Care Home: 4 Maer Lane

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What the care home does well People living at Maer Lane are looked after by a team of staff who have worked at the home for a long time and care for them well. Staff understand their needs well, which benefits their care. People`s health needs are closely monitored and staff work well with health and social care professionals; ensuring their health and wellbeing is promoted. People are provided with a comfortable and homely place to live, where they feel safe and secure. People have the specialist equipment they need in order to promote their independence and keep them safe. People are supported to keep in touch with friends and family. This helps them to maintain relationships which are important to them. People told us the home does the following things well: "People here are exceptionally well cared for" "The general standard of care is verygood" "They support our son well and meet his needs in a professional and caring manner. He is very happy living at the home" "Clients are very well cared for and the staff work well as a team" "Staff know me well" "Provide a person centred approach and an excellent standard of personal care" What has improved since the last inspection? The manager has done the things that we asked after we last visited the home on 9th July 2008. This has improved outcomes for people using the service. The manager is now registered and has started a training course for managers. She has also done lots of courses to update her skills and knowledge and improve the service for people living there. People told us that the manager is `very approachable`, `fair` `brilliant` and `operates an open-door policy`. Staff have done lots of training courses to help better meet peoples needs and keep them safe. Many people have been supported to redecorate their bedrooms in the colours they like. New furniture and fittings have been bought and floor coverings replaced. Lots of things have also been done in the areas of the home that people share tocreate a more homely place for people to live. Care plans are more detailed and written as if the person is telling others about themselves. This ensures they receive the care they need and in a way that they prefer. What the care home could do better: If there was more staff on duty of an afternoon it would mean that people living at Maer Lane would be able to do more things that they enjoy doing such as day trips and activities outside of the home. It would also provide more support for people whose needs have changed which mean they need a higher level of care and support. This needs to be looked at so that there are enough staff on duty to support them to lead the lifestyle they wish and ensure their needs are met. It would be good for staff to have more training and help to meet the needs of the people they support during times when their behaviours may cause harm to themselves or to staff supporting them. People with an interest in the home said: "Carers are very good but sometimes they are overstretched and could sometimes do with more staff" "There are times when staff are targeted,during these times additional staffing would ensure that other clients could maintain social activities" Key inspection report Care homes for adults (18-65 years) Name: Address: 4 Maer Lane 4 Maer Lane Market Drayton Shropshire TF9 3AL 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: Becky Harrison Date: 0 6 0 7 2 0 0 9 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. The first part of the review gives the overall quality rating for the care home:  3 stars – excellent  2 stars – good  1 star – adequate  0 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. They reflect the things that people have said are important to them: 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 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: 4 Maer Lane 4 Maer Lane Market Drayton Shropshire TF9 3AL 01630698092 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : angelaj@tha.org.uk joannesp@trident-ha.org.uk Trident Housing Association care home 10 Number of places (if applicable): Under 65 Over 65 10 0 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 10 The registered person may provide the following category of service only: Care Home Only (Code PC) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning disability (LD) 10 Date of last inspection Care Homes for Adults (18-65 years) Page 4 of 32 A bit about the care home 4 Maer Lane is a building that was built to be a care home. Up to 10 people can live there. The home is in Market Drayton close to local shops. The home has a number of bathrooms, two lounges, a dining room, a conservatory, a sensory room and a kitchen that people can access with staff support as it has a lock on it. There is a lift for people to use to get up the stairs. The home has a large garden. Everyone has a bedroom of their own and are helped to have it the way they like. The home has a book which tells people lots of things about the home and how much it costs to live there. 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 Care Homes for Adults (18-65 years) Page 6 of 32 How we did our inspection: This is what the inspector did when they were at the care home We visited 4 Maer Lane on 6th July 2009 and stayed there for seven hours. The home did not know we were coming. Most people who live at the home were not able to tell us about the service they receive. So we spoke with the manager and staff and spent time watching how staff support people to live their lives. We looked at how the home meets the care and support needs of people who live there by meeting residents, talking about their care with staff and looking at the care plans for two people. We also looked at some parts of the home. Five people completed surveys for us with the support of people who know them well. We also received three surveys from people with an interest in the home and three from staff who work at the home. Some of the comments received are included in this report. We looked at staff files to see how the home makes sure that people working at 4 Maer Lane are safe and suitable to do so and we also looked at other records to see how the home is run. Before the visit the home sent us the Annual Quality Assurance Assessment (AQAA). The manager completed this. Care Homes for Adults (18-65 years) Page 7 of 32 This is a form that tells us how the manager thinks the home is meeting the needs of the people they support and also tells us other information relating to how the home is run. What the care home does well People living at Maer Lane are looked after by a team of staff who have worked at the home for a long time and care for them well. Staff understand their needs well, which benefits their care. Peoples health needs are closely monitored and staff work well with health and social care professionals; ensuring their health and wellbeing is promoted. People are provided with a comfortable and homely place to live, where they feel safe and secure. People have the specialist equipment they need in order to promote their independence and keep them safe. People are supported to keep in touch with friends and family. This helps them to maintain relationships which are important to them. People told us the home does the following things well: People here are exceptionally well cared for The general standard of care is very Care Homes for Adults (18-65 years) Page 8 of 32 good They support our son well and meet his needs in a professional and caring manner. He is very happy living at the home Clients are very well cared for and the staff work well as a team Staff know me well Provide a person centred approach and an excellent standard of personal care What has got better from the last inspection The manager has done the things that we asked after we last visited the home on 9th July 2008. This has improved outcomes for people using the service. The manager is now registered and has started a training course for managers. She has also done lots of courses to update her skills and knowledge and improve the service for people living there. People told us that the manager is very approachable, fair brilliant and operates an open-door policy. Staff have done lots of training courses to help better meet peoples needs and keep them safe. Many people have been supported to redecorate their bedrooms in the colours they like. New furniture and fittings have been bought and floor coverings replaced. Lots of things have also been done in the areas of the home that people share to Care Homes for Adults (18-65 years) Page 9 of 32 create a more homely place for people to live. Care plans are more detailed and written as if the person is telling others about themselves. This ensures they receive the care they need and in a way that they prefer. What the care home could do better If there was more staff on duty of an afternoon it would mean that people living at Maer Lane would be able to do more things that they enjoy doing such as day trips and activities outside of the home. It would also provide more support for people whose needs have changed which mean they need a higher level of care and support. This needs to be looked at so that there are enough staff on duty to support them to lead the lifestyle they wish and ensure their needs are met. It would be good for staff to have more training and help to meet the needs of the people they support during times when their behaviours may cause harm to themselves or to staff supporting them. People with an interest in the home said: Carers are very good but sometimes they are overstretched and could sometimes do with more staff There are times when staff are targeted, Care Homes for Adults (18-65 years) Page 10 of 32 during these times additional staffing would ensure that other clients could maintain social activities If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Becky Harrison 77 Paradise Circus Queensway Birmingham W Midlands B1 2DT 01216005300 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line - 0870 240 7535. Care Homes for Adults (18-65 years) Page 11 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 12 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. Information about 4 Maer Lane is made readily available to help people make an informed choice about whether the home is able to meet their individual needs. A complete assessment of their needs is undertaken with them and others close to them, and people are given the opportunity to visit the home and test drive it to ensure the service is right for them. Evidence: People looking for a care home are provided with lots of information about Maer Lane in the Statement of Purpose and Service User Guide, which the manager has updated. These documents help prospective residents and those close to them understand what the home has to offer. Since our last visit one person has moved into the home. We looked at the persons care file and spoke with the person and staff on duty. The person visited the home lots of times to make sure the home was right for them and has settled into the home very well. At the moment the home has one vacancy and although there has been some interest Care Homes for Adults (18-65 years) Page 13 of 32 Evidence: from people looking for a care home, the manager told us that she will only admit a person whose needs the home can meet and who will get on well with the residents who already live at the home. A new needs assessment document has recently been developed, this is more person centred and focuses on goals and aspirations of the individual referred and also the persons expectations of the service. The document will help the provider determine the care and support an individual requires. Care Homes for Adults (18-65 years) Page 14 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living Maer Lane have detailed support plans in place, which inform staff about their individual needs and how they prefer these to be met. Individuals are supported to make decisions about their life because staff actively promote their rights and provide opportunities for them to make choices. People are supported to take measured risks to enable them to lead the lives they wish and maintain their independence as much as possible. Evidence: We looked at the care records held for two people who live at Maer Lane. These were written in the first person, as if they are telling others about themselves. Both were detailed and covered areas to include peoples personal and health care needs, medication, daily living, leisure opportunities, religion, finance and likes and dislikes. These ensure staff are familiar with the assessed needs of the individuals they support and enable staff to provide the appropriate care and assistance for people. The home intends to develop care plans in an easy read version to make it easier for the people Care Homes for Adults (18-65 years) Page 15 of 32 Evidence: living at the home to understand. Records sampled show that peoples needs are regularly reviewed with people close to them such as relatives, key worker, social worker and the community nurse. We spoke with a number of staff about the individuals we case tracked and they demonstrated a good knowledge of peoples individual needs, which was consistent with the information held on their care files. The AQAA states Person Centred Planning (PCP) is our main focus at the moment looking at customers goals, dreams, wishes and aspirations in life . The planning of this approach with each individual will be bespoke to their needs, abilities and their preferred means of communication. Most people living at Maer Lane are unable to communicate their needs verbally, therefore staff have developed other ways to support people with their preferred communication methods, for example through the use of signs, gestures, symbols and photographs. The AQAA states We would like to develop further methods of consultation with customers and offer objects of reference which will allow them to make more informed choices. Throughout our visit staff were able to interpret peoples communication needs well and were seen to support them with making decisions, for example choosing their activities, meals and refreshments. Advocates, relatives and designated key workers represent peoples best interests. We saw information on one persons file indicating that the person has capacity to make some basic choices but would need support to make more informed choices about major life events with someone acting in their best interest. If a major decision were required then a best interest assessment would be undertaken. The AQAA states We facilitate customer service meetings which is an opportunity for each customer to bring to the meeting anything they want to discuss. ...Support staff play a key role within these meetings as advocates for customers due to the varied communication methods. Both care files seen contained risk assessments covering areas to include activities, manual handling, medication and self help skills. These show that people are not stopped from taking risks but that staff have specific guidelines to follow to minimise the risk of harm, while providing individuals with opportunities to lead the lives they want. One of the people we case tracked had a very detailed behaviour plan in place to ensure staff are consistent in their approach. Care Homes for Adults (18-65 years) Page 16 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People partake in some leisure activities however improved staffing levels would enable individuals to experience a lifestyle that enhances their quality of life. People are able to maintain friendships important to them and are provided with wellpresented meals in accordance with their dietary needs and choice. Evidence: People who were able to told us about the lifestyles they lead and the activities they enjoy. A number of people have also been supported to go on holiday and one person told us how much they had enjoyed this in addition to the clubs they regularly attend. One person stated I like it here, I sometimes help out in the kitchen, Ive been on holiday and I like going to Wayfarers (day service). One person we case tracked would like to continue with their education and staff have accompanied them to visit a college and explore appropriate courses and enrol for September. A record of all activities undertaken was available on the files sampled in addition to activities declined. During Care Homes for Adults (18-65 years) Page 17 of 32 Evidence: our visit a number of people were out attending day services or educational facilities. Others remained at home supported by staff and took part in activities of their choice such as games, watching a film, watering the plants, looking at magazines or household tasks. People told us that the needs of some individuals have considerably increased but staffing levels have been reduced of an afternoon. This restricts opportunities for people to get out into the community, access day trips or do things that they most enjoy, which is currently impacting on their quality of life. One person said the service could improve by Providing more day time staff to be able to take service users out. People living at Maer Lane are supported to maintain relationships that are important to them for example one person told us that he enjoys seeing his friends at a club he attends. Family are invited to attend events held such as barbecues, parties and reviews and contact is also maintained via telephone calls, as observed during the inspection when a relative telephoned the home for an update on her sons health. The AQAA states We encourage and support customers to grow and establish their new found friendships to enhance their social network opening up more opportunities and experiences to the people we support. Care records seen evidence routines are flexible in accordance with peoples needs. For example if somebodys feeling unwell they are able to remain in bed. Preferences in relation to activities, likes and dislikes are recorded and discussions with staff evidence they have a good understanding of these. The AQAA states We promote and support customers with their routines. People are provided with a healthy diet and staff are aware of their personal preferences and any specific dietary needs, such as diabetes. People are supported to choose their meals and pictures are available in the dining room to support this process. The meal cooked and served during our visit was well presented, balanced and those who required assistance were supported in a sensitive manner. Specialist equipment to assist eating has been obtained. A record of all food eaten was available on the files sampled. Food provided is generally British which is reflective of the cultural background of the people currently living at the home, although themed nights have been offered to provide people with the opportunity to try other foods such as chinese and indian. The AQAA states We are promoting and encouraging the governments agenda on Change4Life within the home by providing meals and food options that are healthy and nutritious, full of varied options to meet dietary requirement, customers personal favourites and any cultural and religious requirements. Care Homes for Adults (18-65 years) Page 18 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. People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because there is good evidence of multi agency working in the best interests of the people living at the home. Staff effectively support people with the management of their medication safeguarding their health and promoting their wellbeing. Evidence: Care plans sampled detailed the level of support the individual requires and how they prefer this to be delivered. People were well groomed and dressed in appropriate styles to their age and gender, promoting a positive self-image. The AQAA says Staff members are very alert to changes in moods, behaviour and general wellbeing of each customer and respond in a skilled way to take the most appropriate action. Records seen demonstrate peoples health care needs are closely monitored and that individuals are supported to attend routine health appointments to ensure their health needs are met and additional medical support is obtained. During our visit one person was supported to attend a health appointment and staff prepared him well so that he knew where he was going and who he was seeing. On his return they also talked to him Care Homes for Adults (18-65 years) Page 19 of 32 Evidence: about the outcome of the appointment. Staff expressed serious concerns over the increased health needs of one person in particular, and the significant impact this is having on the persons quality of life. Records clearly evidence the home is working with a number of health and social care professionals and investigations are currently underway. This needs to be addressed at the earliest opportunity in the best interest of the individual concerned. Staff are closely monitoring the persons health condition and recording information to assist the process. One professional told us the service does the following well Staff always seek appropriate support and advice should clients needs change. They support clients to access the community for appointments and have a good relationship with the GP practice to ensure health needs are met. People who are prescribed medication are supported by staff who receive training to ensure they are competent to administer medication, promoting their health and wellbeing. Staff sign to confirm that they have read the medication policy and procedure which states Any mis-administration of medicines is treated as a potential safeguarding adult referral and gross misconduct, which may lead to disciplinary action being taken. The manager confirmed there has been no medication errors since we last visited. Records seen evidence that medication reviews are regularly held to ensure individuals are on the correct prescribed medication and dosage required to maintain their health. Planned improvements include developing a resource library in regards to health conditions, medications and disabilities of people who use the service to further develop knowledge in these areas. Care Homes for Adults (18-65 years) Page 20 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. Staff are able to recognise if individuals are unhappy with any aspect of the service they receive therefore residents can be confident that their feelings will be recognised and responded to. The home has procedures in place to safeguard people from potential abuse and staff receive training in adult protection and local procedures, ensuring people living at Maer Lane are protected. Evidence: People have access to a complaints procedure, which has been developed in an easy read version so that its easier for people to understand. Most of the individuals who live at Maer Lane are unable to communicate verbally, therefore staff use other ways of communicating with the people they support to ensure they are happy, as observed during the inspection. We have not received any concerns or complaints about the service since our last inspection and there have been no complaints received by the home. The home has received a number of compliments to include one from a student stating You are a very close and caring team and the clients are very lucky to be cared for by people such as yourselves. Staff at Maer Lane have access to the policies and procedures in relation to adult protection and whistle blowing. Both the manager and staff demonstrated an understanding of their duty to safeguard people. Information about abuse has also been Care Homes for Adults (18-65 years) Page 21 of 32 Evidence: produced in an easy read format and displayed in the home. We were advised that all but the new staff have received training in adult protection and training has been arranged for the outstanding staff. Two referrals and investigations have been held under safeguarding adult procedures and the necessary action taken and the issues have been concluded. People at Maer Lane need help to manage their money. Individuals are appropriately supported and systems are in place to protect them to include individual bank accounts, finance books, twice daily checks on monies held, obtaining receipts for expenditure, weekly audits by managers and a recent annual audit undertaken by the organisations finance team. The manager has attended training in the Mental Capacity Act Deprivation of Liberty Safeguards and understands the need to look at how this legislation may affect people who live at Maer Lane regarding their capacity to make decisions. The AQAA states Staff have a detailed understanding about what is classed as restraint including equipment like bed rails and wheelchair belts which are only to be used when absolutely necessary and agreed in a multi disciplinary format and is used in the best interests of the individual. Some staff have received training in managing behaviours that challenge, although feedback received from staff clearly evidence they would welcome additional training in this area. This is due to the significant increase in incidents displayed by one individual who is currently posing a risk to them and making them vulnerable when providing direct care. The staff team are currently working with a number of health and social care professionals in relation to the person concerned to ensure the person is receiving the support and service they need. Training would provide staff with the skills to keep them safe and ensure they adopt a consistent approach when supporting the person concerned and any others whose behaviours may challenge the service. Care Homes for Adults (18-65 years) Page 22 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 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 4 Maer Lane are provided with a well equipped, homely, clean and comfortable place to live where they feel safe and secure. Evidence: 4 Maer Lane is a purpose built care home situated in Market Drayton close to local shops. The home is well equipped for people with physical disabilities with aids, adaptations, a passenger lift, overhead tracking devices in some bedrooms and assisted bathing facilities. The home provides a number of bathrooms, two lounges, a dining room, a conservatory, a sensory room and a kitchen. There is a large garden to the rear of the home and there are plans to further develop this area to include a sensory garden with water feature. The AQAA states We are working alongside customers to design and create a sensory garden which will stimulate individual senses providing a haven of peace, a area for customers to chill-out and unwind from the everyday stresses of modern living, this be beneficial to the people we support. We looked at the shared areas of the home, the bedrooms of the people we case tracked and the bedrooms others wanted to share with us. The home was very welcoming, shared areas are well equipped and provide soft furnishings, photographs and ornaments. Bedrooms seen were very personalised, decorated to peoples preferred colour schemes and equipped to meet their individual needs. People appeared comfortable and relaxed in their surroundings. The AQAA states To ensure customers were fully involved in this Care Homes for Adults (18-65 years) Page 23 of 32 Evidence: process several variety of options and ideas of equipment, furnishings and pricing were provided and discussed, giving customers a range of options to choose from. The home was found clean throughout and free from odours. Staff are responsible for supporting people to maintain the cleanliness of the home in addition to cooking and caring. Staff spoken with confirmed that such duties do not infringe on providing quality care. Substances such as cleaning products that could cause harm to people are safely stored and the manager reported that so far five staff have completed training in the control of infection and contamination. Care Homes for Adults (18-65 years) Page 24 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff work positively and receive good training opportunities to equip them with the skills and knowledge to meet the needs of the people they support. An increase in staffing levels would provide greater opportunities for people and improve their quality of life. People have confidence in the staff at the home because the checks have been done to make sure that they are suitable to care for them. Evidence: The people living at Maer Lane are cared for by a well established team of staff who appear very committed to their work and have a good understanding of their individual needs. Staff retention is much improved, compared with previous years providing continuity of care for people living at the home. Of the 17 permanent care staff employed 7 have obtained a care qualification known as NVQ at level 2 or above in care or equivalent and 2 further staff are due to commence the award shortly. Discussions held with a number of staff evidence that they enjoy their work, that morale is good and that they function well as a team. Observations made clearly evidence that staff enjoy their work and have developed positive working relationships with the people they support. Staff stated: I enjoy my work Care Homes for Adults (18-65 years) Page 25 of 32 Evidence: I love my job...we manage but its stressful given the increased needs of some individuals I enjoy working at the home. Everyone works well together and we all try to give the residents a home from home atmosphere I think the clients have good support staff. They are very well cared for and we all work well as a team Concerns were expressed about the reduction in staffing levels during the late shift 2.30pm to 9.30 pm. This reduction is having an impact on residents quality of life and restricts opportunities for people to get out in the community, access day trips or do more things that individuals like to do. Staffing levels have been reduced on this shift from four staff to three staff despite an increase in peoples needs. For example it was reported that three individuals currently require two members of staff to assist with their personal care needs and that the individual needs of some people have changed significantly. In addition staff have to remain vigilant about the whereabouts of one individual following a safeguarding investigation. We were advised that the provider is meeting its contractual obligations but that a meeting is scheduled shortly with the placing authority to negotiate contracts and address this concern. Staff we spoke with demonstrated a clear understanding of the needs of the three people we case tracked and reported that they are provided with good training opportunities. Staff have recently been awarded individual learning accounts to spend on their training needs. Feedback gained through surveys and discussions indicate that staff receive good training opportunities in safe working practices such as moving and handling, first aid in addition to service specific training such as dementia care, relationships and sexuality and autism. We looked at the files of four staff employed since our last visit. With the exception of a staff photograph these contained evidence that the necessary pre recruitment checks are undertaken to ensure people living at the home are safeguarded. 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. The management systems in place ensure that people living at Maer Lane benefit from a safe and well run service. Evidence: People living at the home benefit from a manager who is experienced and has a clear understanding of their individual needs. The manager is now registered with us and has lots of experience in social care and is well supported by her deputy manager and the staff team. She stated I have a fantastic team of staff who are very supportive, work hard and really care for the people here. The manager has attended lots of training courses relevant to her role and has recently commenced a management qualification. We spoke with several staff and they were all positive about how the home is managed. Comments include: Angela is a brilliant manager The manager is fair and approachable Angela operates an open door policy; shes very approachable and definitely a good Care Homes for Adults (18-65 years) Page 27 of 32 Evidence: leader On the whole things are managed very well but there is always room for improvement The Annual Quality Assurance Assessment (AQAA) forwarded to CQC reflects both the strengths and areas for improvement, which the manager acknowledged at the time of inspection. It was reported that satisfaction surveys are currently being developed with people who use Tridents services. These will then be sent to residents and others with an interest in the service to ascertain their views in order to help assess how the service is currently performing and aid future planning. The AQAA states A comments and compliments book is to be implemented to seek views and opinions from all visitors to the home on what they think the service does well and ideas on how we can continue to improve the quality of the home and the service. Monthly visits required by Regulation 26 are undertaken at the required frequency and detailed reports based on the findings were available for inspection. The AQAA reports The homes manager works closely with the support team and the organisations health and safety officer to ensure all areas of health and safety are covered and health and safety checks are completed in line with policy and procedures. We looked at a variety of health and safety records and the checks that staff do to prevent people from being placed at risk of harm. A monthly health and safety audit is undertaken in addition to a number of checks such as fire tests, emergency lighting, water temperatures at the required frequency. Equipment is serviced as required to ensure its safety and staff spoken with confirmed they receive training in safe working practices for example moving and handling, food hygiene, fire safety and infection control to ensure peoples safety. The manager confirmed that there are no outstanding requirements made by the Fire or Environmental Health Departments. Care Homes for Adults (18-65 years) Page 28 of 32 Are there any outstanding requirements from the last inspection? Yes  No  Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 29 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 Description 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 Description 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 33 A review of staffing levels should be undertaken at the earliest opportunity to ensure that there are sufficient staff on duty at all times to meet the care and support needs of the people living at the home. This is to ensure that peoples identified support needs can be met and people provided with opportunities to enable them to live full, safe and active lives. 2 35 Staff should receive additional training in managing behaviours that challenge to ensure that they can carry out their roles safely and effectively and meet the assessed needs of the people they support. This is to ensure that staff have the knowledge and skills needed in order to meet peoples assessed needs and to keep both themselves and the people they support safe. Care Homes for Adults (18-65 years) Page 30 of 32 Care Homes for Adults (18-65 years) Page 31 of 32 Helpline: Telephone: 03000 616161 or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) 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. Care Homes for Adults (18-65 years) Page 32 of 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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