Care Home: Courtlands Lodge

What the care home does well The home provides a comfortable `homely` environment for people to live in. They have a structured admissions procedure that encourages people to spend time at the home before they agree to move in. People said that they were happy living at the home. They told us that they liked their accommodation and felt safe. Care is provided by a stable staff team who are knowledgeable about the residents they support and interact with them in a very positive manner. People told us that the staff respected their wishes and were helpful and kind. Residents commented, `staff always help in every way`, `I can only say that I am happy here` and `the staff care for me when I need it`. Residents told us that they enjoyed a varied menu of home cooked food, which they had been involved in developing it. They are offered choice and can change their mind at the last minute if they wanted to. One person said, `tasty meals are always served`. There is a robust recruitment process in place that helps to make sure that the staff who work at the home are suitable for the job. The home`s training programme offers staff a variety of courses including the opportunity to complete an N.V.Q. (National Vocational Qualification) in care. Currently 10 out of the 16 care staff employed has achieved an N.V.Q. What has improved since the last inspection? The quality assurance system has been improved so that the views of the people using the service can be gained more comprehensively. Meetings and surveys are used to involve residents in the day to day running of the home. There is also a suggestion box which allows people share their views anonymously if they prefer. Maintenance and redecoration of the home has continued on a rolling basis therefore the environment has been maintained at a good standard. The home`s policies and procedures have been reviewed and updated so that residents have access to clear information and staff receive guidance about how the home intends to operate. The process for keeping peoples money safe has been changed so that it offers a more robust system and a clearer audit trail. What the care home could do better: Each resident must be consulted about his or her social interests. This information can then be used in the care planning process so that staff know how to support people to have the lifestyle they wish. This information can then be used to formulate a programme of activities that meets the needs of individual people living at the home. Staff must be provided with specialist training to meet peoples individual needs, this will help to make sure that they have the right level of skills and knowledge to carry out their job.Other areas that would benefit from some attention included the following. Initial assessment documentation used prior to admission should be reviewed to make sure that it is suitable to record all the information gathered about peoples needs. Care plans should be developed further so that they include more information about peoples likes and dislikes, how they prefer their care to be delivered and their abilities. This will help to make sure that all their needs are met in a more person centred way. The recording of care plan reviews should be more meaningful so that they evaluate peoples progress or deterioration toward identified goals, as well as the effectiveness of the planned care. Peoples files should be audited and any old information archived so that staff have easy access to current information. The provision of appropriate stimulation should be reviewed so that people have better access to job and educational opportunities, as well as leisure outings outside the home. Staff should have access to regular planned appraisal and supervision sessions so that they are given the right level of support to do their job. They should also receive appropriate training about new legislation, such as the the Mental Capacity Act 2007 and Deprivation of Liberties. This will give them a better understanding of their role in supporting people appropriately. The supernumerary time allotted to the acting manager should be reviewed to make sure that it is sufficient for her to fulfill her managerial responsibilities. The provider should review the content of his monthly reports to ensure that they contain all the information required by us, including peoples opinions of the service they are receiving. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Courtlands Lodge 25 Langley Road North Hykeham Lincoln Lincs LN6 9RX     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Dawn Podmore     Date: 2 7 0 5 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 29 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI 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 29 Information about the care home Name of care home: Address: Courtlands Lodge 25 Langley Road North Hykeham Lincoln Lincs LN6 9RX 01522693800 01522687628 courtlandslodge@yahoo.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Life Care (UK) Ltd care home 29 Number of places (if applicable): Under 65 Over 65 5 mental disorder, excluding learning disability or dementia Additional conditions: 24 The maximum number of service users in the home with Nursing needs does not exceed 24 (MD) and the maximum number of service users with Personal Care needs only, does not exceed 5 (of which 2 are under the category of MD and 3 are under the category of MD(E)). Date of last inspection Brief description of the care home Courtlands Lodge is a privately run care home providing nursing and personal care for up to twenty-nine adults of both sexes with a mental disorder, including five residents over 65 years of age. It is situated in North Hykeham, approximately three miles from the centre of Lincoln. The home is located in a cul-de-sac, close to a main road and bus route into Lincoln. North Hykeham has a range of community facilities including a variety of shops, post office, swimming pool, public houses and food outlets. The home is a single storey building consisting of eleven single and nine double rooms. The spacious garden is well maintained to provide a secure outdoor area for residents to use. There are ten car parking spaces at the front of the home. The provider keeps a printed copy of the latest statement of purpose, service user guide and inspection Care Homes for Adults (18-65 years) Page 4 of 29 Brief description of the care home report at the home available for people using or enquiring about the service. On the day of the visit the fee rates ranged from three hundred and seventy four pounds to seven hundred and sixty five pounds and seventy five pence, depending on peoples assessed needs. Care Homes for Adults (18-65 years) Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This key inspection was unannounced and took any previous information held by C.Q.C. about the home into account. Throughout this report the terms we and us refers to the Care Quality Commission (C.Q.C). Before the the visit the provider had returned an Annual Quality Assurance Assessment (AQAA). This gave us information about their own assessment of how well they are meeting standards and their plans for improvement over the next twelve months. We sent out surveys to residents and staff, of which 21 were returned and the content is included in this report. The main method of inspection used was called case tracking. This involved selecting a Care Homes for Adults (18-65 years) Page 6 of 29 proportion of residents and tracking the care they received through the checking of records, discussions with them and the staff who care for them, and observation of care practices. A partial tour of the home was also conducted, which included looking at some bedrooms, communal areas and bathing and toilet facilities. Documentation was sampled and the care records of the three people being tracked were examined. We spoke with 6 residents and 4 members of staff. They shared their views about how the home operated on a day to day basis and the support and facilities provided. The acting manager was available during the visit and the general outcomes of the visit were discussed with her. On the day of the visit 23 people were living at the home. What the care home does well: What has improved since the last inspection? What they could do better: Each resident must be consulted about his or her social interests. This information can then be used in the care planning process so that staff know how to support people to have the lifestyle they wish. This information can then be used to formulate a programme of activities that meets the needs of individual people living at the home. Staff must be provided with specialist training to meet peoples individual needs, this will help to make sure that they have the right level of skills and knowledge to carry out their job. Care Homes for Adults (18-65 years) Page 8 of 29 Other areas that would benefit from some attention included the following. Initial assessment documentation used prior to admission should be reviewed to make sure that it is suitable to record all the information gathered about peoples needs. Care plans should be developed further so that they include more information about peoples likes and dislikes, how they prefer their care to be delivered and their abilities. This will help to make sure that all their needs are met in a more person centred way. The recording of care plan reviews should be more meaningful so that they evaluate peoples progress or deterioration toward identified goals, as well as the effectiveness of the planned care. Peoples files should be audited and any old information archived so that staff have easy access to current information. The provision of appropriate stimulation should be reviewed so that people have better access to job and educational opportunities, as well as leisure outings outside the home. Staff should have access to regular planned appraisal and supervision sessions so that they are given the right level of support to do their job. They should also receive appropriate training about new legislation, such as the the Mental Capacity Act 2007 and Deprivation of Liberties. This will give them a better understanding of their role in supporting people appropriately. The supernumerary time allotted to the acting manager should be reviewed to make sure that it is sufficient for her to fulfill her managerial responsibilities. The provider should review the content of his monthly reports to ensure that they contain all the information required by us, including peoples opinions of the service they are receiving. 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 set out 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 29 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 29 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 have access to the information they need to decide if the home can meet their needs. The home has a satisfactory system in place to assess peoples needs prior to admission. This means that people can make sure that the home can support them appropriately before they move into the home. Evidence: People have access to information about the home, this includes the Service Users Guide which is given to new residents when they move into the home. A review of all information available prior to this visit, and the content of people care records, showed that the home does not admit people without assessing their needs. There had been no recent admissions but we looked at the assessment record of someone who was to move into the home shortly. An initial assessment had been carried out by the homes staff and information had been collected from other sources, such as their social worker. However the assessment document used by the home was limited and gave little room to record information comprehensively. Care Homes for Adults (18-65 years) Page 11 of 29 Evidence: Trial visits had been arranged to introduce them to the other residents and so that they could see if the home suited their needs, These visits can range from a few hours to an overnight stay. Staff had maintained records of these visits so that they could assess the outcomes. Care Homes for Adults (18-65 years) Page 12 of 29 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. People are empowered to make choices about their lives and feel that they are supported to lead their lives as they prefer. Care plans identify peoples needs and acknowledge that people can take responsible risks. However shortfalls in information about peoples individual preferences might lead to their support not being delivered as they prefer. Evidence: We looked at the care plans for 3 people with different needs. They contained some good information about their main needs, but were not person centred in their approach. This means that that did not clearly outline peoples likes and dislikes and how they preferred their support to be delivered. However one of the files we saw had a personal profile document which did include this information and the manager said these were being completed for everyone. A discussion took place regarding incorporating this information into care plans. Care Homes for Adults (18-65 years) Page 13 of 29 Evidence: None of the files we looked at contained a plan for meeting peoples social needs, although the profile we looked at outlined the residents interests. Risk assessments were included in people files identifying areas of potential risk. They included everyday life experiences such as going into the community, as well as topics such as safe manual handling. The planned care had been reviewed regularly but the content of some were meaningless as they did not evaluate progress or deterioration in peoples condition. For example one person was on a weigh loss regime, but there was no target weight identified and evaluation comments included no change and remains relevant. Annual care reviews had also taken place involving social workers, staff, the resident and their relatives, if appropriate. The home has started to include the content of the Mental Capacity Act into the care planning process, but this had not been fully incorporated into individual care plans. This is new legislation that is aimed at protecting peoples rights and choices. Residents told us that they were happy at the home and that staff were meeting their needs. They said that they were able to make decisions and choices about their daily lives and enjoyed living there. One person said the staff are very good, they always put you right if you need anything. There is a key worker system in place so that each resident has a named person they can relate to. Staff were knowledgeable about the people they supported and the need to encourage independence, giving us good examples. They described how they tried to make sure that residents were as involved as possible in making choices about their daily lives. Care Homes for Adults (18-65 years) Page 14 of 29 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples social and leisure requirements have not been used to formulate a formal programme of stimulation to meet their individual needs. Some residents are able to go into the community if they choose to. Meals provided are nutritious and offer choice. Evidence: The home does not employ a designated person to coordinate activities and leisure pursuits. Although there was a programme of activities this was very limited. Staff said that each afternoon time was set aside for activities such as bingo, arts and crafts and watching DVDs. They told us that outings were limited due to staff availability and no outside entertainers had visited the home recently. Although care plans contained some information about what people liked to do this Care Homes for Adults (18-65 years) Page 15 of 29 Evidence: was minimal and there were no plan of how the home intended to meet peoples individual social needs. One person said that they went out shopping sometimes. Another resident told us that she went to Blackpool last year for a holiday, which she enjoyed. Staff said that nothing has been arranged yet for this year, but they were looking into it. During the afternoon of the visit we saw 2 residents drawing with a staff member and 2 other people went shopping with the cook, who also works as a carer. Two people also went out to the local pub together. Some of the people we spoke to, and those who returned surveys said they would like to do more. One person commented, we could do with entertainers coming to the home often. Staff also told us that residents would benefit from more leisure opportunities and in house activities. The home has a minibus so that residents can access the community and go on outings. However this is limited to staff availability and it does not have a lift so cannot be used by people in wheelchairs. The acting manager said that currently there were no residents accessing educational courses or day centre. However one resident works at a local shop and two others help with household jobs and the garden. People told us that there was open visiting at the home and relatives and friends were made welcome. One person commented in a survey returned to the home, 100 made welcome, homely and able to visit and staff are available if you want to make a complaint and very satisfied. The meal at lunchtime was served directly from the kitchen by the cook. She told us that she aimed to provide good home cooking with homemade pies and cakes. She demonstrated a good knowledge of the residents and their preferences and discussed how people were consulted about the menu options. One person told us, its good food, well it suits me. Another said, lovely food especially the Yorkshire puddings and meats. Care Homes for Adults (18-65 years) Page 16 of 29 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. There are good processes for the provision of personal and health care support, which meet the needs and wishes of the residents. People are able to manage their medications themselves if they can, but if they need help staff are trained to support them with it in a safe way. Evidence: People told us that they were happy with the way staff supported them regarding their daily lives, including their health needs. Records and peoples comments showed that residents had access to outside agencies such as specialist nurses, doctors, chiropodists and opticians. Records, observation and discussions demonstrated that the home has satisfactory policies and procedures concerning the receipt, storage, administration and disposal of medications. No issues were highlighted by the pharmacist following their visit in July 2008. Although there were no residents looking after their own medications when we visited, systems are in place for this to happen. Care Homes for Adults (18-65 years) Page 17 of 29 Care Homes for Adults (18-65 years) Page 18 of 29 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. Residents are protected by clear policies and procedures for handling complaints and allegations of abuse. Evidence: The home has a complaints procedure, which tells residents and relatives how to make a complaint and how it will be handled. A copy is given to all new residents as part of the Service User Guide and is displayed in the home. People told us that if they had any complaints they were happy to speak to staff about them. Information provided by the acting manager showed that the home had received one complaint over the last year, but this was not upheld. The home has a policy and procedure about safeguarding people from abuse so that staff know what they should do if they have any concerns in this area. Two alerts have been made to the safeguarding team over the last year one required no action and the other is still being investigated. Training records, as well as staff comments, demonstrated that the majority of staff have received training in this subject. Care Homes for Adults (18-65 years) Page 19 of 29 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. People live in a well maintained, clean, comfortable and homely environment, which offers a satisfactory standard of decor and furnishing. Evidence: We took a partial tour of the home looking at the bedrooms of the people being case tracked, communal areas and bathing facilities. The general atmosphere of the home was welcoming and homely. People told us that they were happy with their rooms, which had been personalised by the resident or their relatives. The communal areas were domestic in nature giving rooms like the lounge a homely feel. There is a rolling programme in place for redecoration and a handyman is employed to maintain the building. The garden and car park were well maintained and seating was available. Residents are encouraged to be involved in the garden, as well as helping with household tasks. Ramps are in place to enable easy access to the home. Separate housekeeping and laundry staff are employed, but care staff told us that they help out with the latter. The home has an infection control policy and most staff have Care Homes for Adults (18-65 years) Page 20 of 29 Evidence: completed a course in this subject. Care Homes for Adults (18-65 years) Page 21 of 29 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 receive support from staff who are robustly recruited and knowledgeable about their needs, Staff have access to training to help them meet the needs of the people they care, but shortfalls in specialist training means that peoples needs may not be fully met. Evidence: Residents said that staff were meeting their needs. However some staff felt that an additional carer in the afternoon would allow more time for activities with the residents. There is a nurse on duty 24 hours a day with 3 carers in the morning and two in the afternoon. Staff felt that this left little opportunity to take people out into the community. Currently peoples dependency levels are not used to determine how many staff are needed throughout the day. Observation showed that staff supported people in a calm and relaxed manner, and included them in the routines of the home. For example taking them shopping for household goods. Recruitment of new staff was being carried out correctly with essential checks, such as written references and C.R.B. (Criminal Records Bureau) checks, being undertaken. Care Homes for Adults (18-65 years) Page 22 of 29 Evidence: The acting manager said that residents were being encouraged to take part in helping to select new staff. Records and staff comments showed that new staff received an induction to the home, but one induction record we looked at had not been fully completed. The home has a training programme which includes essential subjects such as manual handling, protection of vulnerable adults from abuse, fire safety, food hygiene and first aid. However records and staff comments failed to demonstrate that they had received training in specialist subjects to meet current residents needs, such as mental health disorders and conditions affecting older people such as diabetes. Training had been provided to some staff about the Mental Capacity Act, which is aimed at protecting people rights and choices. The company encourage staff to complete an N.V.Q (National Vocational Qualification) in care. Information provided showed that out of 16 care staff 10 have attained an NVQ and 6 others are currently doing the award. Residents said that they were happy with the way staff supported them. One person said, they are very kind, lovely. Another residents told us, they are very good. Care Homes for Adults (18-65 years) Page 23 of 29 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. Leadership and guidance is provided to staff to ensure that support to residents is delivered in a consistent manner. The home is managed in the best interest of the residents. There are systems in place to make sure that the health, safety and welfare needs of the residents are met. Evidence: Currently Mrs Heather Brown the deputy manager is overseeing the day to day running of the home. However she has only been allocated one day a week to fulfill these responsibilities. Comments from residents indicated that they felt that the home was well run. They told us. its lovely here and I am happy living here. The staff we spoke to said that the Mrs Brown was approachable and always available. One person said shes really gone out of her way to improve things. When asked what the home did well one said, provides a comfortable place for people to live, its Care Homes for Adults (18-65 years) Page 24 of 29 Evidence: homely and its like one big happy family. We also asked if they thought there was anyway the home could be improved. Three people told us that they would like more time to take people out and do activities. Although staff said that they felt supported in their work, records and staff comments failed to show that they were receiving regular formal supervision. Most staff had received an appraisal and the acting manager had planned other sessions. The home has a quality assurance system so that they can gain the views of the people who use the service. The acting manager said that this included surveys, meetings and care reviews. Surveys had been sent out to residents in March 2009 and the summary of the outcomes showed that in the main people were happy with the service they received. Comments included, if I could have picked a home I could not have wished for a better one, I am happy and contented. very satisfied and if I have a problem it is sorted out by the staff. Relatives surveys also contained positive comments. The provider had carried out monthly visits to the home as required and completed a report of his findings. However the content did not provide information about what people had said and their opinion of the service and facilities provided. The financial records for the person allowances of three people were examined and found to be accurately documented and included receipts. A new system has recently been introduced to make the recording and accounting system more robust. The home has health and safety polices and procedures to guide and instruct staff. There is also a programme in place to service and maintain equipment in the home on a regular basis. Information provided in the AQAA and sampling on the day of the visit demonstrated that regular checks on equipment, such as fire systems and the sluicing machine had taken place as scheduled. The home has recently reviewed and amended their policies and procedures to ensure that they cover all essential areas. Care Homes for Adults (18-65 years) Page 25 of 29 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 26 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 14 16 Records must demonstrate what peoples daily routines and recreational needs are, and what support staff need to provide to meet their wishes. This will help to make sure that staff know what people want to do and their role in supporting them. 27/07/2009 2 35 18 The training programme must include specialist subjects to meet the needs of peoples living at the home. This will help to make sure that staff have the knowledge and skills to meet the needs of the people they are supporting. 26/10/2009 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. Care Homes for Adults (18-65 years) Page 27 of 29 No. Refer to Standard Good Practice Recommendations 1 2 Initial assessment documentation should be reviewed so that it has enough space and guidance to record peoples needs and potential risks in better detail. This will help to make sure that staff have enough information to decide if they can fully meet peoples needs. Care plans should contain better information about peoples individual preferences and abilities. This will help to make sure that all their needs are met in a more person centred way Documentation of the monthly reviews of peoples care should be more meaningful so that they reflect any progress or deterioration in the residents condition and evaluate if the planned care is effective. The provision of stimulation should be reviewed so that people have better access to job and educational opportunities, as well as leisure activities outside the home. The home should make sure that all staff are aware of the content of new legislation, such as the Mental Capacity Act and Deprivation of Liberties, so that they have a better understanding of supporting people appropriately. Staff should have access to regular planned appraisal and supervision sessions so that they are given the right level of support to do their job. The supernumerary time allocated for the deputy manager to fulfill her managerial responsibilities as acting manager should be reviewed to ensure that she has enough time to undertake this role. The content of the providers monthly reports should be reviewed to make sure that they contain all the information required. This will help to demonstrate that service provided by the home is meeting peoples needs. 2 6 3 6 4 14 5 35 6 36 7 37 8 41 Care Homes for Adults (18-65 years) Page 28 of 29 Helpline: Telephone: 03000 616161 or Textphone: or 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) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. 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