Care Home: Alice Lodge

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What the care home does well Most people we met expressed satisfaction with the positive attitude of most staff who worked there and the generally relaxed atmosphere within the home. Typical comments made by the people using the service included - `I like it down here the foods great`, `best thing about this place is the staff, most are `friendly` they leave you alone to get on with it`, and `it`s better than my last place always plenty to do here.` All the staff who were on duty at the time of this inspection, which included the manager, two support workers, the cleaner and the cook, were observed interacting with everyone who uses the service in a very kind, respectful, and professional manner. The atmosphere in the home remained extremely relaxed and congenial throughout the visit, which included the period during lunch. Furthermore, while most of the interior is in need of some refurbishment, the environment nevertheless looked and felt quite `homely` and `cosy`, especially in the main communal areas. What has improved since the last inspection? The range of opportunities the people using the service now have the chance to participate each day, both inside their home and the local community has significantly improved in the past year. All the people we met during this visit confirmed this was the case. The majority of the people who use the service told us they particularly liked going out for meals together and having weekly takeaways. Others expressed satisfaction with the fortnightly inhouse massages, the karaoke evenings, and group cooking sessions. Typical comments included - `I choose not to do many of the new activities on the notice board, but I like going out for the meals, especially Chinese`, `I look forward to having a takeaway each week that`s the best`, `I`ve been to the pictures recently and go food shopping with staff quite a lot`, and `most things advertised on the new activities notice board usually happen`. What the care home could do better: All the positive comments outlined above notwithstanding the service needs to improve its practice in a number of keys areas to ensure Alice Lodge is no longer just an adequate place for people to live: The services Statement of Purpose and Guide must be kept under constant review (we recommend annually) and, where appropriate, revised to contain all the information people who use the service need to know about their home. This should include up to date information about the range of fees the provider charges for services and facilities provided, and the qualifications of the manager and his staff team. This will help people decide whether or not the home is right for them. All the people who use the service should have the chance to take greater responsibility for looking after their own medication, financial affairs, and door keys. The service is obliged to thoroughly assess whether or not anybody currently residing at Alice Lodge is willing and capable of doing more for themselves. This will ensure the rights of people who use the service to live their lives as independently as they can are respected and promoted. All the people who use the service must have up to date health care action plans that contain detailed information about the outcome of all the appointments they have with various community based health care professionals. This will ensure anyone authorised to inspect this record can determine whether or not the health care needs of the people who use the service are being suitably met and monitored. We also recommend the way in which the service develops care plans with the people who use the service should be reviewed as the current care plan format does not set out clearly enough what each person unique strengths are and what support they actually require to achieve their goals. Care plans should be more person centred and better arranged so that the people who use the service and staff can manage them more readily. The provider must ensure the proper and safe recording, handling, safekeeping, safe administration and disposal of medicines received into the home. The health, safety and welfare of people using the service and staff must be promoted and protected. Key inspection report Care homes for adults (18-65 years) Name: Address: Alice Lodge 40 Brighton Road Purley Surrey CR8 2LG     The quality rating for this care home is:   one star adequate 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: Mohammad Peerbux     Date: 0 3 0 2 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 31 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 31 Information about the care home Name of care home: Address: Alice Lodge 40 Brighton Road Purley Surrey CR8 2LG 02086688448 02087630706 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Ms Alice Manteaw-Dankyi care home 16 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of service users who can be accommodated is: 16 The registered person may provide the following category of service only: Care Home Only (CRH - PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Mental Disorder, excluding learning disability or dementia - Code MD Date of last inspection Brief description of the care home Alice Lodge is one of a number of care homes owned by this proprietor Mrs Dankyi. This particular home has been refurbished throughout. The home caters for adults with mental illness. There are 14 bedrooms, some are shared and some are ensuite. There is a large open-plan lounge, a separate dining room and small smoking room. The home has the usual facilities for such a care home including kitchen, small laundry, a very small office, plus bathrooms and toilets. The home has a small conservatory and garden to the rear and limited parking to the front. Fees as at April 2008 were from GBP525 to GBP690. Care Homes for Adults (18-65 years) Page 4 of 31 Over 65 0 16 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. As part of the key inspection a site visit was made to Alice Lodge on 3rd February 2010. During our visit we met eight out of the nine people who currently reside at Alice Lodge and spoke at length to five of them. We also spoke at length to the relatively new acting manager and a support worker who were both on duty at the time of this inspection. They are all thanked for their time and all of those who provided feedback for their support in the inspection process. We also selected three people we met to look at the care they received in more depth. We did this by looking at all the records and documents the service keeps in respect of them, including their care plans and associated risk assessments, which we call case tracking. We spent the remainder of this site visit touring the premises and external grounds. Care Homes for Adults (18-65 years) Page 5 of 31 Care Homes for Adults (18-65 years) Page 6 of 31 What the care home does well: What has improved since the last inspection? What they could do better: All the positive comments outlined above notwithstanding the service needs to improve its practice in a number of keys areas to ensure Alice Lodge is no longer just an adequate place for people to live: The services Statement of Purpose and Guide must be kept under constant review (we recommend annually) and, where appropriate, revised to contain all the information people who use the service need to know about their home. This should include up to date information about the range of fees the provider charges for services and facilities provided, and the qualifications of the manager and his staff team. This will help people decide whether or not the home is right for them. All the people who use the service should have the chance to take greater responsibility for looking after their own medication, financial affairs, and door keys. The service is obliged to thoroughly assess whether or not anybody currently residing at Alice Lodge is willing and capable of doing more for themselves. This will ensure the rights of people who use the service to live their lives as independently as they can are respected and promoted. Care Homes for Adults (18-65 years) Page 7 of 31 All the people who use the service must have up to date health care action plans that contain detailed information about the outcome of all the appointments they have with various community based health care professionals. This will ensure anyone authorised to inspect this record can determine whether or not the health care needs of the people who use the service are being suitably met and monitored. We also recommend the way in which the service develops care plans with the people who use the service should be reviewed as the current care plan format does not set out clearly enough what each person unique strengths are and what support they actually require to achieve their goals. Care plans should be more person centred and better arranged so that the people who use the service and staff can manage them more readily. The provider must ensure the proper and safe recording, handling, safekeeping, safe administration and disposal of medicines received into the home. The health, safety and welfare of people using the service and staff must be promoted and protected. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 31 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 9 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using this service experience good quality outcomes in this area. We have made this judgment using a range of evidence, including a visit to this service. The people who use the service and others enquiring about it do not have access to all the information about the homes facilities and services, or how much the provider charges for them. Anyone who has a stake in the service must have access to more up to date information about the home in order to help them decide whether or not its the right place for them. Prospective service users needs and wishes are thoroughly assessed prior to admission and they are given the opportunity to visit the home and find out about it for themselves before any decisions about moving in are made. Evidence: All the people we spoke with about the information they had been given about Alice Lodge told us they had been provided with a Guide to the home when they first moved in. One person who uses the service showed us a copy of a Guide they had been Care Homes for Adults (18-65 years) Page 10 of 31 Evidence: given, which they kept in their bedroom. The Guide we saw contained a lot of the information people who use the service needed know about their home, but because it had not been reviewed for sometime it did not contain any information about the new managers qualifications or the current range of fees the provider charged for services and facilities. Similarly, although the manager was also able to produce a copy of the homes most recently revised Statement of Purpose on request this too did not contain enough up to date information about the service. The relatively new manager confirmed that he had only accepted one new referral during his time in charge at Alice Lodge and that none of the services placements had broken down under his tenure. The manager demonstrated a good understanding of what constituted best practice regarding assessing the suitability of new referrals. He was very clear that he would not admit anyone unless he believed the home could meet that individuals needs. The manager told us he always talks to the people who use the service about prospective new admissions and several people we spoke with confirmed they had met the homes most recent arrival before they had moved in. Care Homes for Adults (18-65 years) Page 11 of 31 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using this service experience adequate quality outcomes in this area. We have made this judgment using a range of evidence, including a visit to this service. Care plans reflect what needs a person who uses the service has, but there is significant room to improve these documents by including more detailed information about what is important to the individual, what their strengths are, and what support they need to achieve their personal goals. This will ensure the people who use the service have their needs met in a person centred way in accordance with the Care Programme Approach (CPA) to care planning. In the main the people who use the service are protected by the homes arrangements for identifying, assessing, and managing risk. However, the service could do more to actively support and encourage those individuals who are willing and capable of doing more for themselves by taking responsible in order to help them maintain and develop their independent living skills. The service has developed some good arrangements for actively consulting and encouraging the people who use the service to make informed decisions about every aspect of their lifes and the day to day running of their home. Care Homes for Adults (18-65 years) Page 12 of 31 Evidence: All the people who use the service told us they each had a care plan which they knew was kept in the office and they could look at when they liked. Three individuals we spoke at length about their care plans confirmed they were always invited to attend their care plan reviews with their next of kin, care coordinator, and designated key worker. We looked at three care plans in depth which had been drawn up in respect of the aforementioned individuals and were able to confirm they had all be reviewed in the past six months in line with best practice. It was evident that these care plans had been generated from needs assessments carried out by care coordinators and the home, and had been drawn up with the help of the people who use the service. However, despite clearly setting out what peoples needs and personal goals were, these plans lacked a lot of detail regarding the unique strengths of these individuals and the actual support they required to help them achieve their identified goals. The manager and a member of staff we spoke at length with both told there although the current care plan format remained functional; there was still considerable room to improve it, as recommended by us in the homes last inspection report. This outstanding good practice recommendation is therefore repeated at the end of this report. The three people we spoke at length with about their participation in running their home all told us - they knew who their key worker was and felt able to talk to them or the manager if they werent happy about something; they regularly attended residents meetings every fortnight where they helped staff plan the menus and social activities for the forthcoming week; and, they always met new members of staff before they started working at the home. Typical comments made the people who use the service about their involvement in running the home included - most staff here listen to you and sometimes do what you say, I like the meetings - we always talk about where we are going for our meal out, and staff let you get on with here - they alright. The manager told us his staff maintain minutes of all the residents fortnightly meetings, which are kept on the homes computer. However, the manager was eventually only able to produce print off the minutes from one meeting held as far back as 2008 when we requested to see the outcome of the last three residents meetings. We recommend the service maintains an up to date single bound hard copy of all the minutes taken at residents meetings from now on. A member of staff told us it was part of the services ethos to actively encourage and support the people who use the service to do as much for themselves as they were willing and capable of doing so. A number of the people who use the service told us Care Homes for Adults (18-65 years) Page 13 of 31 Evidence: they were expected to get involved in various household chores, including doing their own laundry, tidying their bedrooms, and washing up - for example. Most said they didnt mind a bit of housework every now and then. Typical comments included - I love cooking my favourite food for everyone, I dont have to cook if I dont want too unlike my last place, but I will do the washing up sometimes, and I go to the shops once a week to buy my own stuff. All the people who use the service told us they were not aware of anyone that looked after their own medication and had not been asked whether or not they would be willing and/or capable of self medicating. We received a similar response from the people who use the service when we asked them about managing their own financial affairs or having their own front door. The three care plans we case tracked contained a number of risk assessments, but no reference could be found to peoples willingness and capacity to look after their own medication, finances and/or front door key. Best practice dictates that so far as reasonably practicable people who live in residential care services should have the opportunity to take responsible risks in order to live their life as independently as they possible can. The willingness and capacity of everyone who currently resides at Alice Lodge to take greater responsibility for looking after their own medication, finances, and door keys must be thoroughly risk assessed and any limitations placed on people as a result must be in their best interests and agreed to by all parties involved. Care Homes for Adults (18-65 years) Page 14 of 31 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using this service experience good quality outcomes in this area. We have made this judgment using a range of evidence, including a visit to this service. The people who use the service now have far more opportunities to participate in stimulating social, recreational, and leisure activities, both at home and the wider community. This represents a significant improvement since the services last key inspection. People who use the service with family involvement continue to have regular contact with them. Dietary needs and preferences are well catered ensuring the people who use the service are provided with daily variation, choice, and nutritionally well-balanced meals that meet their specific food preferences. Care Homes for Adults (18-65 years) Page 15 of 31 Evidence: One person who uses the service told us they use to attend a place of worship in the area and felt confident they could go again if they chose too. Staff we met confirmed people who use the service would be supported to attend places of worship of their choosing and that one individual with specific spiritual needs regularly attends services held at a local church. The range of opportunities the people using the service now have the chance to participate each day, both inside their home and within the local community, has significantly improved in the past year. All the people we met during the visit confirmed this was the case. The majority told us they particularly liked going out for meals together and having weekly takeaways. Others expressed satisfaction with the fortnightly in-house massages, the karaoke evenings, and group cooking sessions. Typical comments included - I choose not to do many of the new activities on the notice board, but I like going out for the meals, especially Chinese, I look forward to having a takeaway each week thats the best, Ive been to the pictures recently and go food shopping with staff quite a lot, and most things advertised on the new activities notice board usually happen. During this visit we observed the manager organise a relaxation session in the main lounge, which was advertised on that weeks activity schedule. The session was well attended by the majority of the people who were at home at the time of this inspection. During a tour of the communal areas we noted a phone for use by the people who lived at Alice lodge that was located in its own booth to ensure privacy. We also noted a variety of home entertainment equipment and resources in the main lounge, which included a giant sized wide screen television, a music centre, numerous books, board games, and puzzles. The three people we asked about the services visitors policy told us they were not aware of any restrictions on visiting times and that their relatives and friends regularly came to see them. One person who uses the service also told us you can meet your guests in private and spend time on your own in your bedroom if you choose. All the verbal feedback we received from the people who use the service about the meals was in the main very positive. Typical comments included - the food is great here, I like the meal its probably the best thing about living here, you can choose what you want from the weekly menus, which we help plan, and you can make a main meal for everyone once a week, and I enjoy going for a Chinese with everyone and Care Homes for Adults (18-65 years) Page 16 of 31 Evidence: having takeaways. The food served at lunchtime on the day of this inspection matched the choices on that days planned menu. All the people who were at home on the day of this inspection sat down together around a large table in the dinning room to have their lunch. The atmosphere around the table during the meal remained very relaxed and congenial throughout. It was also positively noted during lunch that a member of staff responded without hesitation or fuss to a request made by one person who uses the service to exchange their desert for something else from the pantry. During a tour of the basement pantry and the kitchen we noted a wide selection of frozen and fresh food stocks, which matched many of the choices identified on the four weekly menus conspicuously displayed in the kitchen. We also noticed displayed in the kitchen a chart specifying all the services uses unique dietary requirements and food preferences. One service user told us they liked Afro-Caribbean style, which they told us they sometimes helped staff prepare for everyone who lived at Alice Lodge. Care Homes for Adults (18-65 years) Page 17 of 31 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. People using the service experience adequate outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. In the main suitably robust arrangements are in place to ensure the emotional and general health care needs of the people who use the service are met, although the way staff maintain records of appointments held with various health care professionals needs improving. However the practice for administration, storage and disposal of medication remains inadequate and potentially places people at risk. Evidence: All the people who use the service we met were dressed in well maintained clothing. One person who uses the service told us they get up and go to bed when they like; do the activities they want, when they want; go shopping and buy their own clothes; choose who cuts their hair and what make up they wear; and have a bath when they want. All the people we met who use the service told us staff actively support them to access various community based health care professionals and attend GP surgerys, Care Homes for Adults (18-65 years) Page 18 of 31 Evidence: Care Coordinator meetings, and outpatient appointments as and when required. A staff member we spoke at length with told us advice is continually sought from various community based health care specialists to meet the changing emotional and general health care needs of the people who use the service. However, staff record keeping regarding all the advice and health care checks ups attended by the people who use the service is rather limited. In the care plans we looked at staff to just file away the letter of appointment the people who the service receive from the various health care professionals they meet. The service needs to review the care planning it has in place to meet peoples health care needs in terms of the what guidance and support is required. We also looked at the arrangements in place for the recording, handling, safekeeping, safe administration and disposal of medications. The medication administration records were audited. There were a number of instances where prescribed medication had been omitted or administered but not signed for. In all cases where medication is not given as prescribed, staff must ensure that they record the reason for this. The administration/non-administration of all medication must be recorded accurately at all times for the health and safety of people using the service. We also found a number of items of medication which were kept unlocked in the office which residents have access as the office was not locked during our visit. The manager was unable to comment on why the items of medication were left on the office table unlocked. He agreed that it was unsafe and it is not the way items of medication must be stored. All items of medication must be securely stored at all times for the safety of people using the service. The home is reminded that medicines in the custody of the home must be handled according to the requirements of the Medicines Act 1968, guidelines from the Royal Pharmaceutical Society, the requirements of the Misuse of Drugs Act 1971 and Nursing staff abide by the NMC Standards for the administration of medicines. All staff must make an accurate record, immediately after observing a resident taking or refusing their medicines. The Commission is also concerned that despite medication audits being carried out on a daily basis those concerns were not identified. Care Homes for Adults (18-65 years) Page 19 of 31 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The ethos of the home is that it welcomes complaints and suggestions about the service, uses these positively and learns from them. Evidence: The home has a complaints procedure that generally meets the national minimum standards and regulations. It keeps a full record of complaints and this includes details of the investigation and any actions taken. The policies and procedures for safeguarding adults are available. We were informed that all staff working within the home are fully trained in safeguarding adults and know how to respond in the event of an alert. The one member of staff informally interviewed about safeguarding matters demonstrated a relatively good understanding of what constituted abuse and what their reporting responsibilities were if they suspected or witnessed it. Care Homes for Adults (18-65 years) Page 20 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Evidence: Although there is an on-going maintenance programme in place the environment does not always meet the individuals needs. A number of the fixtures and fittings need replacing and the decor requires upgrading. The provider is looking into improving and upgrading the furnishings and fittings. The home is generally clean and tidy. There is clear seperation of laundry, cooking and bathing facilities. Care Homes for Adults (18-65 years) Page 21 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service experience good outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has the numbers and skill mix of staff sufficient to meet people needs and ensure their safety at present however staffing level must be reviewed when the home is fully occupied. There is a staff training and development programme in place. This ensures that staff fulfil the aims of the home and meet the changing needs of individuals. Evidence: All the staff we met during the course of this inspection, which included the manager, two support workers, the cleaner, and cook, were observed interacting with the people who use the service in a very kind, respectful, and professional manner. All the verbal feedback we received from people who use the service about staff working there was very positive. Typical comments included - best thing about this place is the staff, most are friendly they leave you alone to get on with it, you can speak to staff about things that are bothering you, and staff are okay I guess some are better than others, but most are nice, and they always knock on your door before they come in. Care Homes for Adults (18-65 years) Page 22 of 31 Evidence: All of the people we met who live at Alice Lodge and one member of staff confirmed there was always at least two support workers on duty throughout the day, a cleaner in the morning, a cook in the afternoon, and the manager who usually worked across the day. Everybody we met told us this level of supervision during the day was sufficient to meet the needs and wishes of the people who currently resided at the home. A recommendation is made that the provider reviews the staffing level when the home is fully occupied. Three staff files was examined at random and found to contain the information required by the Care Homes Regulations 2001 including a completed job application, terms and conditions of employment, an enhanced CRB check and proof of their identity. The home ensures that all staff receive relevant training that is focussed on delivering improved outcomes for people using the service. The manager puts a high level of importance on training so as to meet the individual needs of people using the service. From staff files sampled at random there were evidence that staff are attending mandatory training as and when required. Care Homes for Adults (18-65 years) Page 23 of 31 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. People using the service experience adequate outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home management generally provides guidance and direction to staff to ensure people receive quality care. However the health and safety of people and staff are not always being promoted/protected and this potentially places them at risk. Evidence: All the people who use the service we spoke with about the relatively new manager told us they liked him and felt able to talk to him if they were not happy about anything at the home. With regards to effective quality assurance and quality monitoring systems, the manager was able to produce the last three reports compiled by senior representatives of the registered provider following their monthly unannounced visits to the service. Such visits involve checking documentation and the premises and interviewing both service users and staff. Care Homes for Adults (18-65 years) Page 24 of 31 Evidence: Checks show that records keeping in the home could be improved, as medication administration records are not being completed accurately when staff is administering items of medication. There are also concerns around finding records in the home for example minutes of meetings We tested the temperature of hot water emanating from a tap attached to a bath on the first floor, which we found to be within recommended level. All the WCs we inspected were well stocked with ample supplies of toilet tissue. The two fire extinguishers we looked at on different floors of the home had both been checked by suitably trained fire safety officers within the past year as recommended by the manufacturer. A number of health and safety issues arose during this inspection and they are as follows: - Two fire doors were not closing fully to the doorframes. - A number of extractor fans needed cleaning and one was loose and not secured to the wall. - A number of electric wires were not covered in the residents phone room. - The fire exit staircase at the back of the property was very slippery. - There was a high number of broken furniture. - A number of food products have passed their use by date. It is recommended that a visual inspection be carried out on a regular basis as this will help to identify any potential risks and hazards within the environment that may pose a risk to people using the service. Care Homes for Adults (18-65 years) Page 25 of 31 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 20 13(2) The provider must ensure 01/04/2010 that all arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home are in place and are effective Decor: The premises must be 01/04/2010 maintained in good order and decorated to a reasonable standard. 2 24 23(2)b Care Homes for Adults (18-65 years) Page 26 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 1 5 The services Guide must be 01/04/2010 kept under constant review (we recommend annually) and, where appropriate, revised to include a brief summary of the services Statement of Purpose and up to date information about the range of fees the provider charges for services and facilities offered. The revised version of the Guide must be supplied to each person who uses the service. This will ensure everyone who lives at Alice Lodge and prospective service users have all the information they need to determine whether or not the home is right for them. . 2 1 4 The services Statement of Purpose must be kept under 01/04/2010 Care Homes for Adults (18-65 years) Page 27 of 31 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action constant review (we recommend annually) and, where appropriate, revised to contain all the matters listed in Schedule 1 of the Care Homes Regulations (2001), including up to date information about the relevant qualifications and experience of the new manager, and his staff team. We must also be supplied with a copy of the revised version of the Statement. This will ensure anyone with a stake in the service can access all the up to date information they need to know about the home on request. . 3 6 12 All the people who use the 01/04/2010 service must have up to date health care action plans that contain detailed information about the outcome of all the appointments they have with health care professionals. This will ensure anyone authorized to inspect the record can determine whether or not the health Care Homes for Adults (18-65 years) Page 28 of 31 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action care needs of the people who use the service are being suitably met and monitored. . 4 9 12 All the people who use the 01/04/2010 service should be able to manage their own medication, financial affairs, and door keys within an appropriate risk framework. Assessments must be carried out to ascertain the willingness and ability of all the people who use the service to do more things for themselves and take responsible risk. The assessment should involve the individual concerned and/or their representatives, and a copy included in care plans. This will ensure the rights of the people who use the service to take responsible risks in order to live their life as independently as possible are respected and promoted. . Care Homes for Adults (18-65 years) Page 29 of 31 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 5 42 13 The health, safety and welfare of people using the service and staff must be promoted and protected. . 01/04/2010 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 6 The way in which the service develops care plans with the people who use the service should be reviewed as the current care plan format does not set out clearly enough what each person unique strengths are and what support they require to achieve their goals. Care plans should be more person centred and better arranged so that the people who use the service and staff can manage them more readily. This good practice recommendation is repeated here because it was made in the services last inspection report, but was not implemented to a satisfactory standard. 2 8 The way in which the service records the outcome of all the residents meetings should be reviewed because there is very little written evidence to show us that the people who use the service are given any feedback about their participation in running their home. A recommendation is made that the provider reviews the staffing level when the home is fully occupied. It is recommended that a visual inspection be carried out on a regular basis as this will help to identify any potential risks and hazards within the environment that may pose a risk to people using the service 3 4 32 42 Care Homes for Adults (18-65 years) Page 30 of 31 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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