Care Home: Coulsdon Lodge

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What the care home does well The service at Coulsdon Lodge offers a warm, comfortable and welcoming environment. The home successfully offers a high level of personal support that is specific to the needs of the individual and, wherever possible, support is provided until the end of life. All residents are actively encouraged to be as independent as possible and enabled to make decisions and take risks as part of their daily lives, with the required level of assistance. The service strives to make sure it offers what people living in the home want and need. Furthermore, resident`s health needs are well met and they are protected through safe systems for the handling and the administration of medication. People who live in the home benefit from the support of a committed, well trained and competent staff team. There is a very friendly yet professional atmosphere in this home. Staff commented favourably on their work in the home and the leadership and support the registered manager provides. Service users are supported and encouraged to keep in touch with their family and friends and have access to a range of meaningful daily activities and leisure pursuits. People who were asked what the home does well said......People are provided with a very good level of support by the staff. Another said.....Very pleased with the service and the friendliness of the staff. And ....up to now, everything is perfect. What has improved since the last inspection? The AQAA records some environmental improvements made over the last 12 months. The manager states.....Our fire system has been upgraded. Door guards have now been replaced by an automatic device system. New curtains have been fitted in the dining room, lounge and landing. Since the last inspection we have supplied new and more comfortable lounge chairs to the people we support. There have been increased leisure opportunities for residents and more people living in the home have been able to take a holiday away from Coulsdon Lodge with appropriate levels of staff support. What the care home could do better: Minor improvements to the home`s infection control measures would ensure everyone living, working or visiting the home is fully protected. People using the service will benefit from a minor review of the complaints procedure to ensure they have all the information they need. The home is looking tired and aged in some areas, both internally and externally. Residents will benefit when the redecoration and refurbishment work planned by the new provider is completed. A staff training matrix could be formulated by the manager. This would aid the inspection and audit of staff training records and provide a clear overview of all training completed, training booked and refresher courses due for the individuals employed. Access to appropriate planning information would have guided the inspector and enabled the provider to better evidence their recruitment policy and practices, designed to ensure residents safety and protection. Key inspection report Care homes for adults (18-65 years) Name: Address: Coulsdon Lodge Coulsdon Lodge Coulsdon Road Caterham Surrey CR3 5YA     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Marion Weller     Date: 1 1 0 5 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 30 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 30 Information about the care home Name of care home: Address: Coulsdon Lodge Coulsdon Lodge Coulsdon Road Caterham Surrey CR3 5YA Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mr Precass Sharmah Ramkissoon Type of registration: Number of places registered: care home 10 Look Ahead Housing & Care Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users to be accommodated is 10. The registered person may provide the following category of service only: Care home only (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning disability (LD) Date of last inspection Brief description of the care home Coulsdon Lodge is a large detached house set within its own grounds. The care home is registered to provide accommodation and personal care for up to 10 service users with learning disabilities. The property is situated in Caterham, Surrey and stands on the site of the old St. Lawrence Hospital. There are shops, local amenities and transport links within walking distance of Coulsdon Lodge. Look Ahead Housing and Care has recently taken over the ownership and operation of the home from Surrey and Borders NHS Trust Partnership as part of the Trusts planned Care Homes for Adults (18-65 years) Page 4 of 30 Over 65 0 10 Brief description of the care home re-provision programme. Look Ahead Housing and Care have made no changes to the homes management, staff team or the service user group accommodated. Service user bedroom accommodation is for single occupancy and is arranged over two floors of the property. The communal areas of the home comprise of a large lounge, a conservatory and a separate dining area. The home does not have a passenger lift or en-suite facilities; however adequate bathroom facilities can be accessed on both floors. There are gardens to the front and to the rear of the house, which are enclosed and secure. The home provides its own transport, which is made available to service users. There are parking facilities for visitors to the front of the property. The fees charged are £1,294.29 per week. This sum may vary according to service users assessed personal needs. Please contact the Registered Manager for more detailed information. Care Homes for Adults (18-65 years) Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: Coulsdon Lodge is now owned and managed by Look Ahead Housing and Care. A new registration of this pre existing service was agreed by the CQC on the 1st March 2010. The purpose of this site visit was to undertake the homes first baseline inspection to judge the quality of service in operation under the new ownership and management of Look Ahead Housing and Care. The inspector, who was unaccompanied during the site visit, arrived at the service on Tuesday 11th May 2010 at 10:45 am and was in the home for four and a half hours. The inspector spoke briefly with the support staff on duty and at considerable length with the Registered Manager who remained on the premises throughout the inspection. Judgements made about the residents wellbeing in this report relies heavily on information taken from written records, intelligence received about the service and in direct and indirect observations made during the site visit. A number of documents relating to service users were sampled including individual care plans, risk assessments Care Homes for Adults (18-65 years) Page 6 of 30 and medication records. Staff training records were checked and reports relating to the homes quality assurance systems were viewed. The inspection report takes into account all the information obtained about the service prior to the site visit. This includes any formal notifications, reports, phone calls and letters received and any information we have concerning complaints or allegations. Some people directly involved with the service were contacted by telephone to find out their levels of satisfaction with the home. The manager was asked to complete the homes Annual Quality Assurance Assessment (AQAA) prior to the inspection. The AQAA is a self assessment that focuses on how well outcomes are being met for people using the service. It also gives some numerical information about the service. The completed document was received from the manager within the timescale set and provided a good picture of what was happening in the service and their plans for further development. During the site visit the inspector looked at how well the service was meeting the standards set by government and has, in this report, made a judgement about the quality of service provided by the home. The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. Care Homes for Adults (18-65 years) Page 7 of 30 What the care home does well: What has improved since the last inspection? What they could do better: Minor improvements to the homes infection control measures would ensure everyone living, working or visiting the home is fully protected. People using the service will benefit from a minor review of the complaints procedure to ensure they have all the information they need. The home is looking tired and aged in some areas, both internally and externally. Residents will benefit when the redecoration and refurbishment work planned by the new provider is completed. A staff training matrix could be formulated by the manager. This would aid the inspection and audit of staff training records and provide a clear overview of all training completed, training booked and refresher courses due for the individuals employed. Care Homes for Adults (18-65 years) Page 8 of 30 Access to appropriate planning information would have guided the inspector and enabled the provider to better evidence their recruitment policy and practices, designed to ensure residents safety and protection. 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 30 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 30 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. Prospective residents and their representatives can access the information they need to make an informed decision about whether the service is right for them. They also benefit from having their individual needs, choices and aspirations assessed prior to them making a firm decision to move in. Evidence: The home has a detailed statement of purpose which includes information on the services to be provided at Coulsdon Lodge and how those services are to be met. The document includes information on staffing structures, facilities and care and social services to be offered. The homes new provider, Look Ahead Housing and Care submitted this document as part of their application for registration with the CQC. A service users guide is available in a written and pictorial format in the home. The manager spoke of his plans to produce this guide in other formats to better meet individual need. For instance, he discussed developing an audio version for those people who suffer sensory loss. The manager clearly understood the importance of people having sufficient up to date information when choosing a home and for those Care Homes for Adults (18-65 years) Page 11 of 30 Evidence: living there, or for their representatives, who may wish to retain information and guidance for later reference. The people living in the home have been there for many years. There have been no new admissions and there are currently no vacancies. The registered manager said that admission procedures are designed to ensure that potential residents are thoroughly needs assessed before a decision to move in is reached. The assessment was said to involve the individual and their family or representatives. Where the assessment had been undertaken through care management arrangements, the service would insist on receiving a summary of the assessment and a copy of the care plan. The manager stated that a prospective resident would also be encouraged and supported to visit and spend time in the home, meet the staff, other service users and see their intended room. This process would ensure that staff were confident in their assessment that they could meet the individuals needs and aspirations, and their compatibility would have been firmly established with the people already living there. Everyone who lives in the home is provided with a statement of terms and conditions to enable them and their representatives to understand their rights and responsibilities. These documents were seen on individual resident files. The manager also has plans to offer these documents in a more user friendly version. Intermediate Care is not offered at Coulsdon Lodge. Care Homes for Adults (18-65 years) Page 12 of 30 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home can be confident that their needs will be known and understood and care will be provided in line with their individual wishes and preferences. Evidence: Each person who lives in the home has an individual plan of care. Two were looked at in detail on this visit. It is clear that care plans are developed with the involvement of residents, their relatives, keyworkers, care managers and other relevant healthcare professionals. They are being reviewed regularly and updated where necessary as peoples needs change. Key workers actively provide one to one support and engage and encourage individuals, where possible, to be fully involved with the development of their care plan and the ongoing review process. Care Plans seen included reference to peoples diverse needs and covered such areas as gender, age, sexual orientation, race, religion and beliefs. The homes AQAA records......People we support are respected and treated as individuals. Care Homes for Adults (18-65 years) Page 13 of 30 Evidence: Care Plans were seen to focus on the individuals strengths and personal preferences and set out in detail the action to be taken by staff with regards to meeting their personal care needs, health needs and social support. Information about service users health is included in their individual Health Action Plan. The manager spoke of plans to develop Hospital Passports to ensure that service users going to hospital had their needs, preferences and wishes set down for relevant people to clearly see and follow. In line with a recommendation given at the last inspection, the location and storage of peoples care plans, health action plans and risk assessments has been reviewed. Current practice ensures they are easily accessible to inform, direct and guide staff. Risk assessments are in place and are being updated regularly to promote peoples lifestyle choices and their safety. Any limitations on freedom, choice or facilities are always taken in the persons best interests and the individual is supported to understand and agree the limitations. Peoples right to make decisions about how they wish to live their lives are respected. People are supported to make decisions in a number of ways. Each resident has an allocated key worker who is trained to offer one to one support. They know the resident well and understand his or her needs. Photographs and pictures are used to help people make choices; a pictorial account of daily life and choices is used to help people choose meals, activities and places to visit. Some people are able to help with household chores such as setting and clearing tables, shopping and simple cooking tasks. Peoples communication needs are complex, varied and challenging to inexperienced visitors. None of the residents can communicate with speech; however staff clearly know people living there very well and understand how each person prefers to communicate. It was observed that staff always address residents by name before any support is offered. Everyone was engaged in some activity during the visit. Cakes were being made by three service users when the inspector arrived. The way all the staff on duty interacted with people throughout the inspection was impressive; support is offered and provided discreetly in a way that promotes peoples privacy and dignity. All interaction observed was respectful, good humoured and kind. The home was a recent finalist in a Surrey Care Association competition. The Association recorded......Coulsdon Lodge offers high quality patient centred care in a warm friendly environment, where the dignity of the residents is at the heart of all that the team does. Care Homes for Adults (18-65 years) Page 14 of 30 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in the home are encouraged to be as independent as possible. They enjoy opportunities to take part in a range of educational, social and leisure activities and benefit further from a well balanced and nutritious diet that meets their individual needs and preference. Evidence: The manager and staff promote service users rights to live an ordinary and meaningful life, which is appropriate to their peer group, in both the home and the community. Records further show that residents enjoy a full and stimulating individual daily timetable, which suits their needs and abilities. Peoples religious and cultural needs are known and respected. The managers AQAA records.....People who live at Coulsdon Lodge are supported to attend places of worship regularly. The manager spoke of improvements made to residents lifestyle opportunities over Care Homes for Adults (18-65 years) Page 15 of 30 Evidence: the last 12 months. He also records in his AQAA......We have implemented a more individualised day care timetable and organised more outings. Key workers have ensured that residents each have a weeks holiday of their choice. This has led to residents being away from the home for either a full week or a weekend break. People have also experienced, for the first time, a four hour limousine trip around London and had snacks at a London restaurant. Some residents now have aromatherapy sessions, which is proving beneficial. Eight residents have been able to obtain their passport, which has enabled two of them so far to have holidays abroad for the first time. Four people have also enjoyed a day trip to Euro Disney by train. Staff also work flexibly to support residents to use local services such as hairdressers, pubs and restaurants. People are supported to maintain contact with family and friends and visitors are welcome in the home at all reasonable times. Peoples privacy is respected; all bedrooms have keys, although not all residents can use these the manager said they rarely have incidents of people entering each others rooms without permission. People who live in the home choose their meals through the use of a pictorial menu and have their nutritional needs assessed in consultation with a dietitian. As mentioned previously the home was a recent finalist in the Surrey Care Association competition, with the Association recording.......Many of the residents have extreme difficulties involving eating and drinking. To help overcome this staff have devised an excellent visual daily menu that is displayed on the wall of the dining room so that residents can easily choose their meals. This has resulted in meal times becoming enjoyable experiences, even for those with the most severest of problems. Care Homes for Adults (18-65 years) Page 16 of 30 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service have their personal care needs met in the way they prefer and require. Their health needs are met through the primary health care team and their medication is managed safely. Minor improvements to infection control measures would ensure they are fully protected. Evidence: Observation showed that support staff ensures appropriate personal support; care and encouragement are provided to residents in such a way as to respect the persons privacy and dignity. Guidance and support regarding personal hygiene is provided and people are able to choose their own clothes, hairstyles and other aspects of personal grooming. Residents are well supported with their healthcare needs. Each person has an individual health action plan; this document helps staff monitor and promote peoples health. Visits are arranged to the local G.P when necessary or the GP visits the home if this is not possible. People receive regular annual health checks. Residents are supported to access other healthcare professionals where this is necessary, including the dentist, optician, chiropodist and physiotherapist. Where people have specialist Care Homes for Adults (18-65 years) Page 17 of 30 Evidence: healthcare needs, the home liaises in a timely manner with specialist healthcare professionals to ensure the residents receive the best possible care. Evidence supported the judgement that people are protected from harm through the safe handling of medication at Coulsdon Lodge. None of the resident group is currently able to self medicate. Medication administration is reviewed every three months by the manager and peoples ability to manager their own medication would be reassessed. Medication administration records seen were being well maintained and kept up to date. All designated medication administrators receive comprehensive external training and the manager monitors staffs ongoing competency regularly. Infection control procedures were largely satisfactory. Not all waste bins however were foot operated and a communal cotton hand towel was available for use in the visitors toilet. A recommendation was made that all pedal bins used for the disposal of paper hand towels should be foot operated to ensure the homes infection control measures are not compromised. Good practice suggests that communal hand towels should be removed. The manager spoke of his firm intention to resolve this minor shortfall to evidence their good practice. Care Homes for Adults (18-65 years) Page 18 of 30 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. There are systems and procedures in place to ensure that residents are protected from abuse and they or their representatives can be confident that concerns and complaints will be acted upon. People using the service will benefit further from a review of the written complaints procedure. Evidence: The homes complaints procedure is made available to residents, their relatives and other people visiting the home. It is also produced in a simplified pictorial format to better meet the needs of the people who live there. The resident group have difficulty with communication and therefore staff rely on their skills of observation, monitoring and their knowledge of known behaviour patterns to inform them of a service users level of satisfaction or unhappiness. The manager spoke of plans to produce the homes complaints procedure in an audio version to better meet individual resident need. The homes AQAA records that the service has received no formal complaints in the last 12 months. Some minor review of wording should be undertaken to the homes complaints procedure to reflect that the Care Quality Commission can be involved at any stage of a complaint, but the Commission is not a complaints reconciliation service. The quality of the service provided is the responsibility of the provider and concerns and complaints should be raised with the home in the first instance. The complaints procedure in the service user guide would also benefit from the inclusion of Care Homes for Adults (18-65 years) Page 19 of 30 Evidence: clear timescales for the resolution of complaints and the contact details for the local Social Services Department. Social Service Departments hold statutory powers to investigate complaints and safeguarding issues raised with them about registered homes. People surveyed after the inspection visit raised no concerns about how the home deals with complaints or concerns and said they always found the manager and staff responsive to any issues raised with them. There are procedures in the home for responding to suspicion or evidence of abuse or neglect to ensure the safety and protection of residents. The staff induction and staff NVQ training all have elements of adult protection and there has been protection of vulnerable adults training for staff. The manager said this training is ongoing for the staff team. Any allegation of abuse would be referred to the concerned agencies without delay. Our records show that Criminal Record Bureau checks have been obtained for staff before they started work. In addition, evidence was seen that staff CRB checks had been repeated by the new provider at the point of transfer to further safeguard residents. The registered manager is aware of his obligations with regard to ensuring the safety of residents and protecting them from any form of abuse. Care Homes for Adults (18-65 years) Page 20 of 30 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. Coulsdon Lodge provides a physical environment that is appropriate to the needs of the people who live there. It is homely, clean and comfortable. Residents will benefit further when the planned refurbishment work is completed. Evidence: People who live in the home benefit from the spaciousness and cleanliness of the premises. The home is comfortable, generally well furnished and everyone living there has his or her own room. Communal areas of the home include a lounge on the ground floor, a conservatory/activities room and a separate dining room and kitchen. Residents can access the garden with support, which is mainly laid to lawn. A new perimeter fence is now in place and more work to the grounds is planned by the new provider. Patio type garden tables and chairs are laid out at the front of the property for people to use. Residents bedroom accommodation is personalised and reflects the taste and personal interests of the occupants. People are supported to choose the colour schemes in their bedrooms to suit their preferences. Residents have easy access to sufficient bathrooms and toilet facilities. The service has sought advice from Occupational Therapists and Physiotherapists to ensure the home is suitably equipped to meet the needs of all the people who live there, regardless of their age or ability. Care Homes for Adults (18-65 years) Page 21 of 30 Evidence: There is a small laundry on the ground floor, which is meeting the residents current care needs. The AQAA records some environmental improvements made over the last 12 months. The manager states.....Our fire system has been upgraded. Door guards have now been replaced by an automatic device system. New curtains have been fitted in the dining room, lounge and landing. Since the last inspection we have supplied new and more comfortable lounge chairs to the people we support. The manager is aware that internally and externally the home is looking aged and tired and in need of redecoration and refurbishment in some areas. The manager stated that the new provider organisation, Look Ahead Housing and Care has assessed what is required to ensure the correct standard of accommodation is offered and this work is now planned and due to start soon. Timescale for completion is the end of 2010. Care Homes for Adults (18-65 years) Page 22 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Coulsdon Lodge benefit from a qualified, competent and motivated staff team who know them well. Access to appropriate planning information would have guided the inspector and enabled the provider to better evidence their recruitment policy and practices designed to ensure residents safety and protection. Evidence: Residents benefit from the support of a well trained, motivated and dedicated staff team. Staff spoken with evidenced a good understanding of residents needs and preferences. All interactions between residents and staff were seen to be warm, supportive and respectful. Conversations with staff during the visit showed a high level of commitment to promoting the best interests of people who live in the home. People involved with the home who were spoken with after the site visit were very complimentary of the staff group. One person said....Having a consistent staff group at the home is good and they are always so friendly and helpful. Staff recruitment records were not available to see. The manager informed the inspector that the new provider centralises staff records at their head office in London. The home does however continue to hold staff training records and staff training completion certificates, together with supervision and appraisal records. The centralisation of staff recruitment records was not included for information and Care Homes for Adults (18-65 years) Page 23 of 30 Evidence: guidance in the homes AQAA and the inspector could find no other information received from the provider in relation to this matter held by CQC. The inspector was therefore unable to plan and arrange for staff files to be seen in preparation for this base line inspection to evidence the new providers good practice. Coulsdon Lodge does however have a consistent staff team and our records previously evidence robust and sound recruitment practices in place prior to the transfer taking place. Some PC based information from the new provider regarding recent CRB checks for staff was shown to the inspector. Staff training records are maintained individually. It was discussed with the manager that it would aid the inspection and audit of staff training records if a training matrix could be formulated. This should give a clear overview of all training completed, booked and refresher courses due for the individuals employed. There was sufficient staff on duty to meet peoples support and care needs on the day of the inspection. People who live in the home can also be confident that staff are well supervised and competent to carry out their duties. Commendably almost all of the substantive staff have completed NVQ Level 2 or above. All staff undertakes additional training relevant to the specific needs of the people they care for. The manager stated that all refresher courses are arranged regularly for all mandatory training and he will be discussing staff training needs with the new provider. He also spoke of his plans to arrange formal staff training in the Mental Capacity Act and Deprivation of Liberty Safeguards due to the vulnerability of the resident group. Regular staff meetings are held and staff receive formal supervision. All new staff follow a structured induction programme in line with standards set by Skills for Care. Care Homes for Adults (18-65 years) Page 24 of 30 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home benefit from an experienced and competent manager who provides an excellent role model. Clients benefit further from policies, procedures and systems of work which support their best interests and promote their welfare and safety. Evidence: Look Ahead Housing and Care now owns and manages Coulsdon Lodge. The new provider organisation was registered with the CQC on the 1st March 2010. The service had an existing registered manager in post at the point of staff transfer. The manager is qualified, competent and experienced in running the home to meet its stated purpose, aims and objectives. He understands the principles of equal opportunity and diversity and applies the concept to his practice with both residents and staff. Throughout the inspection the manager clearly had the residents welfare at heart and demonstrated openness, honesty and a clear sense of leadership and direction to the staff group. Care Homes for Adults (18-65 years) Page 25 of 30 Evidence: People can be confident the home is managed in their best interests. The home has quality assurance monitoring systems in place. Representatives from the new provider organisation met with residents, their relatives and representatives to explain future plans for Coulsdon Lodge. Look Aheads Chief Executive is also due to visit the home on the 23rd May 2010 and speak with people. The CQC spoke with some individuals currently involved with the home who evidenced high levels of satisfaction with the service offered. The new provider is undertaking monthly regulation 26 visits; the most recent reports were viewed and found to be comprehensive and detailed. People are involved as far as possible in decisions about how the home is managed through monthly resident meetings where they are supported to voice their opinion and concerns. Minutes of these meetings are available in a pictorial format to ensure those with communication difficulties are aware that their views are taken into consideration and acted upon. The CQC received the managers completed Annual Quality Assurance Assessment (AQAA) on time, which indicates that Look Ahead have a range of operational policies and procedures, which have been brought to the staffs attention. The manager records that all staff receive training in basic food hygiene, first aid, moving and handling, health and safety, fire safety and infection control to secure service users welfare. In addition, the document provided a good picture of improvements made by the service over the last year and future plans. The manager provided information to indicate that records and certificates and identified systems are in place for routine service and maintenance arrangements for the environment. It is fundamental to independence and choice that people living in the home manage and have access to their own money and personal bank account. In line with good practice Look Ahead are trying to set up personal bank accounts for residents. The manager however reports some difficulty with the banks they have approached so far who are not accepting people with learning disabilities as customers in their own right, on the grounds of lack of capacity. Relatives and independent advocates may have a role in ensuring best practice financial arrangements are realised. The new provider should refer to the revised arrangements for managing residents personal finances in the homes statement of purpose and service users guide. In relation to The Mental Capacity Act 2005 and Deprivation of Liberty Safeguards, assessments of capacity and decision making for residents are being undertaken with a best interest approach. It was recommended that further training for all staff should be arranged to ensure a good working knowledge of this legislation and compliance with published codes of practice due to the complex needs of service users and their Care Homes for Adults (18-65 years) Page 26 of 30 Evidence: vulnerability. There is no one living in the home who is currently the subject of a deprivation of liberty authorisation. Care Homes for Adults (18-65 years) Page 27 of 30 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 28 of 30 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 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 29 of 30 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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