Care Home: Burntwood Lodge

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What the care home does well Residents live in a clean, comfortable and homely environment with their private accommodation personalised to reflect their lifestyles. Comments about the environment included "that the home is always clean" "environment seems clean pleasant enough" and "cosy home very homely". Residents enjoy the quiet relaxed gentle lifestyle provided at the home and described their experiences of the home as "they treat me well" "I am happy here" "alright" "Life is very nice very quiet just how I like it". A relative said "they seem a very friendly care home". Flexible routines are an important part of the home which are determined by the needs and preferences of residents. A residents said "I can go to bed whenever I want I like to lie in until mid morning and then I gets dressed after lunch". Resident`s benefit by being supported to maintain relationships with their families, with a relative commenting "always felt like a warm comfortable place to visit". The meals are good offering flexibility, choice and variety with residents commenting "food very nice" "quite nice" and "get a choice of food". Consistent feedback was received and evidence seen was on how well the home provides a good standard of physical care which respects resident`s privacy and dignity. A relative commented "she always looks very well and care for". Residents benefit from a stable staff team who are generally well trained and that know them and that have been robustly recruited and employed in sufficient numbers as is necessary to meet their needs. Feedback about staff included "staff seem very knowledgeable, residents always seems relaxed in their company" and "staff are very nice on the whole they are ok". What has improved since the last inspection? The shortfalls noted at the previous inspection have now been addressed or are in the process of being addressed. This has helped to improve parts of the environment through their refurbishment and improved residents safety by the fitting of radiator covers to prevent accidental burning. The manager informed us that recommendations following a fire safety officers visit are in the process of being implemented which has improved fire safety standards at the home. The manager reported that the majority of staff have now obtained a National Vocational Qualification in care. What the care home could do better: There are a number of shortfalls noted at this inspection which have resulted in requirements being made in order to address them and improve practices at the home. In order to ensure that the home promotes an enabling lifestyle for residents in which their independence is actively encouraged care plans and risk assessments need to identify how staff should support them to do this and staff and management need the training to help improve their understanding and knowledge about best care practices in the care of people who have learning disabilities. The home needs to continue with the refurbishment and upgrade of the building including making the garden area more inviting and well maintained. A relative said about the environment "ok a bit of decoration needed but very homely". Residents lives need to be further enriched through increased access to community facilities including leisure services. Good practices in which the manager agreed to address was in establishing which residents would like a suitable lock fitted to their bedroom door in order to further promote their privacy. The provider must ensure that they are suitably monitoring standards and facilities at the home and taking prompt action to rectify any shortfalls as part of their required monthly visit to the service. Key inspection report Care homes for adults (18-65 years) Name: Address: Burntwood Lodge Burntwood Lodge 84 Burntwood Lane Caterham-on-the-hill Surrey CR3 6TA     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: Jane Jewell     Date: 0 8 0 6 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 34 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 34 Information about the care home Name of care home: Address: Burntwood Lodge Burntwood Lodge 84 Burntwood Lane Caterham-on-the-hill Surrey CR3 6TA 01883381692 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: burntwoodlodge@fsmail.net Mr Abdulha Aziz Coowar care home 6 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability physical disability Additional conditions: The maximum number of service users to be accommodated is 6 The registered person may provide the following category of service only: Care home only (PC) t service users of the following gender: Either whose primary care needs on admission to the home are within the following category: Physical disability (PD) learning disability (LD) Date of last inspection Brief description of the care home Burntwood Lodge is a registered care home, providing care and accommodation for up to six adults with learning difficulties some of whom may also have physical disabilities. The building is a converted domestic house which is in a residential area at the top of Caterham on the hill, with shops and other amenities a short drive away. The home is presented across two levels with stairs providing access to the bedroom on the first Care Homes for Adults (18-65 years) Page 4 of 34 Over 65 0 0 6 6 Brief description of the care home floor. Communal facilities include dinning room, kitchen, lounge which leads onto a veranda that overlooks a large sloping garden. Residents accommodation consists of four single bedrooms and one double bedroom with one bedroom providing en-suite facilities. The manager reports that the fees for residential care are currently £900 to £1000 per week, depending on the services and facilities provided. Extra such as: newspapers, hairdressing, chiropody, transport , toiletries are additional costs. For the full range of additional costs refer to the home directly. Care Homes for Adults (18-65 years) Page 5 of 34 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 information contained in this report has been comprised from an unannounced inspection undertaken over six hours and information gathered about the home before and after the inspection. The manager had completed an Annual Quality Assurance Assessment form within the timescale requested and the information contained in this document has been used to inform the inspection process. The inspection was facilitated in part by Sally Skinner (Registered Manager). The focus of the inspection was to look at the experiences of life at the home for people living there. The inspection consisted of being shown around the communal areas, and being invited to view several residents bedrooms, examination of the homes documentation and observations of residents daily routines and in their interactions with staff. Four residents, three staff and three relatives were consulted as part of the inspection process. Care Homes for Adults (18-65 years) Page 6 of 34 Feedback surveys were sent to the home for distribution in order to obtain the views on the quality of the services and facilities being provided. Five were returned, four from residents which were completed with the aid of staff and one from a staff member. Their feedback is included in this report. There were five residents living at the home at the time of the inspection. The last key inspection of the home was undertaken on the 8th July 2008. Care Homes for Adults (18-65 years) Page 7 of 34 What the care home does well: What has improved since the last inspection? What they could do better: There are a number of shortfalls noted at this inspection which have resulted in requirements being made in order to address them and improve practices at the home. In order to ensure that the home promotes an enabling lifestyle for residents in which Care Homes for Adults (18-65 years) Page 8 of 34 their independence is actively encouraged care plans and risk assessments need to identify how staff should support them to do this and staff and management need the training to help improve their understanding and knowledge about best care practices in the care of people who have learning disabilities. The home needs to continue with the refurbishment and upgrade of the building including making the garden area more inviting and well maintained. A relative said about the environment ok a bit of decoration needed but very homely. Residents lives need to be further enriched through increased access to community facilities including leisure services. Good practices in which the manager agreed to address was in establishing which residents would like a suitable lock fitted to their bedroom door in order to further promote their privacy. The provider must ensure that they are suitably monitoring standards and facilities at the home and taking prompt action to rectify any shortfalls as part of their required monthly visit to the service. 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 9 of 34 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 10 of 34 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. There is some accessible information available about the home and the services and facilities it provides, to help residents and their families make informed choices about the home. The home is able to identify and meet the needs of the people whom it supports. The assessment process ensures that only residents whos needs can be safely met at the home are admitted. Evidence: The homes statement of purpose, which is a book that tells people who the home is for and the service users guide, which is the book that tells people how the home works is made available to residents and interested parties. The service users guide has been produced in a format intended to make this information accessible to residents, using photographs and symbols. There have not been any new admissions to the home for a significant number of Care Homes for Adults (18-65 years) Page 11 of 34 Evidence: years. Therefore, this standard was assessed in respect of the admission procedure for future prospective residents. The manager was aware of the admission criteria for the home and knowledgeable about admissions practices that would ensure a range of information is gathered about prospective residents. This would then inform their decision whether prospective residents needs could be met at the home. Residents at the home are assessed as having low to medium assessed needs with some residents having physical needs, vision impairments and mental health needs. Residents age ranges from 48 to 74 years with a mixture of male and female residents. Through observation, looking at records and feedback from staff and other stakeholders involved in residents care, evidence was gathered that the home is meeting most needs of residents. However, some further work is needed to ensure that residents independence is further promoted and community access increased. These issues are discussed further under the lifestyles section of this report. Residents appear to benefit from the quiet relaxed gentle lifestyle provided at the home. Residents described their experiences at the home as they treat me well I am happy here alright Life is very nice very quiet just how I like it. A relative said they seem a very friendly care home. The manager confirmed that prospective residents are provided with the opportunity to visit the home in advance to assess the quality, facilities and suitability of the home with their family and representative. The length and type of any visit would depend on the individuals needs and preferences. The first six weeks of residency is looked upon as a trial occupancy. The manager stated that residents are provided with a written contract of terms and conditions of residency with the home. This is used with residents and their families to make explicit the placement arrangements and clarify mutual expectations around rights and responsibilities. Care Homes for Adults (18-65 years) Page 12 of 34 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. Care plans provide a framework for the delivery of good consistent physical care, however they do not provide clear guidance for staff on the promotion of residents independence as part of an enabling lifestyle. Residents are involved in decisions about their lives in accordance with their range of preferences and strengths. Evidence: Four individual person centred plans of care were inspected and were found to largely contain relevant information on the needs of residents and the appropriate guidance for staff on how to support their personal, health, communication, social, cultural and religious needs. This also included how to manage some behaviour that could be challenging. Residents are involved in the development and review of their plan within the range of their strengths and preferences. The manager ensures that changes in residents support needs are identified through the regular review of care plans. Staff Care Homes for Adults (18-65 years) Page 13 of 34 Evidence: consulted with have worked at the home for a number of years and were knowledgeable about the physical support needs of residents. Staff were observed using a variety of communication tools to provide some choices regarding food, drink and personal care. The manager was aware of new legislation (Mental Capacity Act) which effects residents rights to make decisions in their lives. The manager spoke of developing picture menus to help further, residents understanding of the food choices available. A range of ways was seen of how residents are involved in the overall running of the home with regular meetings and consultations regarding practices at the home and events and activities. However, care plans did not identify clear goals or any targets to their attainment in the promotion of independence and the participation of residents in daily activities at the home. For example in residents being enabled to make drinks and snacks for themselves, or participate in some household tasks as part of an enabling lifestyle. Residents were instead observed asking staff for food, drinks and equipment which staff confirmed they could undertake for themselves. Risk assessments are in place which provides staff with the guidance on how to manage or reduce the risks faced and posed by residents. However, it was discussed with the manager that the risk assessment process should be used to underpin the further promotion of residents independence through increased involvement in undertaking some tasks for themselves eg meals snacks drinks laundry. In light of the need to further promote residents independence it has been required that care plans and risk assessments include the guidance necessary to further promote residents independence in their daily lives. Care Homes for Adults (18-65 years) Page 14 of 34 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. Residents have some opportunities to take part in appropriate and enjoyable activities however access to community based activities is currently limited. Current practices did not always promote residents personal development. Flexible routines are a central part of the home which are determined by the needs and preferences of residents. Residents benefit by being supported to maintain relationships with their families. The meals are good offering flexibility, choice and variety. Evidence: Some residents attend day services for periods during the week where there is the opportunity to learn and develop new skills. However, as previously noted there are Care Homes for Adults (18-65 years) Page 15 of 34 Evidence: limited opportunities for residents to use practical life skills at the home as currently residents have little participation in daily practices. Staff commented upon the sometimes institutional behaviour of some residents. Following discussion with the manager and staff regarding increasing residents independence they highlighted several areas in which residents personal development could be improved and appeared motivated in initialising this, which included meal preparation, meal time routines, laundry and making and preparing snacks and drinks. Staff spoke of the flexible weekly activities plans that each residents has. This included attending day care services, rides out and shopping. Staff spoke mainly of the in house activities provided, which includes a visiting music entertainer, puzzles, foot massages, nail and hand care. A residents spoke of their recent birthday celebration and relatives spoke of attending parties and barbeques. A relative voiced their concern regarding the lack of general activities and suitable occupation provided to their relative and they were advised to discuss this directly with the home. Consistent feedback was received from residents, staff and relatives regarding the need to increase opportunities for residents to access the community by going out more, which also included holidays. A staff member fedback that the biggest barrier to being able to access the community was the lack of drivers in order to use the homes mini bus, as local facilities are not within walking distance. The manager spoke of the maintenance staff now undertaking four hours on a Saturday in order to drive the bus to enable residents to go out. The manager stated that residents prefer day trips instead of holidays and a plan of days out was in the process of being organised. However a relative felt the residents were not given a choice about holidays. Arrangements are in place to meet residents cultural and spiritual needs, with staff knowledgeable about any residents individual needs. It was evident that residents are supported and encouraged to maintain family links. A resident spoke of the importance of being able to phone their relative each week and how staff assisted them to do this, another resident spoke of being able to visit their close relative regularly. All relatives consulted with said that they could visit at any time and that they were made to feel welcome when they did by being offered refreshments with a relative commenting always felt like a warm comfortable place to visit. On the day of the inspection, it was observed that the routines of the home were reflective of individual needs and their lifestyle. Residents were able to move around the communal space freely, choosing which rooms to be in and what level of company Care Homes for Adults (18-65 years) Page 16 of 34 Evidence: they wanted to enjoy. Staff spoke of the flexibility in daily routines regarding meal times, going to bed, rising and bathing. A residents said I can go to bed whenever I want I like to lie in until mid morning and then I gets dressed after lunch. Staff spoke of the menus being developed based on residents likes and dislikes and that there was some flexibility in order to meet the needs of residents at the time. The manager spoke of the current plans to incorporate pictures of the meals on offer in order to aid residents understanding of the choices available. Part of the lunch time meal was observed where residents individual preferences were respected and discrete sensitive support was provided to those residents who needed assistance to eat. Residents comments about food included food very nice quite niceand get a choice of food. Staff undertake the cooking as part of their duties, staff said that currently no residents are involved in the preparation of meals and meal time routines. As previously noted the manager agreed to review this as part of the need to further promoting an enabling lifestyle for residents. Care Homes for Adults (18-65 years) Page 17 of 34 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. Residents benefit from personal and health care support that meets their individual needs whilst respecting their privacy and dignity The medication systems are well managed promoting good health Evidence: Staff said that all residents require some level of personal support. Care plans documented the actions necessary to meet the physical needs of residents with staff observed supporting residents in a sensitive manner whilst respected their dignity. Various specialist equipment is provided in order to help support residents with eating standing and transferring. A resident spoke of the importance of maintaining privacy whilst they were showering and how they had been provided with a special alarm call which gave them the confidence to bath in private. Staff unanimously stated that the best thing about the home was the good standard of physical care provided to residents. A relative commented she always looks very well and care for . Staff support residents to ensure their health needs are met, with health care plans containing a record of any visits or contact with professionals external to the home. There was evidence of involvement from General Practitioners, art therapist, Care Homes for Adults (18-65 years) Page 18 of 34 Evidence: behavioural management teams, specialist nurses and psychologists. Where concerns have been raised about the health care needs of residents then this has been sought promptly. The system for the administration of medication were good with clear and comprehensive arrangements being in place to ensure residents medication needs are met. Good practices were noted in the administration of as directed medication which provided staff with clear instructions when these types of medication should be prescribed and clear records of when they were prescribed to ensure that their use can be effectively monitored. All medication is double signed for by staff as an additional safety measure to confirm that the prescribed instructions are followed. There is a need to ensure that controlled drugs are recorded in a controlled drugs register which the manager confirmed they had and would instigate its use straight away. Care Homes for Adults (18-65 years) Page 19 of 34 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. An effective complaints procedure and appropriate adult protection policies helps to protect the rights and interests of residents. Evidence: There is an accessible complaints procedure in place for residents, their representative and staff to follow should they be unhappy with any aspects of the service. Although it is recognised by staff that residents would require support to make a complaint and were knowledgeable on how they would support a resident to do this. The manager reported that no complaints have been received or recorded by the home since the last inspection. Residents and relatives consulted with all felt able to approach the staff and manager with any concerns they had. The home has written policies covering adult protection and whistle blowing. These make clear the vulnerability of people in residential care, and the duty of staff to report any concerns they may have to a responsible authority for investigation. Staff have received formal training in safeguarding adults and prevention of abuse and the staff consulted with showed an understanding of their roles and responsibilities under safeguarding adults guidelines. There have been no safeguarding referrals relating to the home since the last inspection. Residents financial interests appear to be safeguarded through the robust management of residents monies held at the home on their behalf. Care Homes for Adults (18-65 years) Page 20 of 34 Evidence: Care Homes for Adults (18-65 years) Page 21 of 34 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. Residents live in a clean, comfortable and homely environment with their private accommodation personalised to reflect their lifestyles. However there are variable standards of decoration while the home undergoes a gradual refurbishment. The outside space is uninviting and not well maintained. Evidence: The home continues to undergo a slow gradual upgrade of its facilities. Since the previous inspection the manager reported that the hall way and lounge have been redecorated . Standards of decor were variable with parts decorated and maintained to a good standard while others in need of refurbishment and included works in the process of being completed, leaving partially decorated rooms and rewiring work exposed. However much effort is made to create a homely feel in the decor and furnishings. Communal space consists of a well decorated ground floor dinning room and large lounge with a ramp leading to a veranda which overlooks a sloped garden. The veranda leads onto a patio area and outhouses used for storage and laundry. Although most of the garden is not accessible to people with a restricted mobility the veranda and patio area provided some level access to the outside. However this area was uninviting with little or no added stimulus provided despite the weather having been Care Homes for Adults (18-65 years) Page 22 of 34 Evidence: clement enough for residents to use this space regularly. Part of the patio was being used to store some old furniture which the manager reported was due to be removed in the immediate future. A sample of comments made about the environment from staff and relatives included environment seems clean pleasant enough the outside is underutilizes cosy home very homely and ok a bit of decoration needed but very homely. It was previously required that the home be maintained to a good standard and areas required to have been improved have now been undertaken. However in light of the remaining outstanding works and the need to improve the outside space it has been further required that the home be reasonable decorated and the garden well maintained in order to ensure a nice, consistent environment in which to live. Residents spoke of their bedrooms providing everything they needed and bedrooms seen by the inspector had been individualised to reflect their preferences and lifestyles. One resident wanted a larger bedroom and this request was passed onto the manager. Not all bedroom doors had been fitted with suitable locks. The manager reported that residents have been consulted and all initially declined, however one resident now requested a lock on their door and the manager agreed to look into this. A resident spoke of being provided with a lockable facility in their bedroom to secure any small valuables they had. There is one shared bedroom with the manager reporting that the occupants have shared for many years and continue to make a choice to share. The manger confirmed that although there is no dividing curtain all personal care is undertaken in a nearby bathroom in order to promote both residents privacy. The inspection was undertaken on a warm summers day, with good ventilation throughout. A resident confirmed that in cooler weather the home is always warm enough for them. There are sufficient number of toilets and assisted bathing facilities located around the building including one bedroom providing en-suite facilities. The home provides a range of individual aids and adaptations including raised toilet seats, ramps, grab rails, pressure relieving mattresses, height adjustable beds and various hoists to aid in residents mobility around the home. A residents uses a call bell system to enable assistance to be called and a resident said that when they have used it staff always come very quickly. Care Homes for Adults (18-65 years) Page 23 of 34 Evidence: All areas viewed were observed to be cleaned to a good standards, a relative commented that the home is always clean. Systems were in place for the control of infection and staff confirmed that they have been trained in this area and were observed to be working in ways that minimised any risk of infection. Care Homes for Adults (18-65 years) Page 24 of 34 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. Residents benefit from a stable staff team who are generally well trained and that know them and that have been robustly recruited and employed in sufficient numbers as is necessary to meet their needs. However additional training in good practices when caring for people who have a learning disability is recommended as part of the need to increase staff awareness and understanding of the promotion of residents independence. Evidence: It was observed throughout the inspection that the staff understood their roles and had good planning skills. The tasks of the day were organised at handover and the individual staff appeared confident in carrying them out. This helped ensure that residents knew who was available to support them. Staff were observed supporting residents in a dignified manner and demonstrating a good understanding of the supports needs of each residents. Feedback about staff included staff seem very knowledgeable, residents always seems relaxed in their company and Staff are very nice on the whole they are ok. The staffing structure is for three staff to be available throughout the waking day. Residents and staff consulted with felt that this was sufficient for them to undertake their roles in a timely manner and for residents to receive the support they needed, Care Homes for Adults (18-65 years) Page 25 of 34 Evidence: when they wanted it. Residents spoke about having a key worker and what this meant to them in terms of going out shopping with them and being able to talk to them if they had any problems or queries. For the majority of staff consulted with this was their first caring role, and who have now worked at the home for a number of years. The manager fedback that the majority of staff have undertaken a National Vocational Qualification (NVQ) in care The manager reported that there is little staff turnover, helping to promote the continuity of care. The personal files of three staff were inspected and these showed that a robust recruitment process is followed which includes the use of an application form, interviews, Criminal Records Bureau (CRB) checks and written references prior to employment commencing. This helps to ensure that only staff who are suitable to work with vulnerable people are employed. Staff consulted with said that they had completed all of the mandatory areas of training needed for them to work safely with residents. This included manual handling, food hygiene, safeguarding adults, first aid and medication. They spoke of the areas of specialist training in epilepsy awareness they had also undertaken. Staff consulted with said that they had undertaken learning disability awareness as part of their NVQ training. The manager had identified further areas of specialist training that staff would benefit from this included visual impairment and dementia. It is required that staff undergo specific training in learning disabilities awareness, which incorporates best care practices in promoting and enabling independent lifestyles for residents. This would help underpin the work needed to further promote residents independence at the home. The manager confirmed that any new care staff undertake the recommended national induction standards, to equip them with the basic understanding of their roles and responsibilities when they first start. Care Homes for Adults (18-65 years) Page 26 of 34 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. Residents benefit from a manager who has many years experience in the care industry and who is motivated to continue to update their personal knowledge and practices at the home, however the provider is not able to demonstrate that they are effectively monitoring the services and facilities to ensure good practices and good health and safety practices. There are some mechanism in place for the home to regularly review aspects of its performance through a program of feedback from residents and staff. Evidence: The manager has been in post for three years and confirmed they have undertaken the recommended management qualification including a registered managers award and National Vocational Qualification level four in management. They have many years of experiences in working with older people and reported that they have undertaken training recently in mental capacity in order to update themselves in changes in legislation. In light of the need to further enhance residents independence and promote a more enabling lifestyles for residents the manager felt that they would also Care Homes for Adults (18-65 years) Page 27 of 34 Evidence: benefit from additional training in best care practices in caring for people who have a learning disability. It was clear that the manager has a good rapport with residents and staff. Feedback about the manager varied but was largely positive with particular reference to their approachability. Two relatives fedback that the manager did not always communicate clearly or effectively. There are several mechanisms in place for the home to obtain some feedback on the quality of the services and whether it is achieving its aims and objectives. These includes annual placement reviews, and feedback surveys sent to residents and relatives. Residents surveys were in a easy read picture format and stored in their files. As a result of feedback from relatives changes were made to the environment to include more pictures and flowers around the building. Written guidance is available on issues related to health and safety. Records submitted by the home stated that all of the necessary servicing and testing of health and safety equipment has been undertaken. However some health and safety issues were identified at inspection relating to the laundry room which had not been picked up through regular health and safety audits. Systems are in place to support fire safety, which include regular fire alarms and emergency lighting checks, staff training and maintenance of fire equipment and fire drills were reported to have been undertaken. The manager reported that a fire risk assessment has been completed which records significant findings and the actions taken to ensure adequate fire safety precautions in the home. The manager confirmed that recommendations made from a visit by a fire safety officer are still in the process of being actioned but confirmed that this is within the timescales set. The manager reported that Environmental Health made no recommendations as a result of an assessment of the kitchen facilities. It was previously required that the registered person consult with the environmental health office as to whether radiator covers are required due to the ageing process of people living in the home. The manager reported that radiator guards have now been fitted to radiators. It was previously required that the provider undertakes the required monthly audit of services and facilities and ensures that the report of these visits are recorded and available. Although records of these visits were not all held at the home the manager confirmed that the provider had undertaken them and agreed to ensure that missing Care Homes for Adults (18-65 years) Page 28 of 34 Evidence: copies were obtained and stored at the home. However the reports seen did not demonstrate that the provider was effectively monitoring standards at the home, as bore out through the concerns noted in this report which should have been identified and actioned by the provider. Staff said that they receive regular supervision with the manager regarding their performance, conduct and training needs. All staff consulted said that they felt supported by the manager to undertake their roles and felt able to approach them for advice and guidance. Care Homes for Adults (18-65 years) Page 29 of 34 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 30 of 34 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 7 15 That care plans detail the 14/08/2009 actions needed and the assessment of risks to ensure that residents independence is promoted at all times in their daily lives, within the range of residents personal strengths To promote residents independence and an enabling lifestyle. 2 14 16 That further opportunities 14/08/2009 are provided for service users to participate in valued and fulfilling activities which includes local social and community based activities. To further enhance residents lives. 3 24 23 That all parts of the care home are reasonably decorated and that the garden is well maintained, safe and is suitable to meet 18/09/2009 Care Homes for Adults (18-65 years) Page 31 of 34 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 the needs of the residents being accommodated. To ensure that residents live in a nice environment throughout and can use the garden which is safe and inviting for them to use. 4 35 18 That staff undergo further training in learning disability awareness which incorporates best care practices in promoting and enabling independent lifestyles for residents. To ensure that staff have the understanding and skills of how to promote residents independence and an enabling lifestyle. 5 43 26 That at least monthly unannounced visits by the Registered Provider or their representative to monitor standards of services and facilities are undertaken in accordance with National Minimum Standard. To ensure that standards at the home are being monitored consistently by the provider and action taken to rectify any areas of shortfall . 14/08/2009 18/09/2009 Care Homes for Adults (18-65 years) Page 32 of 34 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 Care Homes for Adults (18-65 years) Page 33 of 34 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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