Care Home: Court Lodge

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What the care home does well Court Lodge provides the necessary information for prospective service user`s and their families/representatives to help them make an informed decision as to whether or not the home is a suitable place for them to live in. People living at the home know what they will be paying for when they come to stay. A service user told us " I visited the home a few times before I decided to come and stay. I met the other people who live here and the staff". The staff we spoke to have a knowledge and understanding of the service users. The care staff on duty talked and interacted with the service users in a respectful and caring way. The service users are encouraged and supported to do as much as possible for themselves and make independent choices and decisions. A service user said "I decide what I want to do every day". The routines of the home are flexible in order to support the individual and diverse needs of the people living in the home. People are actively encouraged to express their concerns and can be confident that they will be listened to. One person told us they were not sure if this was the right place for them to live. The manager had taken this concern seriously and was actively addressing the issue. The home does meet the physical and healthcare needs of the people who live there. There is input from the local specialist teams and people see their doctor when they need to. Each of the service users has their own rooms, which are personalised and reflect their individual tastes and choices. People living at the home said that their views are taken into consideration and acted on. They are involved in the day to day running of the home and are also involved in the recruitment of staff. The home has a Quality Assurance System in place for the benefit of the service users. What has improved since the last inspection? At the last inspection it was required that the manager of the home become registered with the commission. The manager did register with the commission but has spent little time at the home due to other company commitments. The goals and aspirations of the people who live at the home have been further developed and are being achieved. The majority of people are doing what they want. Most of the people we spoke to told us that they are happy living at the home. They said they are able to make decisions about how they live their lives What the care home could do better: Some of the staff at the home have not received the training they need to do their jobs effectively and safely. This means that some staff may not have the updated knowledge and skills to support the service users in the way that suits them best. The home does not have a long term maintenance plan place with timescales. The bathrooms at the home need to be upgraded. This will make sure that people live in a well maintained, pleasant home. On the day of the visit the registered manager told us he would be leaving the home the following day. There was no plans in place to make sure the home would be effectively managed once the registered manager left. The company had not kept the commission up to date on changes to the position of the registered manager. We had not been informed that his secondment was extended from 6 to 14 months. We were not informed that he was leaving the service and what plans were in place to make sure the home was managed effectively and safely and in the best interest of the people who live there. At the time of the inspection which was the day before the manager left no-one at the home knew what was happening. This was confirmed by service users,staff and relatives. The company had not made sure that the service was going to be effectively managed by a person with the qualifications and skills to do at all times. This situation was rectified when we raised it with the services` area manager and operational director. We were told on the 11th August 2009 that a new manager was starting work at the home on 17th August 2009. Key inspection report Care homes for adults (18-65 years) Name: Address: Court Lodge Church Road Mersham Ashford Kent TN25 6NS     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: Mary Cochrane     Date: 0 6 0 8 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 32 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 32 Information about the care home Name of care home: Address: Court Lodge Church Road Mersham Ashford Kent TN25 6NS 01233503117 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: courtlodge@counticare.co.uk Counticare Ltd care home 6 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 6. The registered person may provide the following category/ies 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 Court Lodge provides personal care and support for 6 adults with a learning disability. The home is owned by Counticare Limited which in turn is now owned by CareTech, a national provider. The home is situated in the village of Mersham about 15 minutes drive from the town of Ashford where there is a variety of amenities such as shops, swimming pool, a cinema, churches, pubs, clubs and colleges. The home has access to a minibus. Court Lodge is a detached chalet bungalow which comprises individual bedrooms for each resident, a lounge, kitchen, dining room, laundry room and office. There is a large enclosed rear garden with seating and a barbecue area. There is a parking area to the front of the property. Care Homes for Adults (18-65 years) Page 4 of 32 Over 65 0 6 Brief description of the care home The homes current fees range from £1,020.14 to £1,615.60 per week. Information about the home, including the previous inspection report from the Care Quality Commission are available on request from the home. A copy of the last inspection report is kept in the hallway by the front entrance. Care Homes for Adults (18-65 years) Page 5 of 32 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: The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. The last inspection key unannounced inspection on this service was completed on 22nd August 2007. The visit to the service was an unannounced Key Inspection which took place over one day. The inspection started at 10:00 a.m and finished at 2:00 p.m. The registered manager was available during this time. The people living at the home and the staff on duty were helpful and co-operative throughout the visit. We spoke to 3 service users and 2 staff members during the visit. They told us things about the home and the support and care they receive and give. General observations were made how people are supported. All the service users had left the home by 11.00 a.m to do various activities. Care Homes for Adults (18-65 years) Page 6 of 32 We had a look around the communal areas of Court Lodge and looked at the documentation kept by the home. We looked at and discussed service users individual support plans and their risk assessments. We looked at medication procedures and records. We also looked at staff files and training records. We saw how the service recruits their staff and the homes quality assurance systems. An annual service assurance assessment (AQAA) was sent to us by the service. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. Information received from the home since the last inspection was used in the report. The AQAA contained the information we needed to assist in making judgments about the service. We sent 6 surveys to people who live at the home, 5 surveys to the staff and 3 to care managers and 3 to visiting professionals. The home informed that they had not received the surveys. We tried to contact 2 care managers by phone but we where unable to speak to them. We did speak to a relative of a service user. We took into account the things that have happened in the service; these are called notifications and are a legal requirement. Care Homes for Adults (18-65 years) Page 7 of 32 What the care home does well: What has improved since the last inspection? At the last inspection it was required that the manager of the home become registered with the commission. The manager did register with the commission but has spent little time at the home due to other company commitments. The goals and aspirations of the people who live at the home have been further developed and are being achieved. The majority of people are doing what they want. Most of the people we spoke to told us that they are happy living at the home. They said they are able to make decisions about how they live their lives Care Homes for Adults (18-65 years) Page 8 of 32 What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 32 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 32 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. The home provides information about the service for prospective service users who are thinking of moving into Court Lodge. They are asked about what support they need and how they want this to be given. They will only be admitted if the home are confident of meeting these needs. Evidence: We looked at the homes Statement of Purpose and a Service Users Guide. These were last reviewed in February 2009. They both contain the information needed to help people decide if Court Lodge is the right place for them to live. The staffing and management situation has changed since February but the Service Users Guide has not been updated to reflect this. The service user guide tells people what the home has to offer. It includes information on how to make a complaint, peoples rights and terms and conditions. It contains pictures of the home and staff and is written in a way that makes it more accessible to people who may wish to use the service. People thinking of coming to live at the home receive this information. Care Homes for Adults (18-65 years) Page 11 of 32 Evidence: One person told us, I knew about the home and the people before I came to live here. Two new people have come to live at the home in the last 12 months. One person decided the home was not for them and has moved on. We looked at two preassessments. One of these was of the most recent person to come and live at Court Lodge. The assessments were thorough and took had a detailed past history of the person. We saw that the assessment procedure identifies all the persons care/support needs and also looks at all aspects of their lifes. It includes information of the persons, physical and mental health, communication, behaviour, and risks. It also gives information about their family and friends, their likes and dislikes, pastimes and preferences. We did see that the assessments had not been signed or dated so there was no way of telling who had completed the assessment and when it had been done. The registered manager told us that assessments are always done by a member of the companys commissioning team, the home manager and service user. A service user told us that that they visited Court Lodge on several occasions and met the other people who live their and the staff before they made a decision about whether to give it a try. People have a trial period of three months before they have to make a decision about whether or not the home is right for them. The AQAA told us that service users are actively involved during the transition of a new service users. Current service users spend time with the new person and are asked to give feedback on whether they think they will get on with them. Care Homes for Adults (18-65 years) Page 12 of 32 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users have the support and care they need to attain their individual goals and aspirations. They are supported in taking risks as part of an independent lifestyle. Evidence: On the day of the visit there were five people living at the home. Everyone had a support/care plan. The service users and staff are in the process of transferring the care planning system to a one that is is more personal and individualised. It is called My Plan and My healthy living plan. Service users will be assisted to develop their own support plans and be fully involved and consulted in all aspects of their care. Information will be streamlined and will make the plans an easy document to work with. Some service users have already been involved in developing and taking responsibility for the support and care that they need. We saw that one person had started to write their own plan and writing their own daily records. Not all the people living at the home have started their plans and it was identified at the last monthly audit visit as a shortfall. Care Homes for Adults (18-65 years) Page 13 of 32 Evidence: We looked closely at two of the plans and we looked at specific things in a third plan. They covered all aspects of health and social care, medical needs, specialised needs, behaviour management, interventions, and nutritional information. The majority of the care plans are person centred and are easy to understand, follow and cross reference. They had references to peoples beliefs and relationships. The AQAA told us All race and religions are incorporated into the home through care plans. Service users who are currently living here verbally communicate as to what beliefs they have and the home actively supports them in this area. The care plans explained how to support and care for the person in the way they preferred. Likes and dislikes are included and there are profiles in place on how people prefer to communicate. We did see that the plans on how to manage behaviours. This means that people are supported in the way that best suits them while keeping them safe and protecting others. We did see that the support needs of a service user had recently been reviewed and changed. The care plan had not been up-dated to reflect this change. We were told by a relative that staff were not managing a specific aspect of support as well as they should This means service user may not be receiving they needed. The manager told us this was being addressed. This was confirmed by the relative and the operational manager. The plans are reviewed monthly. Goals and aspirations for service users are looked at to see if outcomes have been achieved. Service users are involved with reviewing their plans on a monthly basis. Families are involved in the process and there are annual care management reviews. Court lodge allocates service users with two keyworkers per person. Service users are given a choice of who they would like to be their key-workers. There are risk assessments in place which give information how to keep people as safe as possible while allowing them to be as independent and active. Risk assessments are reviewed monthly. We saw that some of the risk assessments had not been signed and dated. Daily records contain relevant information to show how people have made choices and decisions. It was possible to cross reference information. The AQAA told us the service users at Court Lodge are involved in the day to day decision making within the home, this includes having input with the menu planning, taking part in daily house hold Care Homes for Adults (18-65 years) Page 14 of 32 Evidence: chores and tasks, having input into activity planning both outside and inside of the home. The key workers have regular 1 to 1 talk times with service users. These sessions are used to make sure that all the service users are listened to and time is allowed to for them to express how they are feeling. Relevant information from these sessions is used to improve the service and resolve any issues. We saw and people told us that staff listened to what they want and act on this. There are regular service users meetings. We observed interactions and spoke to staff and service users and we looked at records and documentation. There was evidence to support that people are involved in making decisions on how they live their lives. Any limitations and restrictions are recorded in the individuals care plan. Some people told us that they were not happy with the restrictions that were in place but staff explained clearly and precisely why they were there and that they were to make sure the person was safe. They said they would be reviewed shortly. Care Homes for Adults (18-65 years) Page 15 of 32 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users are encouraged and supported to take part in appropriate activities. They are part of the local community. Service users are supported to maintain family contact and assisted to exercise choice over their lives. The majority of people received a healthy and varied diet. Evidence: The home has a general programme of activities. Some people attend the companys day centre on specific days during the week, others go to college or have some parttime employment. Activities are geared and developed depending on peoples preferences, needs and capabilities. When we visited 2 of the service users were at the companies day centre where they go 2-3 times per week. The other people had planned a trip to the local out-let shopping centre. The majority of people we spoke told us that they are supported to live an active and fulfilling life. They said they are Care Homes for Adults (18-65 years) Page 16 of 32 Evidence: happy with what they do. When we looked at peoples plans and from speaking to staff and service users we saw that the service actively supports the service users to be as independent and involved as possible. Service users told us they enjoy going out. One person told us I enjoy going to the day centre and have a good -time. Someone else said I like to cook meals. The registered manager told us that people are supported to developed education skills. People are encouraged and supported to be creative. The AQAA told us Court Lodge is a home that provides people with the opportunity to integrate themselves into the community. The service users regularly go to the local pub and are known and friends with the locals. The service users also attend the local cinema and bowling alley. People regularly attended clubs and discos where they meet and develop relationships with people outside the home. The service users are encouraged and supported to maintain contact with their family and friends. We saw that people have regular home visits and people are encouraged to bring their family and friends into the home. The service users are involved in the daily routines of the home and are encouraged to take care of their own rooms and are involved in preparing meals and drinks. People can choose when to be in the privacy of their own rooms or in the communal areas. Everyone has the freedom to access all communal areas of the home. Members of staff were observed demonstrating good body language and communication skills when interacting with the service users. They were seen to talk and interact in a positive way and involved and included service users in conversations. Court Lodge caters for people who have special diets. Court Lodge have now implemented a new menu system where the service users select their meals through a service user house meeting. People on special diets can then reduce the fat content of their diet with the support they need. We were informed by a relative that that they felt service users on special diets were not getting the support they need to manage their diet effectively. This is being investigated by the companys using their complaints procedure. Care Homes for Adults (18-65 years) Page 17 of 32 Evidence: Court Lodge has now introduced a cooking day for each of the service users so they are can be fully involved in the shopping, preparation and serving a meal. Service users can use the kitchen whenever they want. Service users said that they enjoyed their mealtimes and the food is good. They said that they had meals out regularly. Care Homes for Adults (18-65 years) Page 18 of 32 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People will receive the support they need to stay healthy. People have the support they need regarding their personal care. Medication policies and procedures have not been adhered to. people may not receive their medication on time and safely. Evidence: We saw that some people did have support plans in place around their daily routines with regards to getting up and going to bed and personal hygiene. They explained the particular way that people like to have things done. Staff have got to know each person well and have found out how they like to be supported with their personal care. Routines have been established for them and guidelines have been written for the staff so that there is a consistent approach from care staff. People told us that they get the support that they need to take care of themselves. The people we spoke to said that they do not require a lot of help with their personal care. At the time of the visit the home were transferring to a different health support plan for the service users. They are in the process of changing to a more person centred plan called My healthy living plan. This transition had not been completed at the time Care Homes for Adults (18-65 years) Page 19 of 32 Evidence: of the visit. When it is people will have more control and independence with regards their health care. The health records gave details of recent appointments and recommendations from health care specialists. We saw that people had contact with the local learning disability team. The AQAA told us that recommendations from the speech and language therapist have been carried out and followed by the staff team at Court Lodge. If people have specific medical needs there are written guidelines on how to support them. We looked at some of the detailed support and records for supporting people on a specialist diet and these gave all the information needed to help and support people to remain healthy and have a well balanced diet. Service users health is monitored and if any problems arise they are dealt with promptly and appropriately. The new health care plans will be taken to out-side appointments so they outcomes can be immediately recorded and actioned. Some of the service users have complex health needs. The service was able to evidence that these are well managed. We looked for guidelines that should be in place for when service users presented with behaviours that might cause a risk to themselves or others. We found that people had guidelines in place that gave staff guidance about what they had to do. Each service user is registered with a local doctor and any area of concern related to health is referred to them. There is contact with specialist services when needed. People are seen by their doctor when they need to. Their medication is reviewed regularly. We looked at the medication procedures at the home. The staff who administer medication have received the necessary training and their competencies are checked. A sample of prescription sheets were seen. All prescriptions sheets had been signed to indicate that service users had received their medication on time. The recording of receipt, administration and disposal of drugs is sufficient to allow an audit trail. The home encourage people to self medicate and there are support plans and risk assessments in place to make sure this is done as safely as possible. The registered manager told us that they are in the process of purchasing individual medicine cabinets for peoples bedrooms so their medication can be stored separately. This will give people more control and autonomy. Care Homes for Adults (18-65 years) Page 20 of 32 Evidence: Care Homes for Adults (18-65 years) Page 21 of 32 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. The home has a satisfactory complaints system and service users are protected from harm and abuse. Evidence: The home encourages and support people to express their views and concerns. This is done in service users meetings and in one to one talk times. There have been no complaints from the people living in the home. We saw that the complaints procedures is easy to access and is written in a format which is understandable for the people who live at the home. This means if there is a concern or complaint people are able to effectively let the staff know. When we spoke to people they said that they have no problem telling staff if they have a complaint. Most complaints are dealt with there and then and on an informal basis. We saw evidence of this on the day of the visit and the outcome was satisfactory for the service user. People said that they are taken seriously. The home has recently received one complaint from a relative. They told us and we saw evidence that this was being dealt with according to the companys complaints procedure but due to staff holidays there has been a delay in moving this forward. Since our visit we have also received a complaint. The complaint is the same as the one received by the service. The commissions policies and procedures state that complaints of this nature are to be referred back to the provider to investigate. We have done this. Care Homes for Adults (18-65 years) Page 22 of 32 Evidence: The home keeps a record of complaints and this includes details of the investigation and any actions taken. Timescales are adhered to. There have been no safeguarding vulnerable adults alert raised since the last inspection. The majority of staff have received training in safe guarding vulnerable adults and for those who havent (who are mainly the new staff) training is being booked. People can access advocacy services if they need to. One person told us that they have an advocate who supports them. The homes recruitment procedure includes undertaking formal checks to ensure that potential employees are suitable to work with vulnerable adults. The service has records to demonstrate that the service users finances are managed appropriately and safe guarded by the service. The registered manager is able to audit and trail monies. The home has developed systems of supporting people to manage their personal monies, which protects them from abuse. Care Homes for Adults (18-65 years) Page 23 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides an environment that is appropriate to the needs of the people who live there. Improved maintenance and improvements to some parts will enhance peoples lives and make the home a more attractive place to live. Evidence: We found that there are some parts of the home that need attention and maintenance. There are two bathrooms in the house and they are not well maintained. In the upstairs bathroom some of the grouting between the tiles is black, the bathside is cracked and old. The flooring is stained and the toilet seat discoloured. In the downstairs bathroom there is mould and damp on the ceiling. The manager told us this had been treated but it has not worked. The paint on the ceiling was flaking. The toilet was discoloured and the floor past its best. The manager did tell us that some of the taps had been replaced and tightened up. These shortfalls were identified in the inspection in 2006 and 2007, but nothing has been done to improve these areas of the home. The service does not have a long term maintenance plan in place so the manager could not tell us if the work was planned or when it would be done. The service does do a monthly maintenance audit which is forwarded to the companys maintenance manager. We did speak to the companys Quality and Performance Manager and she told us that long term maintenance plans were being developed for Care Homes for Adults (18-65 years) Page 24 of 32 Evidence: all the homes in the company. The other communal areas in the home were suitable for purpose. The kitchen was clean and service users can help themselves to drinks and snacks. We did not see any of the service users bedrooms as they out, but the AQAA told us all service users bedrooms are personalised with items that they have chosen. This was confirmed in the last inspection report. Two service users have key to their bedroom which enables them to lock their own bedroom door when they are not in their room. The service showed us evidence that monthly safety checks are done. All areas of the environment are looked at. If they are not satisfactory an action plan is developed to address the issue. The monthly visits done by the company identified that there are still outstanding maintenance issues at the home. We did find that the water temperatures at the home exceeded the recommended temperature and had done for some time but this had not been picked up on the monthly checks. No action had been taken to address this issue. The registered manager told us he would immediately put a risk assessment in place to make sure people were safe and the fault would be reported to the maintenance team. We also spoke to the area manager about this and she told us that the necessary action would be taken to rectify the situation. The service has provided a small shed in the garden for a service user who smokes. On the day of the visit the downstairs of the house was clean. The upstairs bathroom and landings had not been cleaned but the manager told us this would be done when people returned from their activities. Service users are encouraged and supported to do the daily cleaning tasks in the home. There is a laundry room is a small area in the upstairs of the house. We were told that it is serviceable and people are encouraged and supported to do their own washing. There are no hand washing facilities in the laundry room. At the last inspection the deputy manager agreed to provide an alcohol gel cleaner or something similar, so anyone can clean their hands before leaving the laundry area. This was not available at the visit. There was a hand cleaner available in the downstairs hallway. Care Homes for Adults (18-65 years) Page 25 of 32 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. There are enough staff to support the people living at the home. Staff have not had the training to make sure they have the competencies and skills to support people. People are protected by the homes recruitment processes. Evidence: At the time of the visit the home employed 6 care staff. They have recently employed two new staff members. We were told that the home has been using staff from other homes to cover the shortfalls and this meant that people did not know who would be supporting them. This situation is now improving. We found that there is usually three staff on duty during the day. There is a sleep-in staff member at night. We were told that there is only one member of the care staff team who can drive the homes mini -bus and this sometimes impacts on the service users when they want to go different places or when the staff member is not available. We saw and the staff told us that they developed good relationships with the service users. The staff support and communicate with service users in a respectful manner. and are accessible and approachable. It was evidenced that the staff on duty put the needs of the service users first. People responded positively and openly to staff. Some of the staff have worked at the home for a reasonable length of time and have a good knowledge and understanding of the service users. Service users told us they like the Care Homes for Adults (18-65 years) Page 26 of 32 Evidence: staff and get on well with them. The home has an NVQ programme and has reached the 50 target of staff with NVQ level 2 or above. The company has an agreement with the commission that staff files will be held centrally and home managers are notified that all safety checks and reference have been received before someone starts work at the home. We saw evidence of these notifications. The registered manager is involved in interviewing prospective staff and so are the service users. Following an interview the prospective staff are introduced to the service users and spend time with them. Service users show staff around the home. There is then a discussion to decide whether the service think the person will fit-in. This means that people living at the home are protected by the services recruitment procedures and have a say in who works at the home. The manager was not able to show a planned training programme for staff. We were told by the area manager that the training programme has been suspended for two months because of holidays. A new programme for October onwards is being developed. She said in the interim period if managers identified a group of staff that needed training then it will be provided. There is a training matrix which shows the training the staff have completed and that which remains outstanding. We did identify gaps in both mandatory and specialist training. We found that some staff were out of date with mandatory training and some people had not received some mandatory training even though they had been at the home for some. The area manager told us she would look into this. The AQAA said the staff team would benefit from more specialised training in order to support individuals more. This means that people may not be receiving the support and care they need as staff may not have the necessary knowledge and skills. The home has a new induction programme which is linked to skill for care and two new members of staff are in the in the process of undertaking the programme. A supervision and appraisal programme is in place and staff confirmed they are receiving supervision and we saw evidence of this in staff files. Care Homes for Adults (18-65 years) Page 27 of 32 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager has the qualifications and experienced to run the efficiently and safely. There are quality assurance systems in place to improve the service and for auditing and recording purposes. People know their health and safety will be protected. Evidence: The operations manager informed us on the 5th April 2008 that the registered manager of Court Lodge was being seconded on other company business for a period of 6 months and deputy manager would be acting manager. When we went to do inspection found that the deputy/acting manager had left the service in June 2009 and the registered had only returned to the on 1st June 2009. This means that he had been away from the home for a period of 14 months. The commission had not been kept up to date about the registered managers other commitments and had not been told that he was away from the home for longer than 6 months. At the inspection the registered manager told us that he was leaving the home on following day. He did not know the arrangements for managing the home once he had gone. This concern was Care Homes for Adults (18-65 years) Page 28 of 32 Evidence: also raised by a relative. No-one at the home knew what what was happening with regards the management of the service. We contacted the the area manager and she told us that interim arrangements had been made but the person who was going to take over the managerial role had let them down at the last minute. She said that other arrangements would be made to make sure the home was managed effectively and safely until a new manager was appointed. This was clarified on the 11th August 2009by the Head of Operations. She told us that a manager from another home would be at Court Lodge on 17th August 2009. We were told that he is a fully qualified and very experienced manager who has a lot of would be taking over managerial responsibility for the interim period . The post has been advertised and the company are awaiting applications from suitable people. This means that the service users will live in a home that is effectively managed on a day to day basis and they will receive the support that they need. The home undertakes monthly quality assurance audits to identify short falls in the service. A quality assurance visit was done by the Quality Assurance and Performance manager on the 17th June 2009, the results of this are not yet available at the home. The home manger could not give any information on the previous quality assurance outcomes. he was unable to find the information in the home. We spoke to the Quality Assurance and performance manager who told us that the quality and performance survey was concluded and published in December 2008. She sent us a copy of this. She told us this information had been passed on to relatives and other stake holders. This had identified the shortfalls and strengths of the services in the Caretech group and explained how the company are going to improve the services that they offer to people. She also told us that surveys for service users are being sent out in September 2009. The AQAA told us all of the necessary Health and Safety checks have been carried out in the home. The random checks that we did confirmed this. Environmental and personal risk assessments are in place. All fire assessments and checks are done at the required intervals. Water temperatures are taken but exceed the recommended temperature ( this was discussed in the environmental section of the report). The home tells about any event or incident that may affect the well being of the people who live at the home. Monthly visits are done by the company to make sure the service is supporting and meeting the needs of the people who live there. Care Homes for Adults (18-65 years) Page 29 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 30 of 32 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 31 of 32 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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