Care Home: 42a-b Lowther Park

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What the care home does well When a person is thinking of movingin to the home they are given relevant information in an easy read format to make sure they are aware of all the rules about living in the home. Visits are also arranged so that they have the opportunity to meet the people already living there. During this time needs assessments will be completed to make sure the home is suitable for them. This involves the person, their family or Representative and any other professionals involved and helps them to make an informed decision about moving in. Person centred assessments and care plans have been introduced that provide staff with detailed information about all aspects of a person`s life. This enables them to develop a good understanding about individual needs and preferences about how people want to live their lives and achieve their goals. Short, medium and long term goals are identified for each person, which gives staff an insight to each person`s priorities in their day today lives. They also include valuable information about how a person communicates and the level and type of support they require to lead an independent lifestyle of their choosing.Healthcare records are also very detailed making sure staff are aware of personal and healthcare needs and support people to access appropriate services when required. The home has a knowledgeable and competent staff team who are receiving regular training in both core skills and specialist areas such as epilepsy management, autism awareness and behaviour management. Good recruitment procedures are in place making sure staff are safe and suitable, with people who live in the home being actively involved in the recruitment process. Good quality monitoring systemsare in place that check out with people if they are satisfied with the service and give people the opportunity to raise concerns or make suggestions about the running of the home. The new manager is providing good leadership and support to the people living and working in the home and makes sure the home is operating in their best interests. What has improved since the last inspection? The organisation has ensured policies and procedures have been kept under review making sure they are up to date and accurate and support and guide good practice. The format of care plans have improved with a more person centred approach being adopted. More information is being producedin easy read and accessible formats making it easier for people to understand.How people make choices is being recorded more effectively, which is helpful to staff in supporting people to lead an independent lifestyle.A new heating system has been installed and garden maintenance completed making sure the environment is safe. What the care home could do better: Financial safeguarding procedures must be reviewed and strengthened to ensure people are adequately protected from financial abuse.The staff levels in the home must be reviewed and increased to ensure there are sufficient staff on duty to meet the needs of the people living in the home.When goals are identified as part of the care plan, timescales for achieving them and when they have been achieved should be recorded, to enable people to see their progress and gain a sense of achievement. PRN (as and when required medication) recording procedures should be reviewed to make sure a consistent and safe system of recording is used to ensure it is clear when medication has been administered.The manager should now complete the registration process with the commission.Specific and more detailed manual handling risk assessments and guidelines need to be developed for each person to make sure they are supported in a safe and consistent manner. Key inspection report Care homes for adults (18-65 years) Name: Address: 42a-b Lowther Park 42a-b Lowther Park Kendal Cumbria LA9 6RS one star adequate service The quality rating for this care home is: 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: Ray Mowat Date: 0 7 1 0 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 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 Information about the care home Name of care home: Address: 42a-b Lowther Park 42a-b Lowther Park Kendal Cumbria LA9 6RS 01539731159 01539735202 martyn.strange@oakleatrust.co.uk www.oakleatrust.co.uk The Oaklea Trust care home 7 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) : Number of places (if applicable): Under 65 Over 65 7 1 0 0 learning disability physical disability Additional conditions: 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 - Code LD, Physical disability - Code PD (maximum place - 1). The maximum number of service users who can be accommodated is: 7. Date of last inspection A bit about the care home 42A/42B Lowther Park is situated on a residential housing estate on the outskirts of Kendal, Cumbria. The premises are two halves of a semi-detached property, which has been adapted to create one dwelling. The home is owned by Impact Housing Association and operated by the Oaklea Trust, a not for profit charitable organisation, specialising in providing services to people with a learning disability. It can provide a home for up to seven people with a learning disability, one of who may have a physical disability. It is approximately two miles from the amenities of Kendal town centre, with local shops and amenities within walking distance. There are two ground floor bedrooms and six upstairs rooms, one of which is a staff sleep-in room, which doubles as an office. There are adequate bathing and toilet facilities on both floors, including two toilets and a fully accessible walk-in shower on the ground floor and two bathrooms with traditional baths and a toilet on the first floor. The communal space in each side of the home is identical, comprising a lounge, kitchen/diner and small laundry room. There is ramped access to the front door and accessible garden and patio areas to the front and rear of the home. The fees charged are dependant upon individual assessments, with additional charges for sundry personal items such as toiletries. Information about the home is supplied to people in an easy read format and previous inspection reports are displayed in the home. Summary This is an overview of what we found during the inspection. The quality rating for this care home is: one star adequate service Our judgement for each outcome: Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home How we did our inspection: This is what the inspector did when they were at the care home. The quality rating for this service is 1 star. This means the people who use the service experience adequate quality outcomes. During the visit we (The Care Quality Commission) met with people living in the home and spent time with the manager and care staff on duty. The manager completed a self assessment questionnaire called an Annual Quality Assurance Assessment (AQAA) and sent it to us before the inspection visit. This provided us with information about how the home is run and the managers views on what the home does well, where they have improved and plans for the future. There is also information about the people who live in the home and the staff working there. Surveys were sent out as part of this inspection to people living in the home, staff and other professionals with their views being used to formulate the judgements in this report. We also examined records relating to the running of the home that are required by legislation, which included care plan files that guide staff in supporting people to achieve their goals and lead independent lives. We examined staff files and records relating to the maintenance and safety of the home. The last key inspection on this service was completed on 17th July 2007. What the care home does well When a person is thinking of moving in to the home they are given relevant information in an easy read format to make sure they are aware of all the rules about living in the home. Visits are also arranged so that they have the opportunity to meet the people already living there. During this time needs assessments will be completed to make sure the home is suitable for them. This involves the person, their family or Representative and any other professionals involved and helps them to make an informed decision about moving in. Person centred assessments and care plans have been introduced that provide staff with detailed information about all aspects of a persons life. This enables them to develop a good understanding about individual needs and preferences about how people want to live their lives and achieve their goals. Short, medium and long term goals are identified for each person, which gives staff an insight to each persons priorities in their day to day lives. They also include valuable information about how a person communicates and the level and type of support they require to lead an independent lifestyle of their choosing. Healthcare records are also very detailed making sure staff are aware of personal and healthcare needs and support people to access appropriate services when required. The home has a knowledgeable and competent staff team who are receiving regular training in both core skills and specialist areas such as epilepsy management, autism awareness and behaviour management. Good recruitment procedures are in place making sure staff are safe and suitable, with people who live in the home being actively involved in the recruitment process. Good quality monitoring systems are in place that check out with people if they are satisfied with the service and give people the opportunity to raise concerns or make suggestions about the running of the home. The new manager is providing good leadership and support to the people living and working in the home and makes sure the home is operating in their best interests. What has got better from the last inspection The organisation has ensured policies and procedures have been kept under review making sure they are up to date and accurate and support and guide good practice. The format of care plans have improved with a more person centred approach being adopted. More information is being produced in easy read and accessible formats making it easier for people to understand. How people make choices is being recorded more effectively, which is helpful to staff in supporting people to lead an independent lifestyle. A new heating system has been installed and garden maintenance completed making sure the environment is safe. What the care home could do better Financial safeguarding procedures must be reviewed and strengthened to ensure people are adequately protected from financial abuse. The staff levels in the home must be reviewed and increased to ensure there are sufficient staff on duty to meet the needs of the people living in the home. When goals are identified as part of the care plan, timescales for achieving them and when they have been achieved should be recorded, to enable people to see their progress and gain a sense of achievement. PRN (as and when required medication) recording procedures should be reviewed to make sure a consistent and safe system of recording is used to ensure it is clear when medication has been administered. The manager should now complete the registration process with the commission. Specific and more detailed manual handling risk assessments and guidelines need to be developed for each person to make sure they are supported in a safe and consistent manner. 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 Care Quality Commission North West Citygate Gallowgate Newcastle Upon Tyne NE1 4PA Tel: 03000616161 Error! Not a valid filename.03000616171 Email: enquiries.northwest@cqc.org.uk mailbox businessservices @cqc.org.uk 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 http:/www.cqc.org.uk/. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line - 0870 240 7535. 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 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. The admission process ensures peoples needs can be met and they are given suitable information to decide if the home is suitable for them. Evidence: People are issued with suitable information about the home including a service user guide. These are produced using pictures and symbols to make them easier for people to understand an audio version of the complaints procedure is also provided which is good practice. There has been one new referral to the home since the last inspection. We examined this persons care plan file and related records. The home has introduced a person centred model of assessment and care planning called my life my choice. The assessment is very detailed and records valuable information about all aspects of a persons life including domestic living skills, personal and health care support, lifestyle and cultural needs. It also included a good range of risk assessments specific to the needs and desires of the individual that ensure that they are safeguarded at all times. Specific personal care and health care needs were well documented identifying the level and type of support people require ensuring their independence is promoted. Visits to the home are arranged as part of the assessment process which enables people to make a more informed decision about the suitability of the home. This also enables staff to assess the persons compatibility with people already living in the home and to make sure the environment is suitable. All the referrals to the home have been as a result of a full care needs assessment by a social worker, who works closely with other agencies to make sure specialist needs are assessed. From this information the manager can assess if staff have the appropriate skills and knowledge to support a person safely and effectively. Staff we met had a good understanding of individual needs and are providing a consistent and reliable service to them. Evidence: Contracts of terms and conditions are agreed and signed at the end of a probationary period. This allows people to have a chance to experience life in the home before making a firm commitment to move in. Relatives or representatives support people through this process making sure they are aware of their rights and responsibilities. The contracts are produced in easy read formats using pictures and symbols to make them easier to understand and help people to make a meaningful choice. 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. Through a detailed person centred care planning process staff make sure peoples individual needs are met and they achieve their goals and aspirations. Evidence: Staff have worked closely with people and their relatives to develop comprehensive person centred care plans called my life my choice. These include informative pen pictures and a life story that gives staff an insight to what is important to people and significant events and relationships in their lives. In addition to this personal information individual healthcare and personal care needs are assessed and strategies agreed about how best to support and care for a person. These include key areas such as behaviour, nutrition and daily living skills. Communication needs are also well documented in what is called a communication passport. This records how an individual communicates their needs and highlights common phrases, utterances or behaviours that people use and based on previous experience their possible meaning. Another important part of the care plan is the record of people’s daily routines and night time routines that help and guide staff in supporting people in their preferred manner, with the activities and routines of their choosing. When a person expresses a preference or desire to do something these are recorded as short, medium or long term goals. Also recorded is how it will be achieved, who will be involved and progress toward the goal. Supporting people with decisions and choices in their lives is empowering them and makes them feel valued and that their rights are respected by staff. Regular house meetings also provide an opportunity for people to be involved in decisions about the running of the home. They share relevant information about the organisation and what is happening in the local community enabling people to make informed decisions about their lives. Evidence: The person centred care plans reflect a positive attitude to risk in peoples lives with clear risk assessments in place to safeguard people whilst pursuing their chosen lifestyle. However manual handling assessments need to be more detailed with a specific manual handling assessment completed for each person. As part of the admission process risk assessments are completed, which are then kept under review to make sure they are up to date and accurate. Staff have a good awareness of the importance of maintaining confidentiality when handling or discussing personal and confidential information. They do this on a need to know basis which is agreed with each person or their representative, with a signed agreement within the care plan about how and when information will be shared with a third party. All the records we examined were securely stored in line with data protection guidelines. 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. Opportunities for people to pursue their hobbies and interests in the local community are limited due to the staffing levels in the home particularly at weekends. Evidence: The person centred care plans record peoples needs and preferences in relation to their social, emotional, independent living skills, hobbies and interests. This enables staff to provide personal support and identify opportunities for personal development. Also included are peoples spiritual and cultural needs and preferences. All the people currently living in the home attend the local day service five days each week. However there is still flexibility for them to do alternative activities when the opportunities arise with staff from their home supporting them. Based on our discussions with people and the staff that support them they are accessing a varied range of activities, these include regular horse riding sessions, aromatherapy, a work placement at a nursery, swimming and attending a social club. In addition one off activities and trips are planned based on people’s individual preferences. Some examples of this was two people on the day of this visit who were going to a concert in Manchester and staying overnight in a hotel with staff. Another person was planning a trip abroad and another person had recently been on a pampering weekend in a spa hotel. Supporting people to enjoy this type of activity is highly valued by the individuals and is helping them to achieve their goals and enjoy a fulfilling lifestyle. However opportunities to access the local community on a day to day basis and at weekends is severely limited due to the staffing levels in the home. Some evenings and weekends there are two staff on duty to support seven people which is totally inadequate and very restrictive on people pursuing their interests and hobbies. This issue is Evidence: addressed in the staffing section of this report. Staff support people to maintain links with their family and friends through visits or phone calls. Family members are regular visitors to the home and they liaise regularly with staff. The staff also work closely with day service staff to maintain a good continuity of care. The day service provides another opportunity for people to meet and socialise with their peer group as well as taking part in a range of vocational or leisure activities. The home effectively operates as two houses with three people living on one side and four on the other. They plan separate menus and shop for the ingredients independently. Menus are agreed with people on a weekly basis with suitable alternatives provided to the planned meal if someone changes their mind. During this visit we spoke to people and the staff supporting them as they prepared their evening meal. People were aware of the menu and confirmed the food is good. One person who is involved in interviewing for new staff, when I asked him what skills staff should have they said they must be a good cook. Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples personal and healthcare needs are well documented enabling staff to provide consistent but flexible support in the way they prefer. Evidence: Comprehensive care plans provide detailed information to support and guide staff in providing a consistent and well planned service that meets individual personal and health care needs. This is achieved by respecting each individuals personal preferences about how they like to live their lives and promoting an independent lifestyle. Daily and night time routines and specific strategies have been agreed with each person to guide staff in providing personal support in the way they prefer. Health care records including a health action plan are in place that record all medical and health related issues, including routine and one off appointments and health interventions by other professionals or agencies. The manager is in the process of developing a hospital passport. This records relevant information to guide hospital staff if someone needs treatment, giving them an insight about how best to support and communicate with the individual. The new manager is in the process of reviewing the medication systems and procedures in the home. We examined the contents of the medication cabinet and checked these against the records held. There is a clear stock control system that is working effectively ensuring all medication coming in to or leaving the home is accounted for. There is a separate returns book that is used to record all medication returned to the pharmacy. PRN guidelines have been developed for all medication that is given on an as and when required basis and they are stored separately from the regular medication. PRN medication is recorded on the medical record sheets (MAR chart), however the completion of these was inconsistent with different codes used that could cause confusion or errors. It is recommended PRN recording procedures are reviewed to make sure a consistent and safe system of recording is used. All staff have completed relevant medication training to make sure they are Evidence: knowledgeable and competent to administer medication and are aware of the organisations policies and procedures. Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Financial safeguarding procedures must be improved and regularly monitored to ensure people are adequately protected. Evidence: People living in the home receive relevant information in alternative and easy read formats to ensure they are aware of their rights and how to raise a concern or complaint. There were no formal complaints recorded since the last inspection. When informal concerns are noted they are recorded in a communication book or personal file. This ensures relevant people are aware of the concern and it is dealt with consistently and is resolved in a timely manner. Through induction and ongoing training staff are made aware of how to deal with complaints and concerns. Staff we met were aware of the organisations policies and procedures and their own responsibilities. All new staff complete relevant safeguarding training giving them the skills and knowledge to identify and report any concerns or allegations of abuse or mistreatment. Since the last inspection there has been one safeguarding referral made. This related to financial irregularities that came to light and were reported immediately to the Police. They conducted a full investigation resulting in a prosecution of the member of staff responsible. The organisation also conducted their own investigation as it was evident from the Police investigation that internal checks had not been completed as required to provide a financial safeguard. Disciplinary action was taken and procedures are being reviewed to ensure adequate controls and checks are in place. In addition the organisation made sure people were compensated for their loss as it was clearly an organisational shortfall. Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is clean and comfortable and provides a safe and homely living environment for the people residing there. Evidence: We examined all areas of the home and found them to be clean, hygienic and free from hazards. The garden and grounds had been recently maintained as part of a maintenance contract. In addition the people living in the home are fully involved in the up keep of the garden areas, with some people growing their own vegetables. People are also involved in choosing new furniture, flooring and bedroom furniture for all parts of the home. All the bedrooms are decorated to peoples personal tastes with evidence of them personalising the room with pictures and personal items. People also get involved with the cleaning of the home and take responsibility for their own bedrooms. The manager explained the programme of planned maintenance and renewals, which were included in the homes annual business and development plan. Plans are in place for the decoration of the two kitchens and hallways with the manager negotiating with senior management regarding contingency funding for other planned projects. The environment is suitable for the needs of the people living there with an accessible walk-in shower room on the ground floor. There is ramped access to the front door and grab rails are fitted around the home to help people with specific activities. The laundry facilities are adequate for the small domestic nature of the home and are sufficient to deal with the volume and type of soiled laundry produced. Suitable infection control procedures are in place and there were no malodours. 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. The staffing levels in the home are not sufficient to enable staff to support people with their interests and access the local community when they choose. Evidence: The organisation has good recruitment policies and procedures in line with good practice guidelines and legislation. These ensure all staff are suitable and safe for their role with all relevant checks and references completed prior to appointment. One of the people we met who lives in the home explained to us how they were going to be involved in some forthcoming interviews. They had been supported by a member of staff to put together some questions they wanted to ask the candidates. This level of involvement is good practice and empowers the people living in the home making them feel valued and that their views are listened to. Induction training is thorough making sure staff have the necessary skills and are aware of their specific roles and responsibilities. Based on our discussions with the manager and staff team and also from examining the staff rotas it is evident there are insufficient staff on duty at the weekends and some evenings. This is having a direct impact on the opportunities for people to access the local community and pursue their hobbies and interests with two staff supporting seven people. The staff levels in the home must be reviewed and increased to ensure there are sufficient staff on duty to meet the needs of the people living in the home. The organisation has a training department who maintain a record of all training provided to staff and supply the manager with a database to enable them to plan with staff future training they require. The training department produce a regular training plan that is circulated to managers to enable them to book staff on future events. If the manager identifies any specialist areas of training the staff require they can organise local events or liaise with the training department to organise a course. Based on discussions with staff and the manager and on examining staff files held in the home, a good range of both core training and specialist training is being provided, including autism awareness, challenging behaviour, effective communication, epilepsy awareness and visual impairment. The new manager has also attended relevant training for her role such as budget management, supervision Evidence: and appraisal, recruitment and selection and Mental Capacity Act training. All the staff were receiving regular formal supervision from the manager and talked of being well supported and knowing there was always someone on the end of the on-call phone for support. Instead of annual appraisals six monthly performance reviews have been introduced. The manager completes these with individual staff members agreeing targets or goals for the next six months. These are then signed off and agreed by the regional manager. Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. On the whole the home is being managed in the best interests of the people living there. Evidence: A new manager Emma Wilson has been appointed to the Registered Manager role. She is in the process of registering with the Commission and is currently working toward the NVQ 4 Registered Managers award. She has relevant experience of the role working in another small home covering for the Registered Managers short term absence. She has been well supported in the role by the Regional Manager and has completed suitable training courses including: Recruitment and selection, supervision and appraisal, budget management, person centred planning, Mental Capacity Act and safeguarding. Staff feel confident in the new manager, who is providing clear leadership to the staff team, with staff saying they feel valued and part of the team. Staff meetings are held on a regular basis enabling staff to contribute to the effective management of the home and have their views or concerns listened to and acted upon. A quality audit was completed by the home in August 09 with people living in the home and the staff who support them. Positive comments were recorded including we get good support and regular supervision, I am impressed with all the training, I feel supported by the new manager. When asked what the service could do better some common themes emerged about the environment being improved including the garden and kitchens, not enough fresh food, not enough staff, we can feel pressured in to working extra shifts. The manager has acknowledged these comments and concerns and is working to put plans in place in response to them. Comments from people living in the home included the following; I like living here, I like my job and the food is good, the staff are nice and we always have good holidays. Evidence: The organisation produce a comprehensive range of policies and procedures to guide and support good practice, which are kept under review to make sure they are up to date and relevant to new legislation. Through the structured induction process and ongoing supervision the manager ensures staff understand the policies and their individual role and responsibilities. All the records we examined were up to date and securely stored in line with data protection guidelines. The safety and welfare of people who live in the home and the staff that support them are safeguarded by the health and safety policy and procedures, which on the whole are compliant with current legislation and good practice. However it was noted that specific more detailed manual handling risk assessments and guidelines need to be developed for each person to make sure they are supported in a safe and consistent manner. 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 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 1 23 13 Financial safeguarding 12/11/2009 procedures must be reviewed and strengthened and regular monitoring taking place to ensure people are adequately protected. Peoples finances were not adequately protected due to management checks not being completed. This system must be strengthened and more closely monitored to prevent future incidents. 2 33 18 The staff levels in the home 12/11/2009 must be reviewed and increased to ensure there are sufficient staff on duty to meet the needs of the people living in the home. Some evenings and at weekends there are only two staff on duty to support seven people. This is totally 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 inadequate and restricts peoples opportunities to access the community and pursue their hobbies and interests. 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 7 When goals are identified as part of the care plan, timescales for achieving them and when they have been achieved should be recorded, to enable people to see their progress and gain a sense of achievement. PRN recording procedures should be reviewed to make sure a consistent and safe system of recording is used to ensure it is clear when medication has been administered. The manager should now complete the registration process with the commission. Specific and more detailed manual handling risk assessments and guidelines need to be developed for each person to make sure they are supported in a safe and consistent manner. 2 20 3 4 37 42 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. 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