family and friends are also encouraged to participate in daily routines with the agreement of the person concerned. The service has a menu as a guide to the meals provided but this depends on what people want to eat at any particular time. We saw one person enjoying breakfast when we arrived and lunch was well presented and looked appetising and nutritious. During lunch we saw support workers assisting those who needed it, discreetly in an unhurried manner. Lunch was a leisurely communal event and seemed to be enjoyed by all, in a comfortable atmosphere. Care Homes for Adults (18-65 years) Page 16 of 32 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. Peoples dignity and privacy is fully respected and people benefit from their health needs being closely monitored. Medication is generally well managed at The Lodge. Improvement in monitoring medication to ensure they are not used past the shelf life and to compiling a policy relating to over the counter medicines being used, will further protect people living at The Lodge. Evidence: Personal care and support is provided by staff that have a good knowledge of how people prefer to receive personal care. We saw detailed information included in care plans relating to peoples preferences, likes and dislikes and staff have a good knowledge and understanding of the information in the care plans. Health care needs are assessed and monitored regularly with health professionals involved when necessary. Responses, to surveys sent prior to this inspection, from Care Homes for Adults (18-65 years) Page 17 of 32 Evidence: two health professionals confirmed they felt the home meets health needs. One commented that the home Links with professionals reflects on clients needs and another I have no doubt that The Lodge provides the best service to our clients. Good records of peoples health care needs and how they are monitored are maintained at the home. There was good evidence that such monitoring takes place, including records of routine well person health checks being undertaken, consultations with speech and language and behavioral therapists and annual flu vaccinations being offered to one person. Care plans for some health needs had not been undertake. For example one person has a chronic health condition, which they are prescribed regular medication to control. No plans informing staff how to meet their needs on a day to day basis, and in the case of an emergency, had been undertaken. People living at The Lodge are encouraged and supported to attend medical appointments. Details of appointments with opticians, and dentists were seen in care plans and records of the outcome of appointments. This ensures that peoples health care needs are met. Staff spoke to us about how they respect peoples privacy and dignity when offering support for personal care. They told us they always knock on bedroom doors and wait to be invited before going in or, in some instances wait a reasonable amount of time and then go in if the person is not able to invite them in. Staff are very aware of peoples rights in relation to their privacy being respected at all times. Medication records of administration were accurate and up to date. All staff that administer medication have received appropriate training and their competencies are assessed by the manager to ensure they understand the training they have received and remain safe to administer medication. The service also provides training and supervision on how to give medication and each member of staff has to be signed off as being competent by the manager before they are able to administer medication unsupervised. We looked at the storage of medication at the home, which is stored in a locked cupboard in the office, which is locked when not occupied. We noted several medications were stored despite being past their shelf life. This means that people are potentially at risk of receiving medicines that will not be effective. We also saw several medications which had not been prescribed for people living at Care Homes for Adults (18-65 years) Page 18 of 32 Evidence: the home. We were told that these may be for staff but that some of them could be given to people living at the home. The service does not have a policy relating to medication that has not been prescribed but has been bought over the counter. This means that people are potentially at risk of receiving medicines that have not been prescribed for them, may cause a reaction if used with other prescribed medicines and have not been agreed to by the doctor. The deputy manager told us that they will compile a list of homely remedies and present it to the doctors involved in the care of those living at the Lodge. Some people have medication prescribed to be given in when needed. However, medication administration records did not include clear guidance relating to the circumstances when this would be given. Care Homes for Adults (18-65 years) Page 19 of 32 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home are assured they are listened to and complaints are dealt with appropriately. There are good systems in place to ensure people are protected from abuse or the risk of harm. Evidence: We were told that no complaints have been made to the Lodge since the last inspection and we looked at a Complaints record which confirmed this. People living at the home were not able to tell us what they would do if they were unhappy about anything at the home, and staff said their knowledge of the people living in the home helps them to recognise when someone if unhappy and they then try and resolve the problem. If a visitor or relative made a complaint to a member of staff we were told they would report it to the manager or deputy. All staff have received training in the protection of vulnerable adults and staff spoken to during this inspection demonstrated a good awareness of types of abuse and knew what to do if witnessed poor practice. One person living at The Lodge manages their own money with the support of staff. Care Homes for Adults (18-65 years) Page 20 of 32 Evidence: They have their own bank account and are supported to go to the bank to pay in or withdraw money. Good records are kept of all financial transactions; monies kept on peoples behalf are checked by two staff at each change of shift. These practices protect people from potential financial abuse. Care Homes for Adults (18-65 years) Page 21 of 32 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 are provided with clean, safe and comfortable surroundings that meet their needs. Evidence: The Lawns provides an accessible, homely, clean, hygienic, safe, well maintained, and comfortable environment to meet the needs of people living and working there. The home is well located with easy access to local facilities and transport. The Lodge is situated on the main road to Exmouth; it is used as a bungalow although it has two levels. The upper level is not accessible to staff or service users. The house has 4 en suite bedrooms, a large lounge, large kitchen/dining room, a laundry room, toilet and office /sleep in room and a large garden to the rear of the property. The area to the front of the building is paved and used mainly as a car parking area. The area to the rear of the property is lawned and paved with seating and areas where people living at the home can take part in games including basketball. Since the last inspection the service has worked on improving the garden and has developed a sensory, quiet area and also the front garden has been developed into a vegetable garden which has supplied the service with fresh home grown vegetables all summer. We have been told that people living at The Lodge have been encouraged to be part of this. Care Homes for Adults (18-65 years) Page 22 of 32 Evidence: Peoples bedrooms are all personalised, decorated in their favourite colours and themes, reflecting their interests and with furnishings to suit their needs. Furnishings, fittings and decoration throughout the home are a generally good standard. On the day of the inspection the home was generally clean, fresh and tidy One persons bedroom door is fitted with a key pad lock to enable the person to access their room independently whenever they wish. We were told that assessments of the abilities of others living at the home have been undertaken and shown they would not be able to manage with a lock. Staff told us that when a person is not at the home the door to their room would be locked to ensure privacy and safety. All bedrooms have ensuite facilities, all of which have full size baths. Since the last inspection a shower in one ensuite has been replaced with a bath as the person did not like the shower. A separate laundry is provided for people at the home. This was clean and well organised at the time of this visit. Care Homes for Adults (18-65 years) Page 23 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at The Lawns are supported by caring staff, trained staff to meet their needs and are protected by robust recruitment procedures followed at the home. Evidence: The aim of the service is to provide 1:1 minimum staffing ratio in the home which allows for flexibility and support for those living at The Lodge in a variety of different activities within the home and outside in the wider community to promote their personal development. Throughout the day, from 8am to 10pm, there are 4 members of staff on duty. An additional staff member is on duty from 9am to 4:30 pm bringing the number of staff on duty to 5 between those times. The manager or deputy are included in this number of staff. From 10 pm to 8:30 there are two staff on duty, one is a sleep in from 11pm and the other is awake throughout the night. This number of staff ensures that the peoples health and social care needs, which are often complex and challenging, can be met safely. Staff receive a good level of training and it was clear through reading care files, and observations throughout the inspection that people individual needs are understood and met. Care Homes for Adults (18-65 years) Page 24 of 32 Evidence: The service has introduced a comprehensive online training programme since the last inspection, included safeguarding adults, manual handling, management of medication and infection control, which means that staff can access up to date training regularly and the work undertaken is assessed by the manager. Many staff have received a range of good practice training to help them understand and meet peoples individual needs including epilepsy, autism, breakaway techniques, gentle teaching and mandatory health & safety training and total communication which has helped staff to learn different methods of communication. Staff demonstrated a good understanding of peoples needs, health & safety issues and told us about training they had received and what they had learned from it. Training undertaken during the last 12 months includes management of medication, total communication, manual handling, first aid and safeguarding adults. This means that peoples needs and welfare are met and protected by appropriately trained staff. Information received from the service indicates that all staff have a basic first aid certificate and 4 staff have the 4 day appointed persons First Aid qualification which is updated regularly. All staff also attend an annual Infection Control update in addition to completing the online training course annually. The Manager is an infection control link practitioner and receives additional training on infection control and shares information with the staff. The service has an annual audit undertaken by the infection control department and also has good links with the infection control nurse who has recently done a hand hygiene training session with the staff at the Lodge. As a result of the last inspection a recommendation was made that a minimum of 50 of staff should undertake a Nationally Recognised Qualification. We have been told that to meet this recommendation 7 staff enrolled to undertake this training. However, we have been told that the service are unable to access any support with this when the City & Guild centre closed and now as the service will be closing in March the Trust is not likely to invest in other ways for the staff at The Lodge to access this training. Recruitment practices are robust ensuring that people living at The Lodge are protected from the risk of potential abuse. This includes ensuring new staff do not work in the home until satisfactory police checks are completed and appropriate references are obtained. Interviews are carried out in the home where potential staff are introduced to people living at the home, which gives the manager the opportunity to see how they interact. Care Homes for Adults (18-65 years) Page 25 of 32 Evidence: A structured Induction training is provided by the organisation and the manager to ensure new staff understand health & Safety issues and working with people with a learning disability. One staff member spoken with on the day of the inspection told us they had received a good induction and described what they had learned and how it had helped them to meet peoples needs safely. We received response to surveys sent prior to this inspection, from 5 members of staff. All confirmed they are provided with training that helps them understand and meet individual needs of people living at the home, keeps them up to date with new ways of working and gives them enough knowledge about health and medication. Comments made by staff included the home has been and always will be, until we close, a friendly and homely environment for all our service users. The staff and management all work well together which only enhances the homely atmosphere and makes it easy for new members of the staff team to integrate quickly. Care Homes for Adults (18-65 years) Page 26 of 32 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at The Lodge benefit from various systems to review, develop and improve the home. Development of a Quality Assurance system would further ensure that people living at The Lodge have their views taken seriously. Evidence: The manager has many years of experience in running care homes and has obtained the necessary qualifications and training to remain competent. The manager was on leave at the time of this inspection but their deputy was present for the majority of the time we spent at The Lodge. The Manager and Deputy whilst not employed as nurses are both Registered Nurses and keep themselves updated with current practices. The Manager and Deputy Manager both have their Registered Home Managers Award. Staff spoke very highly of the managers leadership style and said she provided an excellent and clear sense of direction and was extremely supportive. Care Homes for Adults (18-65 years) Page 27 of 32 Evidence: The manager has systems in place that regularly reviews the quality of care people living at The Lodge receive. For example, information relating to individuals is reviewed and up dated regularly. This ensures staff are aware of any changes and the care is appropriate and up to date. Staff supervision, training and team meetings also ensure the home is run in a manner that includes all staff. Policies are reviewed and updated yearly, or when necessary. The manager also ensures all records in the home are monitored, reviewed and updated and ensures staff are aware of changes. There are excellent systems that monitor service users finances, therefore protecting service users from potential financial abuse. The Premier Living Operations Team visit The Lodge on a monthly basis when they inspect home records to ensure they are up to date, check the environment and any maintenance issues outstanding. Any positive changes initiated within the home are also discussed However, a system that seeks the views of those living at The Lodge, staff, relatives and professionals involved in the home has not been sought to ensure the home is run in the best interests of people living at the home. This information should be sought, collated and an improvement, development plan should be produced with clear action on how to improve the service. Staff at the Lawns receive training annually in the use of safe ways of moving people and objects that avoid injury to people living at the home or staff. All staff have undertaken training in first aid since the last inspection. This means that there is always a member of staff on duty who is able to carry out first aid in the case of an accident or an emergency. All staff currently employed at the home have undertaken a period of induction training and 4 staff have attained a Nationally recognised qualification. The Care Quality Commission obtained information from the service prior to undertaking this inspection. Information included indicated that all equipment at The Lodge is well maintained regularly and confirmed that all necessary policies and procedures are in place and are up to date. These were not inspected during this inspection but the information is used to help form a judgement as to whether the Care Homes for Adults (18-65 years) Page 28 of 32 Evidence: home has the correct policies to keep people living there, and staff, safe. Risk assessments are reviewed regularly and are up dated where necessary, to ensure they are appropriate and reduce risks to people living at The Lodge and staff. The service is in the process of huge changes which will affect people living at The Lodge, their families and staff. The manager told us they see it as their role to support all of these groups through this time and to help them develop strategies to support each other. It is vital that as a team we remain committed to support each other through this time so we can continue to provide the quality of service that we strive for. . The home continues to be run in the best interests of people who live there and to protect their health, safety and welfare. Care Homes for Adults (18-65 years) Page 29 of 32 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 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 19 Care plans should provide information relating to all health care needs and how they are to me met and managed. This relates to information not being available as to how acute or chronic health needs are to be met. 2 3 20 20 Systems should be developed to ensure that medications are not used past their shelf life. A policy should be developed to ensure that people do not receive medications that have not been prescibed, unless agreed by a doctor. The homes quality assurance systems should be further developed to ensure there is a clear plan of what work should be completed, with timescales and who is responsible. The plan should also include formal methods of seeking the views of service users with poor communication. 4 39 Care Homes for Adults (18-65 years) Page 31 of 32 Helpline: Telephone: 03000 616161 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) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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