Care Home: Ash Tree Lodge

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What the care home does well The service supports people with a range of complex needs, well. The manager has good systems in place to ensure that people who live in the home have their health and social care needs met, and reviewed when necessary. Staff work well in promoting the independence of people who live at the home, and at the same time adopt effective ways of keeping people safe. The home is clean and tidy. There is a good rapport between staff and people who live at Ash Tree Lodge. What has improved since the last inspection? Information such as the Service User Guide, and the Complaints procedure has been written in a more user friendly format, and now information is given in pictures as well as words to help people understand the content. Parts of the home have been re-decorated, and new beds, mattresses and headboards have been bought. The washing machine has been moved from the kitchen and now complies with Environmental Health guidance. What the care home could do better: The lounge area would benefit from new, good quality furniture as the existing furniture is looking worn. The company should support the manager by having a representative visit the home monthly to ensure that the service is running well. The manager has been in post for two years and has not applied to be registered with the CQC. We would normally expect an application to be sent to us within six months of the manager coming into post. Key inspection report Care homes for adults (18-65 years) Name: Address: Ash Tree Lodge 81 Leicester Road Shepshed Loughborough Leicestershire LE12 9DF     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Fiona Stephenson     Date: 2 8 1 0 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 22 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 22 Information about the care home Name of care home: Address: Ash Tree Lodge 81 Leicester Road Shepshed Loughborough Leicestershire LE12 9DF 01509650169 01509650169 manager.ashtree@aermid.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Aermid Health Care (UK) Ltd care home 6 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: No other additional conditions of registration apply. Date of last inspection Brief description of the care home Ash Tree Lodge is a care home providing personal care and accommodation for six younger adults with a learning disability and associated needs such as epilepsy and autism. The home is situated on a main road near the centre of Shepshed. It is close to shops and pubs and is easily accessible by public or private transport. There is some parking at the back of the house. The home is a converted house on two floors with five single bedrooms. Bedrooms are on the ground floor as well as first floor of the house. There is a lounge and a dining room on the ground floor. 6 Over 65 0 Care Homes for Adults (18-65 years) Page 4 of 22 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This key inspection included a visit to the service. This is the first key inspection of Ash Tree Lodge since July 2007. We (the CQC) visited the home on the 28th October 2009. The manager and the staff in the home helped us during the visit. Our visit started at 9.40 am and finished at 1.00pm. The main method of inspection we used was case tracking. This means looking at the care given to people in different ways. We do this by, - talking to the people who live in the home and their relatives (if they are visiting), - talking to the staff and management, -watching how people are given support, Care Homes for Adults (18-65 years) Page 5 of 22 -looking at records. We looked at the Annual Quality Assurance Assessment (AQAA). This is a document the provider (the person who owns the service) sends to us at the CQC, and it tells us what the provider thinks about the service they deliver to people who live at Ash Tree Lodge. We also looked the surveys called Have Your Say About which are sent out to people who live and work at Ash Tree Lodge, relatives, and professionals who visit the home to support residents with personal and medical care. We received one survey back from a health care professional. They said that the service offers residents choice, and staff will contact relevant parties if they have any concerns. They felt the service could do better by providing ongoing training for new staff around Person Centred Planning, Health Action Plans, and other relevant training. During our visit we asked one of the four residents a range of questions about life at Ash Tree Lodge. This person spoke positively about the staff, the food, the care and his lifestyle at Ash Tree Lodge. We also spent time observing two other residents who were involved in activities with staff. Care Homes for Adults (18-65 years) Page 6 of 22 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 7 of 22 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 8 of 22 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People considering moving into Ash Tree Lodge can be confident that their needs will be properly assessed prior to moving into the home. Evidence: Since the last key inspection there have been no new admissions to Ash Tree Lodge. There has been interest in one of the vacant rooms however the manager considered the needs of the people living in the home, and the needs of the potential new resident, and assessed it as not suitable. All those who live at Ash Tree Lodge had good pre-admission assessments undertaken. We saw that each person living in the home has a service user guide, which is in both written and picture form to help people living in the home, understand the information. We saw that the Statement of Purpose has been updated. This is a legal document which the service has to produce and gives information about management of the home, staffing, and how it will meet the needs of people living there. Care Homes for Adults (18-65 years) Page 9 of 22 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. The individual needs of people living at Ash Tree Lodge are being well met. Evidence: We looked at the care given to people who live at Ash Tree Lodge. We did this by watching the way staff support and help people who live at the home, and by looking at the records of people who live there. We saw that the records give very detailed information about the needs and aspirations of people who live at Ash Tree Lodge, and that these are reviewed regularly. We were told by one person who lives at the home, that he is fully involved in the reviews of his care. We watched staff,and saw that they understood the needs of the people they support, and were seen to be kind, calm and supportive. We saw that the service manages risk well. Risks associated with behaviour are addressed in a positive way to ensure safety, whilst at the same time treating people with dignity and respect. Care Homes for Adults (18-65 years) Page 10 of 22 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 living at Ash Tree Lodge enjoy an active and fulfilling life. Evidence: By talking to people who live at Ash Tree Lodge, talking to staff, looking at the care plans, and by observing how staff work with people who live in the home, we saw that the service has a strong commitment to supporting people in living independent and fulfilling lives. On the day we visited, all residents were at home. We arrived at 9.40am and not all residents were out of bed. During the time we were there, we saw people making their own choices about what they wanted to do with the day. We were told by one resident about the work he does and the day centre he attends on other days of the week. We saw by looking at the records and by talking to staff that all people who live at the home engage in meaningful activities during the week. Care Homes for Adults (18-65 years) Page 11 of 22 Evidence: We saw during our visit, staff and two residents enjoying craft activities. We saw positive interactions between staff and residents. We looked at the menu and saw that there was a good range of meals for the evening meal, and we were told by residents and staff that there is individual choice for lunchtime snacks. One resident told us that he enjoyed the evening meals and that staff were good cooks. Care Homes for Adults (18-65 years) Page 12 of 22 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Ash Tree Lodge receive good personal and health care support. Evidence: We saw that personal health care needs are clearly recorded in each persons plan. An appointment chart is on each persons file which details when the appointment for each area of health care is due e.g. dental, chiropody, diabetes clinic. We checked the management of medication. Medication records were accurate and up to date. Controlled medication is stored correctly, and managed appropriately. Staff administering medication have received the correct training. The manager deals effectively and promptly with any concerns she has about medication prescribed to people living at the home. Staff were seen to be sensitive to the needs of people who live in the home, and people are given personal support in the way they prefer and require. Care Homes for Adults (18-65 years) Page 13 of 22 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. Good systems are in place to protect and support people living at Ash Tree Lodge. Evidence: We were informed by the manager that staff had received training to help them protect people who live at the home from abuse. We spoke with staff who confirmed they had received this training. We saw by looking at risk assessments, that the service balances well the promotion of independence, with the need to protect people in their care. There have been no formal complaints made about the service in the last 12 months. Whilst we were visiting, we saw the manager deal sensitively with an informal complaint from a service user. We saw that their issues were taken seriously, and the matter was dealt with effectively, and to the satisfaction of the person making the complaint. We saw by looking at the records, there had been a medication error. We saw that this had been taken seriously and the correct action had been taken by the manager to protect the person concerned. The manager however, did not notify us at the CQC of this issue, which they should have done under Regulation 37 of the Care Standards Act. The manager was not aware that this type of incident would be seen as requiring notification, but told us she would do so in the future. Care Homes for Adults (18-65 years) Page 14 of 22 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 environment is clean and tidy, but the communal lounge needs refurbishment. Evidence: We looked at the communal areas, and the bedroom of a person living at Ash Tree Lodge. All rooms looked at were very clean and tidy. We were told that the home has five single bedrooms, but it is registered to take up to six people. We are going to write to the company to ask them to change their registration, to reduce the number of people to five. We saw the last report left by the company representative, who noted on his visit to the service in April 2009 that the lounge is looking tired - needs refurbishment. We agreed with his assessment, and saw that the sofas and the carpet in the lounge looked worn. We saw that although the home is called Ash Tree Lodge, it still had a sign at the entry calling it Linden Lodge. Since the visit, we have been informed by the manager that the sign has been taken down. Care Homes for Adults (18-65 years) Page 15 of 22 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. Staff are knowledgeable about the people they care for, and have received the right training to support them in their work. Evidence: We watched how staff worked with people who live at Ash Tree Lodge and saw that they were knowledgeable about the people they support, and responded well to their needs. We spoke with staff and looked at their records. We saw that staff have been given the right training to help them meet the needs and goals of people who live at Ash Tree Lodge. We saw that new staff get a good induction to the job, but this is not linked to the recommended Skills for Care, Common Induction Framework. The manager told us she would look into this. We saw that there were enough staff on duty to meet the needs of people living at the home, both in the day time and in the evening. Care Homes for Adults (18-65 years) Page 16 of 22 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Although the manager is not registered with the CQC, she is managing the home well. Evidence: The current manager has worked at Ash Tree Lodge for two years. Although she was a registered manager at another care home prior to coming to Ash Tree Lodge, she has not applied to be registered as the manager of this home. This means that she cannot be held legally accountable for any actions she takes or doesnt take. But having looked at the records, spoken with staff and people who live at the home, we saw that the manager is managing the home well. The manager has completed a Registered Managers Award and National Vocational Qualification in Care to level 4, and as such is trained to work at management level. A senior manager of the company (called a Responsible Individual) is expected to visit the service once a month to check that the service is being managed well, and that people who live in the home are being cared for properly. The last visit by the company representative was April 2009. Care Homes for Adults (18-65 years) Page 17 of 22 Evidence: We saw that there is on going work on ensuring good outcomes for people. We also saw that there is a quality assurance system in place to get feedback from staff and people who live at the home. This was last completed by staff in April 2009, and by residents in June 2009. Care Homes for Adults (18-65 years) Page 18 of 22 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 19 of 22 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 37 9 The manager must send to the CQC an action plan to show the action being taken to apply for registration as the manager. The CQC needs to determine whether the manager is fit under the The Care Homes Regulations, to be a registered manager. 07/12/2009 2 39 26 The provider must meet its regulatory obligations by visiting the service once a month to ensure the service is being managed well. Senior management at the company should be checking that a service is being well managed, and to ensure the needs of people living in the home are being met. 15/12/2009 Care Homes for Adults (18-65 years) Page 20 of 22 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 23 The manager should notify the CQC under Regulation 37 notifications, of any situation which is covered by this regulation. It is recommended that the company follows through on the recommendation of its company representative, by refurbishing the lounge area. The manager uses the Skills for Care, common induction framework to support the induction of new staff. 2 24 3 35 Care Homes for Adults (18-65 years) Page 21 of 22 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. Care Homes for Adults (18-65 years) Page 22 of 22 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!