Care Home: Conifer Lodge

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What the care home does well People are supported to live an excellent quality of life within the framework of assessed risk and continue to have an excellent range of social activities. Positive comments in residents` surveys included `They take us on nice trips` and that they had `Good meals`. People are listened to and can be confident that any concerns or complaints made will be taken seriously and action is taken to resolve these. Care provided is done in a person centred and therapeutic way that respects the person`s rights and responsibilities. The home is managed in a fair and open manner that is supportive of both the staff and the residents. What has improved since the last inspection? The Statement of Purpose has been amended to accurately reflect the age range of people that the home intends to provide the care and support for. A requirement about the condition of the home, inside and out, has been met as action has been taken to improve the garden areas and repairs have been carried to a broken kitchen window and a floor of one of the resident`s shower room. Although there remains a yellow and black hazard strip to the entrance of the office door the remaining flooring was safer for people to walk on. Although the flooring in the conservatory area remains unrepaired, the AQAA, and confirmed again by the Manager, said that arrangements are in place to repair this trip hazard. The staff morale has improved: staff told us that, under the new management of the home, there are equal training opportunities and that they felt truly supported by the Manager. The staff felt that with this improved morale the staff were happier and worked as a united team. This, they considered, had a beneficial effect on the residents` well-being. What the care home could do better: There needs to be better records in place to account for medicines used in the home for the treatment of residents, this includes more accurate recording of when medicines are given to people and only giving medication from clearly identifiable containers. A requirement has been made about this so that it can be demonstrated that people receive the medicines prescribed for them.Conifer LodgeDS0000062547.V376112.R01.S.doc Version 5.2 Medication that is no longer prescribed for people must be disposed of promptly so that they are not used inadvertently and put people at risk. We expect the home to manage this rather than make a requirement on this occasion. A requirement about staff information has not been fully met as there was one piece of information missing in one of the two staff files that we examined. We have reminded the Manager what is expected, by the associated regulation. We have taken a reasonable and proportionate view not to consider enforcement action, on this occasion. However, to ensure that the residents are protected from harm from unsuitable staff, the home must obtain full and satisfactory information, about that person, before they are allowed to start working in the home. Key inspection report CARE HOME ADULTS 18-65 Conifer Lodge 134 North Brink Wisbech Cambridgeshire PE13 1LL Lead Inspector Elaine Boismier Key Unannounced Inspection 21st July 2009 10:00 Conifer Lodge DS0000062547.V376112.R01.S.doc Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. 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 home adults 18-65 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. Conifer Lodge DS0000062547.V376112.R01.S.doc Version 5.2 Page 2 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 Conifer Lodge DS0000062547.V376112.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Conifer Lodge Address 134 North Brink Wisbech Cambridgeshire PE13 1LL 01945 474912 01945 583951 john.baker@erminecare.com Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Ermine Care Ltd Manager post vacant Care Home 15 Category(ies) of Learning disability (15) registration, with number of places Conifer Lodge DS0000062547.V376112.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 22nd September 2008 Brief Description of the Service: Conifer Lodge is an adapted two-storey domestic dwelling situated on the outskirts of the Cambridgeshire market town of Wisbech and is in walking distance from the town centre. Local amenities include shops, pubs and leisure facilities. The home provides accommodation care and support for a maximum number of 15 people, between 18 and 65 years of age, with a learning disability. All bedrooms have ensuite facilities and are for single occupancy. In addition to the ensuite facilities the home provides three toilets and has two bathrooms. There are two communal rooms and a large garden that provides space for games and gardening activities. Care Principles Ltd is the registered owner of Ermine Care Ltd., which is the registered provider of Conifer Lodge. Current fees range approximately from £1400 to £1900 per week. Further information about the fees can be obtained from the home. Additional costs include those for toiletries, clothing and contributions to holidays. A copy of the inspection report is available at the home or via the CQC website at www.cqc.org.uk Please note that the home’s email account, as detailed in the ‘Service Information’ section of this report, is no longer available. Conifer Lodge DS0000062547.V376112.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. Annual Service Review (ASR) - 17th June 2009 On the 17th June 2009 we carried out this review during which we looked at information that we have about the home, such as notifications, since our last inspection of the 22nd September 2008.We looked at the report of this inspection and we looked at the surveys we have received from some of the residents and surveys from some of the staff. In addition we also looked at the Annual Quality Assurance Assessment (AQAA) that was completed by the home Manager. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. Following on from this ASR we decided to bring the next key unannounced inspection forward to the 21st July 2009 as we had received no information to say that the home was a safe place to be as the AQAA did not tell us when safety and service checks had been carried out on equipment such as fire detection and fire fighting equipment. At our last inspection the staff morale was not as good as we had expected. Key unannounced inspection - 21st July 2009 We, The Care Quality Commission (CQC), carried out this unannounced key inspection, by two Inspectors, between 9:45 and 14:55, taking 5 hours and 10 minutes to complete. Before the inspection we received surveys from six of the residents and three from the staff. We looked at information that we have received about the home since our last key unannounced inspection. During this inspection we looked around the premises and looked at some of the documentation. We spoke with some of the residents and some of the staff, including the Manager, and we watched what was happening within the home. For the purpose of this inspection report people who live at the home are referred to as people, person, resident or residents. Conifer Lodge DS0000062547.V376112.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: There needs to be better records in place to account for medicines used in the home for the treatment of residents, this includes more accurate recording of when medicines are given to people and only giving medication from clearly identifiable containers. A requirement has been made about this so that it can be demonstrated that people receive the medicines prescribed for them. Conifer Lodge DS0000062547.V376112.R01.S.doc Version 5.2 Page 7 Medication that is no longer prescribed for people must be disposed of promptly so that they are not used inadvertently and put people at risk. We expect the home to manage this rather than make a requirement on this occasion. A requirement about staff information has not been fully met as there was one piece of information missing in one of the two staff files that we examined. We have reminded the Manager what is expected, by the associated regulation. We have taken a reasonable and proportionate view not to consider enforcement action, on this occasion. However, to ensure that the residents are protected from harm from unsuitable staff, the home must obtain full and satisfactory information, about that person, before they are allowed to start working in the home. 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. Conifer Lodge DS0000062547.V376112.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Conifer Lodge DS0000062547.V376112.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1 & 2. People using the service experience good quality outcomes in this area. People can be confident that there is a good standard of information to assist them in their decision where to live and that there are systems in place to ensure that the home is a suitable place for them to live there. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Since our last inspection the Statement of Purpose has been reviewed that accurately reflects the age range of the people that the home intends to provide care and support for. Four of the six residents’ surveys said that the person received enough information about the home before they moved in. The AQAA said that prospective residents have a full assessment of their needs to ensure that the home is a suitable place for them to live. According to both the AQAA and the Manager there have been no new admissions to the home, with the exception of one person, who is no longer at the home. We were, therefore, unable to assess the home’s current admission procedures, although we have had no concern about these in our previous inspections. Based on this evidence we consider this key standard has been met. Conifer Lodge DS0000062547.V376112.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9. People using the service experience excellent quality outcomes in this area. People are very well supported in having their needs met and making decisions about what they choose to do within a framework of managed risk. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: We received six surveys from the residents and we had mixed views about their experiences of living at Conifer Lodge: four of the surveys said that the person always or usually had their care and support needs met; one of the surveys said that this was sometimes the case, with the remaining survey saying that the person did not know if their needs were met. The AQAA told us that the standard of care planning has become more person centred with staff having attended such training. The AQAA continued to tell us Conifer Lodge DS0000062547.V376112.R01.S.doc Version 5.2 Page 11 that any restrictions posed, following risk assessments, are discussed with the resident … ‘and their agreement sought’. We examined some of the people’s care files and we spoke with the staff and the Manager. Evidence indicated that the standard of care planning is person centred and provides clear guidance for the staff in how to manage the people’s mental health needs, including managing challenging behaviours. The care plans were actively reviewed each month and any updated information, such as the management of new risks, was included in these records. Health assessments are also carried out for the people’s physical needs including visits to the opticians and dentists. There was some evidence that the people’s care programme reviews are carried out and that there is forward planning for when these are to take place; information about these was available in the main office. We saw the staff talking with the residents and seeking their views in what they wanted to do, including going out of the home or staying in. Decision making, such as managing their personal finances, was recorded in those residents’ care files that we examined. Risk assessments were also carried out, to include going out of the home, and where needed, these were reviewed, each time, with the resident, before they went out and when they returned to the home. We saw, from the care records and from what some of the people and the staff told us, that the residents are supported by the staff in carrying out activities such as cooking, shopping or going out of the home without escorts; communication with and to the home remained via people’s personal mobile phones, for their continued support and guidance. Conifer Lodge DS0000062547.V376112.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): This is what people staying in this care home experience: 12, 13, 14, 15, 16 & 17. People using the service experience excellent quality outcomes in this area. People are provided with a range of social activities to live an excellent quality of life. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The AQAA told us that six of the current residents attend college and this was confirmed by one of the members of the staff. Within one of the people’s care notes we saw that they attended college three times each week. The home is situated on the edge of the town of Wisbech and is easy to access via private transport or walking there. We saw that the staff encouraged the residents to go out to the town, to shop and have a drink and a resident told us that they enjoyed going out shopping for clothes with the support of the Conifer Lodge DS0000062547.V376112.R01.S.doc Version 5.2 Page 13 staff. We have received no complaints from the local residents about the home indicating that Conifer Lodge may be considered as part of the local community. All of the three surveys from the staff said that the home could improve by having an increase in the number of staff and to improve the level of activities provided for the residents. One of the surveys suggested the home could do better to ‘Have a higher staff to client ratio with more vichels (sic) to take our clients out in smaller groups.’ Within the residents’ surveys there were mixed views about activities: written comments included that the home does well as ‘Staff take me shopping’ and ‘They take us on nice trips.’ Other comments and suggestions included, ‘Can we have a new minibus? Plz (sic) Thank you?’ and ‘More games of (sic) at the home.’ Since our last inspection the home has acquired a new large screen television and we saw some of the people watching the morning news. According to the AQAA activities have included go-karting, going to watch both premier league and local football matches and visiting theme parks. We spoke with some of the residents and watched what was happening and our findings indicated that the activities timetable, kept in the main office, is followed as much as possible. Some of the residents were ‘timetabled’ to go swimming and we saw that this activity was being arranged. Other activities included gokarting, playing golf and visiting a local Sunday Market. According to the Manager there is a budget to contribute to a minimum of one holiday a year for each resident. We did not assess, on this occasion, if any of the residents had taken a holiday. People and the staff told us, and from our examination of the care records, that the residents are supported in keeping contact with their families, including visiting and staying with them for a few days at a time. Examination of people’s care records indicated that people are encouraged and supported to wash up, shop for food and prepare a meal, clean their room and do their washing, as part of respecting the person’s rights and responsibilities. Three of the residents’ surveys said that the person always or usually liked their meals whereas the remaining three surveys said that sometimes the person liked their meals. One of the surveys said that the home does well because there are ‘Good meals’. The AQAA told us that the topic of meals is discussed at the residents’ meetings, which are held every month and choices of what people have suggested are available as an alternative menu. The AQAA continued to tell us Conifer Lodge DS0000062547.V376112.R01.S.doc Version 5.2 Page 14 that some of the residents have access to the kitchenette area and some also shop for food and help with preparing their meals. We spoke with a member of the staff and one of the residents, who both told us that people are supported in shopping for food and preparing a meal. Within one of the people’s care files we saw that they had made, one day, spaghetti Bolognese. Conifer Lodge DS0000062547.V376112.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20. People using the service experience good quality outcomes in this area. Although some of the current medication practices pose some risk to the health and safety of the residents, people can be confident that their health and personal care needs are met in a safe, therapeutic and dignified way. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Minutes of the last residents’ meeting, held in May 2009, indicated that the residents are reminded of their responsibilities in maintaining their own personal hygiene. People were dressed in clothes that they liked to wear and were noted to be able to go to their rooms to choose what shoes and clothes to put on. This indicates that people’s dignity, independence and control over their lives are respected. Information provided by the home, since our last inspection, of the 22nd September 2008, indicated that the residents have access to a range of health care professionals to include psychiatrists and general practitioners and the Conifer Lodge DS0000062547.V376112.R01.S.doc Version 5.2 Page 16 AQAA also informed us that the residents’ have access to a clinical psychologist. Examination of people’s care records indicated that the home assesses their health care needs and supports the people to gain access to general practitioners, opticians and dentists. There was clear recorded evidence to indicate that the home’s behaviour modification programme for a person with challenging behaviour was successful; the number of incidents of such harmful behaviour had reduced over a period of time, following the introduction of a ‘token’ award system and allowing the person to reflect on how they felt during the day. The AQAA told us that some of the residents have progressed to be able to move to less dependent living, such as supported living services and we found evidence of this during our examination of a resident’s file and from discussion with the Manager. This indicated that the home offers an enabling and transitional rehabilitation service. Medication is stored securely for the protection of residents and the room is temperature controlled to maintain the quality of medicines in use. The home has clear and detailed written procedures for staff to follow on the safe use of medicines but some aspects are not always followed, particularly with regard to the recording of the temperature of the fridge used to store medication. Records are kept of medication ordered for people and when it is received and disposed of and these were of a good standard. But the records made when medicines are given to people carried a number of discrepancies giving no clear indication of whether medication was administered or not; if not the reason why was not always recorded. It wasn’t possible to fully account for all medication in use as the date containers of medication were started was not recorded so we couldn’t tell if gaps in medication records were because staff had failed to sign the record or if the medication wasn’t given. There were also some medication in people’s rooms that was not recorded on the forms and for one person who takes his medication himself, the record of what support staff were providing wasn’t clear. One person’s medication was provided in a multicompartment container but the individual medicines inside it couldn’t clearly be identified. Another person’s record showed that they were given a medicine to control behaviour but we couldn’t find any of that medication supplied for them, but there was some for another person that may have been used. There needs to be better records in place to account for medicines used in the home for the treatment of residents, this includes more accurate recording of when medicines are given to people and only giving medication from clearly identifiable containers. A requirement has been made about this so that it can be demonstrated that people receive the medicines prescribed for them. There were some medicines in stock that were no longer prescribed for people and these need to be disposed of promptly so that they are not given Conifer Lodge DS0000062547.V376112.R01.S.doc Version 5.2 Page 17 inadvertently and put people at risk. We expect this to be managed by the home rather than make a requirement on this occasion. We were told that when people need medication outside the home they take the full labelled container with them, but we found that for one person this was not the case as they were not in the home and the medication needed for later in the day had already been taken out of the container. We again expect this to be managed by the home. We were told that the medication record forms are completed by the visiting psychiatrist but that medicines are prescribed by the person’s GP. This creates possible confusion as to where the clinical responsibility for treatment lies and we expect this to be resolved by discussion with all parties concerned. Conifer Lodge DS0000062547.V376112.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23. People using the service experience good quality outcomes in this area. People can be confident that they are listened to and can be confident that any concerns or complaints made will be taken seriously and action taken to resolve these. There are good safeguarding systems in place to reduce the risk of harm to them. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: All of the residents’ surveys said that the person knew who to speak to informally if they were not happy about something and three of these surveys said the staff always or usually listened and acted on what was said to them. All of the surveys from the staff said that the person knew what to do if any person had a concern about the home. We have received no complaints from the home although we are unable to tell, from the AQAA, if the home has received any complaints, within the last 12 months, as this area of the document was not completed. We therefore looked at the record of complaints and the information within this indicated that the home has received one complaint which was responded to in a timely and sensitive manner. This indicated that the home has a listening attitude. We have received information from the home that told us there is a clear Conifer Lodge DS0000062547.V376112.R01.S.doc Version 5.2 Page 19 understanding of the safeguarding procedures to protect any of the residents from the risk of recurring harm or abuse. Although the AQAA noted that there have been no safeguarding investigations we received information, in February 2009, that there was a safeguarding investigation, following an allegation of abuse by a resident, from a member of the public. Nevertheless, although we consider that the AQAA was not entirely correct with the information provided we were satisfied that the home had followed correct safeguarding procedures. Since our last inspection, in September 2008, we have received notifications, from the home when staff have used approved restraint techniques, when any of the residents have presented with physical aggression that has been directed at other residents and staff. We were satisfied with the information provided that included follow-up involvement of health and social care professionals. From our examination of some of the people’s care records we saw that the staff used appropriate techniques to reduce the risk of harm to any of the residents, during incidents of residents presenting with challenging behaviours and that these techniques were used as a first line of action, ensuring that physical restraint was only used should these de-escalation techniques were unsuccessful. The home keeps safe some, but not all, of the people’s personal monies of which we looked at two of these records and counted the amount of monies available with the Manager. There was a shortfall of 20 pence in one of the people’s monies although the other person’s monies available reconciled with the record of the balance. The Manager stated that the shortfall of 20 pence would be remedied. Conifer Lodge DS0000062547.V376112.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25 & 30 People using the service experience good quality outcomes in this area. People live in a comfortable home that is safer due to improved maintenance. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: A requirement was made about the premises as we found some areas were unsafe and unsightly. During our inspection of September 2008 we heard from the staff that there was often a delay by Care Principles Ltd, to approve requests for maintenance. According to the AQAA, and confirmed by the Manager, Care Principles has been taken over by a banking organisation and since this take over there has been no delay in getting approval for maintenance requests. We saw that the windows in the kitchen had been replaced and there were now fly screens; a storage shed had been installed; the garden areas were safer as there was no broken furniture; the lawn areas, although slightly overgrown, presumably due to the recent warm and rainy Conifer Lodge DS0000062547.V376112.R01.S.doc Version 5.2 Page 21 weather, were better maintained. We noted that bedroom number 1 shower room floor had been replaced and the floor was no longer in a state of collapse. The office floor was safer for people to walk on as there were no bare or torn areas of carpet. The AQAA told us, and this was confirmed by the Manager, that there has been an agreement to repair the conservatory floor, to reduce the risk of trips and falls. This requirement has been met. Currently the vegetable patch remains in a state of neglect pending the installation of a new sewer system that is ready for installation. We visited two people’s bedrooms and we found that these were individualised with personal items such as posters and photographs. On the whole the home was clean and free of odour. We expected the home to take action to improve the carpet within the quiet room. We were unable to assess what progress had been made in this area as this was occupied with staff attending training. Conifer Lodge DS0000062547.V376112.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34 & 35. People using the service experience good quality outcomes in this area. People can be confident that they are safely cared for by staff who are trained and, on the whole, generally well recruited. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: During our last inspection, in September 2008, we found that there was low morale among the staff due to internal and external management and maintenance of the home. The AQAA told us that almost 60 of the staff have worked at Conifer Lodge for two years or more. We spoke with some of the staff and they told us that within the last few months they have felt ‘very happy’ with working at the home due to increased training opportunities and support from the Manager. We were told that the staff are now working as a whole team and this was considered to have a beneficial effect on the residents’ well-being. Three of these residents’ surveys said that the staff were always or usually available when the person needed them; one of the surveys said that Conifer Lodge DS0000062547.V376112.R01.S.doc Version 5.2 Page 23 sometimes the staff were available with the remaining survey saying that the person did not know. Currently the home is registered to take up to fifteen people with a learning disability and on the day we visited there were nine residents living at the home. We looked at the duty roster and we watched what was happening in the home: we found that the residents were receiving individual care and support in a person centred and unhurried way. This indicated that the were sufficient numbers of staff on duty, at least for that day. According to the AQAA the home currently has 63.6 of the care staff with a National Vocational Qualification (NVQ) level 2, in care or equivalent. According to the Manager this number has increased as 15 of the 16 current staff have this NVQ i.e. 93.75 . From the last inspection report we wrote ‘Two staff recruitment files were seen and it was noted that the application form used does not ask for the dates of an applicant’s employment history, although the interview record format does. Neither of the interview notes was completed in this area. Other required information was available in one of the two files that we saw. For the 2nd file the information provided in the application form was inconsistent with the results of the criminal record disclosure. Furthermore one of the two written references was unsatisfactory as it posed questions about the suitability of the person to work with vulnerable people in care. A requirement has been made to ensure that full and satisfactory information about staff is obtained before they are allowed to work at the home, ensuring that people are protected from the risk of harm from unsuitable staff.’ The timescale for this was the 20th October 2008. To assess what progress had been made to meet this requirement we looked at two of the staff files and we found full and satisfactory information in one of these. For the other file we found that there was almost all of the required information with the exception of a written explanation of a person’s gap in their employment history of six months, which had occurred between December 2008 and June 2009. The Manager explained that the person, during their interview, provided an explanation to the reason why they were not in employment for these six months, although this information was not recorded and kept on the person’s file. We reminded the Manager of the content of the associated regulation. We have taken the reasonable and proportionate view that this requirement has, on the whole, been met and we will not be considering enforcement action on this occasion. We have received mixed views from the staff when we read their surveys. These mixed views were about their induction training with two of the three surveys saying the person was satisfied whereas the third staff survey said that their induction training had not prepared them to do their job. Conifer Lodge DS0000062547.V376112.R01.S.doc Version 5.2 Page 24 The AQAA told us that some of the staff have attended training in person centred care planning and two of the staff have attended training to become in-house trainers for moving and handling, care planning and risk assessments. As part of the home’s quality assurance the AQAA identified areas where staff training could be better and this included areas such as management and care of people with diabetes, schizophrenia, epilepsy, autism and depression. The staff we spoke with said that there had been an increase in training opportunities and on the day when we were at the home a number of staff, as rostered, were attending training in safe food awareness. The staff training matrix was looked at and the Manager told us that he is aware of training areas that the staff need to attend. From our examination of some of the staff files and speaking with some of the staff, findings indicated that there have been training opportunities for staff to attend managing people’s challenging behaviours and ‘Conflict Management and Additional Holding’ i.e. safe control and restraint techniques. Conifer Lodge DS0000062547.V376112.R01.S.doc Version 5.2 Page 25 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39, 40, 41 & 43. People using the service experience good quality outcomes in this area. People benefit from a well-managed home. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The Manager has been in post since June 2008 and although the AQAA reported that he is the Registered Manager the application to register him has yet to be completed and approved. The AQAA told us that he is … ‘currently enrolled on to the NVQ level 5 (portfolio in senior management).’ He qualified in 2004 as a registered nurse for learning disability and has a degree in chemistry. His previous care experience is that of working in private hospitals for people with learning disabilities. Conifer Lodge DS0000062547.V376112.R01.S.doc Version 5.2 Page 26 One of the staff surveys said ‘…our unit operates … proffesionally (sic)…’ under the management of the home. Some of the staff we spoke with endorsed this view (see also the ‘Staffing’ section of this report) and felt that the Manager treated everyone in a fair way and that they were able to speak to him, with confidence, about any concerns that they had. The AQAA was completed in an adequate manner although there were some areas that were not completed: for example the number of complaints made to the home, when service checks had been carried out on fire detection and fire fighting equipment and portable appliance (electrical) equipment. We also were unable to tell when the home’s policies and procedures were last reviewed as this area of the AQAA was not completed. The Manager explained that he had completed these areas but the information was not saved on file within the computer data base. Where the AQAA was completed it identified areas where the home does well; that the residents are consulted about their care and the home and areas where the home could improve upon, such as staff training. Health and safety audits were seen and these are completed each month. The Manager stated that visits to the home, from representatives of Care Principles Ltd, are carried out at least once a month and reports of these visits for June and July 2009 were seen. These reports indicated that residents and staff are spoken to, the condition of the premises is reviewed and audits of records, such as those for staff training and supervision, are carried out as part of a quality assurance system. We examined the areas where the AQAA was not completed, such as the record of complaints and the files containing the policies and procedures; we were satisfied that these met with the National Minimum Standards and the associated regulations. Records for hot water tests, fire drills, and tests for portable electrical appliances, fire alarms and emergency lighting were seen and these were satisfactory. The staff we spoke with said that they had attended training in fire safety and infection control and that arrangements were in place for refresher training in moving and handling. The staff training matrix identified that the majority of the staff have attended such mandatory training and areas where this was to be updated were highlighted by the Manager. Conifer Lodge DS0000062547.V376112.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 x 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 3 33 x 34 2 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 4 x 4 x LIFESTYLES Standard No Score 11 x 12 4 13 4 14 4 15 3 16 4 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 3 2 x 3 3 3 3 3 3 x Version 5.2 Page 28 Conifer Lodge DS0000062547.V376112.R01.S.doc NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA20 Regulation 13(2) Requirement There must be better records in place to account for medicines used in the home for the treatment of residents, this includes more accurate recording of when medicines are given to people and only giving medication from clearly identifiable containers. This will protect residents from harm and demonstrate that they receive the medicines prescribed for them. Timescale for action 31/08/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Conifer Lodge DS0000062547.V376112.R01.S.doc Version 5.2 Page 29 Care Quality Commission Eastern Region Citygate Gallowgate Newcastle-upon-Tyne NE1 4PA National Enquiry Line: 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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