Care Home: 35 Lowther Road

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What the care home does well An assessment is completed before anyone moves into the home this ensures everyone is clear that the home is the right place where the person’s needs can be met. People who use the service have care plans which are person centred and identify their needs and how they should be supported. People who use the service are supported to take risk in their every day life. People who use the service participate in activities in the local community. The home enables people to maintain contact with family and friends. 35 Lowther Road DS0000068520.V378415.R01.S.doc Version 5.3 People who use the service are supported to make decisions in their daily lives. Staff support people to make healthy food choices. Care plans detail how people prefer to be supported with personal care. There is a system in place to enable people to raise concerns and information is available to them in an accessible format. People live in a house which meets their needs and is homely, comfortable and clean. People who use the service benefit from staff that are well supported and supervised. What has improved since the last inspection? At the end of the inspection in October 2008 there were five requirements and six recommendations. Improvements by the registered manager mean that there are systems in place to ensure that suitably qualified and competent and experienced staff are on duty during the day and night. The manager has a system in place to ensure that all staff are completing appropriate training. There is a quality assurance process in place which is reviewed and developed by the manager. All chemicals which are hazardous to health are stored securely. All incidents which occur in the home are reported to the commission and other relevant authorities. The manager has promoted a total communication environment within the home to support the people who live there in making decisions and choices in their daily lives. People who use the service have access to a variety of activities of their choice. Medication systems are in place to ensure there is a clear audit trail.35 Lowther RoadDS0000068520.V378415.R01.S.docVersion 5.3There is a robust system in place to ensure that any agency staff who work in the home have the training and experience the service requires. The manager has developed total communication practice within the home and there is a culture of expanding knowledge and supporting people to express themselves. What the care home could do better: At the end of this inspection there are no requirements and one recommendation. To ensure that people’s health needs are fully met recording of information such as the details of their dietary intake has to be precise and consistent according to guidance otherwise there is no clear audit trail of when staff should be concerned about someone’s health. Key inspection report CARE HOME ADULTS 18-65 35 Lowther Road 35 Lowther Road Charminster Bournemouth Dorset BH8 8NG Lead Inspector Tracey Cockburn Key Unannounced Inspection 16th November 2009 09:45 35 Lowther Road DS0000068520.V378415.R01.S.doc Version 5.3 Page 1 This report is a review of the 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. 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 home adults 18-65 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. 35 Lowther Road DS0000068520.V378415.R01.S.doc Version 5.3 Page 2 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 35 Lowther Road DS0000068520.V378415.R01.S.doc Version 5.3 Page 3 SERVICE INFORMATION Name of service 35 Lowther Road Address 35 Lowther Road Charminster Bournemouth Dorset BH8 8NG 01202 391610 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) lowther@robinia.co.uk www.robinia.co.uk Robinia Care South Ltd Mrs Claudie Thornewill Care Home 4 Category(ies) of Learning disability (4) registration, with number of places 35 Lowther Road DS0000068520.V378415.R01.S.doc Version 5.3 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: 2. Learning Disability (Code LD) The maximum number of service users who can be accommodated is 4 Date of last inspection Brief Description of the Service: 35 Lowther Road was registered as a care home in October 2006. It is a detached house situated in a residential area of Bournemouth and is registered to provide accommodation and personal care to up to four adults with a learning disability. The registered provider is Robinia Care South Limited. The regional office of the organisation is in Hindhead, Surrey. Accommodation at 35 Lowther Road is on two floors. There is one bedroom with en-suite facilities on the ground floor and three en-suite bedrooms on the first floor. There is a communal lounge, spacious kitchen / dining area, conservatory and large garden at the rear of the house. The home is staffed on a 24-hour basis. The home is within walking distance of a bus stop from which the shopping and commercial centres of Bournemouth, Charminster and Winton are easily reached. Bournemouth’s main railway station is also within reasonable walking distance to enable access to places that are further afield. The home has a paved area at the front of the property for parking and additional parking is available on the road. From information provided to us by the service in December 2008 the weekly fees charged by the service, based on individual assessment of needs, ranged from £1507-£1640. General guidance on fees and fair terms of contracts can be obtained from the Office of Fair Trading at www.oft.gov.uk. 35 Lowther Road DS0000068520.V378415.R01.S.doc Version 5.3 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 3 star. This means the people who use this service experience excellent quality outcomes. This inspection was carried out by one inspector but throughout the report the term ‘we’ is used to show that the report is the view of the Care Quality Commission. During the inspection we were able to meet two of the people who use the service and observe interaction between them and staff. Discussion took place with the Registered Manager of the home and some members of staff on duty. A sample of records was examined including some policies and procedures, medication administration records, health and safety records, staff recruitment and training records and information about people who live at the home. Surveys were sent to the home before the inspection for distribution among people who live in the home and those who have contact with the service. We received two surveys from people who use the service who were supported to complete them by members of their family and five surveys from care workers. We received the home’s Annual Quality Assurance Assessment before the inspection, which gave us some written information and numerical data about the service. What the service does well: An assessment is completed before anyone moves into the home this ensures everyone is clear that the home is the right place where the person’s needs can be met. People who use the service have care plans which are person centred and identify their needs and how they should be supported. People who use the service are supported to take risk in their every day life. People who use the service participate in activities in the local community. The home enables people to maintain contact with family and friends. 35 Lowther Road DS0000068520.V378415.R01.S.doc Version 5.3 Page 6 People who use the service are supported to make decisions in their daily lives. Staff support people to make healthy food choices. Care plans detail how people prefer to be supported with personal care. There is a system in place to enable people to raise concerns and information is available to them in an accessible format. People live in a house which meets their needs and is homely, comfortable and clean. People who use the service benefit from staff that are well supported and supervised. What has improved since the last inspection? At the end of the inspection in October 2008 there were five requirements and six recommendations. Improvements by the registered manager mean that there are systems in place to ensure that suitably qualified and competent and experienced staff are on duty during the day and night. The manager has a system in place to ensure that all staff are completing appropriate training. There is a quality assurance process in place which is reviewed and developed by the manager. All chemicals which are hazardous to health are stored securely. All incidents which occur in the home are reported to the commission and other relevant authorities. The manager has promoted a total communication environment within the home to support the people who live there in making decisions and choices in their daily lives. People who use the service have access to a variety of activities of their choice. Medication systems are in place to ensure there is a clear audit trail. 35 Lowther Road DS0000068520.V378415.R01.S.doc Version 5.3 Page 7 There is a robust system in place to ensure that any agency staff who work in the home have the training and experience the service requires. The manager has developed total communication practice within the home and there is a culture of expanding knowledge and supporting people to express themselves. 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. 35 Lowther Road DS0000068520.V378415.R01.S.doc Version 5.3 Page 8 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection 35 Lowther Road DS0000068520.V378415.R01.S.doc Version 5.3 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 2 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Systems are in place to ensure that people’s needs are assessed before they come to live in the home so that there is a smooth transition and to ensure their requirements and wishes can be met. EVIDENCE: One person has moved into the home since the last key inspection, this person was already known to the service and had visited on numerous occasions. A full assessment of his needs was completed before he moved into the home as well as consultation with social care professionals. A care plan has been developed from the assessment. 35 Lowther Road DS0000068520.V378415.R01.S.doc Version 5.3 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9 People using the 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’s needs are recorded in a person centred way which addresses their changing needs and how they make decisions in their day to day lives. People are supported to take risks as part of an independent lifestyle. EVIDENCE: We looked at individual care plans and found they were person centred with heading such as ‘how I communicate’ ‘morning routine’, ‘things I like doing’ for one person this included swimming, bowling, kite flying and football. A new person centred care plan has been developed and this includes information on how people prefer to be supported, their emotions and their future. 35 Lowther Road DS0000068520.V378415.R01.S.doc Version 5.3 Page 11 There was another heading ‘things that make me happy’ and this included family, drums. Another hading is ‘things that make me sad’ an example for one person it said “it makes me bored and sad if I can’t be active and outside” The plan also stated that indoor activities do not hold my attention which is why it is important to accurately record the activities which take place. People are supported to make choices in their daily life with guidance, we observed people deciding what to do during the day, making choices about what to eat and staff using makaton signs and photographs to support people in making choices. We also observed people saying what it is they wanted to do such as going out. All the staff that work in the home have completed Mental Capacity Act training. Not everyone in the home manages their own money; however care plans and risk assessments identify where people are vulnerable and where people have strengths such as understanding the value of money. The recommendation at the last inspection has been addressed and total communication has been embraced by the home. We looked at a sample of risk assessments in place for one person. These focused on promoting the person’s independence including access to activities, public transport and involvement in activities of daily living. Observation of life in the home indicated that permanent staff are keen to promote people’s independence through appropriate risk-taking, for example, enabling people to have space and privacy in their bedrooms as they wish and promoting people’s access to the kitchen where they can be involved in food and drink preparation. In addition, discussion with staff indicated that they are positive about offering a range of opportunities for the people they support, including access to a gym, swimming and trampolining, putting appropriate support in place to overcome possible barriers and maintain people’s safety. We looked at the risk assessments for one person which were in the process of being reviewed and had not yet been completed by the key worker. The service provider has also introduced new risk assessment paperwork which will mean further work for staff. Each person who lives in the home has their care files in their rooms; day to day information is held in care files in the lounge so they are accessible to the people whom they are about. We discussed issues of confidentiality with the manager who had already considered what to do about this and had decided that when people visit the home the information files will be removed and locked away. 35 Lowther Road DS0000068520.V378415.R01.S.doc Version 5.3 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): This is what people staying in this care home experience: 12,13,15,16,17 People using the 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 use the service have opportunities to participate in activities, which interests them in the local community. People who use the service are supported to maintain contact with people who are important to them. People are supported to eat healthily. EVIDENCE: Each person who uses the service has an activity board on the wall in the dining area which details in pictures and symbols what they are doing each day of the week. The annual quality assurance assessment tells us: 35 Lowther Road DS0000068520.V378415.R01.S.doc Version 5.3 Page 13 “We have supported the Service Users with accessing different activities such as Speedway and going to concerts held at a local church. One of our service users is also now accessing college 3 times a week. As the opportunity arose, another Service User requested to be moved to a downstairs bedroom which we were able to accommodate and should be occurring in the next few weeks once all the finishing touches to the room have been carried out. That Service User chose the colour of her new bedroom as well as the curtains, with support from her key worker, mother and approval from her Care Manager. We have changed our conservatory area to a half-game half -relaxation area; Service Users have bought their own air hockey or snooker tables to enhance that room.” The annual quality assurance assessment also tells us of the improvements in total communication: “As all of our residents have communication difficulties, we ensure that staff are using the communication means of the resident (NMS 16.5). Total communication pictures/symbols are displayed around the home to encourage the signing, teaching and learning of new signs for those working or living at the home to enable all involved to best communicate to achieve the best outcomes. We ensure that the Service users timetables - in a written and user friendly format (pictures) - are displayed in an area facilitating access (kitchen): these demonstrate that local amenities, day services, local leisure centres, youth club, church and Occupational Therapist are all part of the residents lives” A member of staff told us in their survey form that the service is good at: “Organising activities for service users using good communication aids and includes service users in the running of the home.” Another member of staff who sent in a survey form thought they could: “Improve on activities we offer to our service users” A relative who wrote to us was concerned about a lack of activities at the weekends and thought that decisions made about what to do each day were made by staff and not by the person using the service. We looked at the activities which people participate in and they are based on peoples interests and hobbies, one person goes to football matches and another person goes sailing in the summer and bowling n the winter. We also looked at the photo albums for people that show a record of the activities they participate in both in the home and in the community. One person is going to college, another person goes swimming. We looked at daily records which reflect what people do each day and thought that staff could be more descriptive of the activities as they tend to use the same language such as ‘relaxed at home’ but this does not describe what they may have been doing. The annual quality assurance assessment says: 35 Lowther Road DS0000068520.V378415.R01.S.doc Version 5.3 Page 14 “When questioned by an advocate as to the efficiency of our menu meeting the dietary requirement of a service user, we invited a LD dietician to ensure that we were following a healthy balanced diet supporting his special dietary needs: her report was positive and we are now openly promoting the 5 a day ethos.” People’s dietary intake is recorded, records showing evidence of times when individuals had chosen to eat different meals. Inspection of kitchen cupboards showed availability of a range of foods including a large selection of cereals for people to choose from. The menu for the week was on display on a notice board, evidencing through photographs the meals on offer for the week, for example, pasta, beef casserole and roast dinners. During our visit we observed one person being asked what they would like for lunch and making a choice. A bowl of fresh fruit is located in the kitchen for people to help themselves to. All meals are recorded and state how much each person eats and drinks, for one person it is very important that the information about what they eat is clear, concise and accurate. We found that information is not consistently being recorded and the information about fluid intake is not precise enough to evidence that this person has drunk the amount of liquid recommended. 35 Lowther Road DS0000068520.V378415.R01.S.doc Version 5.3 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20 People using the 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 use the service benefit from personal and health care that meets their needs and preferences. However care has to be taken when recording information to ensure health needs are being fully met. Medication procedures in the home have improved and are robust and ensure that people who use the service get the medication they need. EVIDENCE: Each person has a care file which details their needs over 24 hours, including health care needs. We found evidence of people attending health care appointments such as GP, dietician and dentist. The annual quality assurance assessment says: “Each Service User has a PCP and Health Action Plan within which risk 35 Lowther Road DS0000068520.V378415.R01.S.doc Version 5.3 Page 16 assessments can be found and explaining how to best support the S.U in a way they prefer and require. Each resident has annual medical reviews with their GPs, have regular visits with other professionals such as dentist or specialist consultants as their special needs may dictate; staff are aware how to best support the resident with this aspect of their care. These healthcare needs are reviewed as and when required and actioned upon as advised by the medical professional in question.” One person has very specific dietary needs which have to be followed to ensure his health remains good. Staff need to ensure they are following the guidance of the dietician and GP. We noted in the records that sometimes the cereal being offered in the morning is not high fibre, the guidance from the dietician is specific about this and staff need to be more conscientious about it. The annual quality assurance assessment says: “We have involved our local pharmacist to come to our home and openly feedback to us where our shortfalls were and acted upon them” Since the last key inspection the manager has develop a clear audit trail of all medication which comes into the home, the manager told us they not only sought the advice of the local pharmacist they also received advice from the Primary Care Trust’s pharmacist. Medication is supplied to the home by a local pharmacy. Medication administration record (MAR) charts are also supplied by the pharmacy for completion in the home. Medication is stored securely in a metal cabinet attached to the wall of the office. The home has a suitable cupboard for the storage of controlled drugs; no controlled drugs were stored at the time of the visit. The manager completes a weekly audit. The recommendation made at the last key inspection has been addressed and all medication is double signed. There is a clear PRN (as and when) record of medication. Some concern had been expressed by a relative that the staff in the home may use a particular medication too often. We looked at the PRN record for this medication and found it had last been used on 18/09/09; this would suggest that staff were not over reliant on this medication. 35 Lowther Road DS0000068520.V378415.R01.S.doc Version 5.3 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 People using the 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 use the service benefit from staff that are responsive to their wishes. Systems are in place to protect people from harm. EVIDENCE: The annual quality assurance assessment says: “Although staff, the manager and the home embrace an open door policy, we need to work on the ethos that any concerns raised, any safeguarding that may be occurring in the home as a result of a complaint have to be dealt with as a learning tool, ensuring that we therefore proactively work on any aspects of our work practice raised.” There is a complaints procedure for the service and it is written in an accessible format for the people who use the service, who have a variety of different communication preferences. All staff who work in the home receive training in safeguarding vulnerable people. There has been one safeguarding investigation since the last key inspection. 35 Lowther Road DS0000068520.V378415.R01.S.doc Version 5.3 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 24,30 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is decorated and furnished to a high standard offering people a homely, attractive and clean environment to live in that promotes an ordinary lifestyle. EVIDENCE: A tour of the home’s premises indicated that it provides a clean and homely place for people to live in. Bedrooms are highly personalised and reflect the tastes and interests of the people they belong to. All bedrooms have en-suite facilities, which promote people’s privacy and dignity in the home. There is a lounge, conservatory and kitchen / dining room on the ground floor. The conservatory has been adapted into a sensory area including lights, soft furnishings and music and an activity area with a small pool table. 35 Lowther Road DS0000068520.V378415.R01.S.doc Version 5.3 Page 19 There is a trampoline outside and a summer house where one person can practice on his drum kit. There is also a raised bed in the garden planted with herbs and the manager told us they are planning to expand this with the involvement of the people who use the service. We saw photographs of people planting the raised bed during the spring and summer. The manager also told us about an art project everyone is involved in which will be displayed in the lounge. Both of the people who sent back surveys said that the home is always fresh and clean. The home presented as clean on the day of inspection and there were no offensive odours. There is a laundry area in the hall which is accessible to everyone and enables people to be involved in laundry if they wish. The home’s AQAA tells us that they have a policy on communicable diseases and infection control. They have also indicated that staff have received training in prevention and control of infection, this being confirmed in the training records that we looked at. 35 Lowther Road DS0000068520.V378415.R01.S.doc Version 5.3 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 32,34,35, 36 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported by staff that are competent and qualified. Recruitment practice ensures that people are protected. Staff receive training that responds to the needs of the people who use the service. The people who use the service benefit from staff who receive regular structured supervision. EVIDENCE: The annual quality assurance assessment says: “Involving the residents in the recruitment process would be a positive step forward, although Residents have sat during this process in the past and observed; candidates were made aware that this could happen and we explained that as their disability did not allow them to ask the candidate the relevant questions, their demenaour or body language would be a good indication of their like or dislike of the potential recruit.” 35 Lowther Road DS0000068520.V378415.R01.S.doc Version 5.3 Page 21 We looked at the recruitment files for two people who work in the service both contained proof of identity, criminal records bureau checks and POVA 1st checks returned before they began working in the home. Two written references were on file. The recruitment files were in good order and easy to read. We looked at a sample of records for agency workers employed to work in the home to ensure the home had obtained sufficient evidence in relation to their recruitment and training. The manager has ensured that there is appropriate evidence in relation to all agency workers including a photograph and evidence of a satisfactory disclosure, references and training courses undertaken. The manager told us that she takes action when an agency does not send through the appropriate paperwork. Induction checklists are in place for all agency workers who are new to the home. This covers an orientation to the home, its procedures and policies, an introduction to people who use the service and record-keeping. Induction checklists are carried out with the agency worker by the permanent member of staff on duty. In the annual quality assurance assessment we noted that 54 of the shifts had been covered by agency staff in the three months before the AQAA was completed. The manager explained why the number appears high: “13.a these are divided in 7.5 hours day shift or 9 hours sleep-in or wake night.; these have been covered either due to staff attending training or due to annual leave as there was no sickness in August.” So that people know who is on duty each day, the staff rota is in picture form on the board in the hall. There is a photograph of each member of staff on duty on each shift including nights. We looked at the supervision records for two people, there was a supervision contract and very detailed supervision notes which clearly demonstrated how staff are supported in the service as well as with their professional development. 35 Lowther Road DS0000068520.V378415.R01.S.doc Version 5.3 Page 22 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 37,39,42 People using the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service is run by an experienced and skilled manager who puts the needs of the people living in the home first and ensures they are listened to and the development of the home is about their needs and wishes. EVIDENCE: Throughout the inspection the manager demonstrated how the service is continuing to improve and the developments for the future. The manager demonstrated how they listen to people through the development of a total communication system. The manager is also training to be a trainer in order to train staff. The manager is also encouraging other staff that show 35 Lowther Road DS0000068520.V378415.R01.S.doc Version 5.3 Page 23 skills in management by ensuring they are put forward for course which will develop their skills. The annual quality assurance assessment says: “Supervisions are planned and records are held in their personel file; training records are also in place in their files. Monthly regulations 26 are held by the Operations Manager (the records of which are kept in the audit file which is readily available to service users and their representatives); the Home Manager carries out auditing of her own, including spot checks (including at night) to ensure consistency and quality of care occurs over a 24 hour period” They are planning to do the following: “To carry on with sending questionnaires but maybe include them as open days to encourage more honest communication and openly show how we work towards meeting extra needs. To carry out a SWOT analysis on a personal view point to establish if hidden talents are within the team and could benefit the staff themselves given them a sense of purpose but also giving the opportunity to the team to expand the SWOT analysis to the service” The registered manager started her NVQ Level 4 in Care in May 2009 and will have completed this by December 2009 when she will move on to the Leadership and management award. We looked at the record of health and safety checks taking place in the home. There were records in place to monitor the temperature of the refrigerator and freezer facilities in the home, which were seen to be up-to-date. The temperatures were checked at the time of the inspection and were within a safe range. Both day and night staff have responsibility for completing these checks to the manager can be assured that action is taken if there is a problem. Checklists are also in place to assess lighting and ventilation, cleanliness, food storage, floor coverings, window restrictors, storage of chemicals, fire safety and security. We looked at training records for care workers for evidence that they have undertaken training in areas of health and safety including moving and handling, food safety, infection control and first aid. All staff were recorded as having received training in moving and handling and infection control. The manager has developed a detailed action plan to cover any emergency including a swine flu pandemic, she is about to update this information into the action plan, we looked at the staff meeting in which it was discussed and all staff have signed to say they have read it. 35 Lowther Road DS0000068520.V378415.R01.S.doc Version 5.3 Page 24 We looked at the COSHH (control of substances hazardous to health) file and associated risk assessments; there is a file for each room where COSHH substances are used. 35 Lowther Road DS0000068520.V378415.R01.S.doc Version 5.3 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 4 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 4 X 3 X X 3 X Version 5.3 Page 26 35 Lowther Road DS0000068520.V378415.R01.S.doc Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA19 Good Practice Recommendations The registered manager should ensure that when staff are recording what people eat they are being specific about what is eaten and the amount, especially if there is guidance from a health care professional on what someone should be eating to maintain a specific health condition. This is also applicable to recording precisely someone’s fluid consumption. If this is not done consistently it is difficult to monitor deterioration and keep a clear audit trail. 35 Lowther Road DS0000068520.V378415.R01.S.doc Version 5.3 Page 27 Care Quality Commission Care Quality Commission South West Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: 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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