Care Home: Elliot Lodge

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What the care home does well Staff know the people living there well. Staff support people in they way they want and need to ensure their well being. People have the information they need before they move in to hep them make a choice as to whether or not they want to live there. Staff have the information they need so they can support people to meet their needs and achieve their goals.Elliot LodgeDS0000062618.V378064.R01.S.docVersion 5.3People have the food they need to help them keep well. They are given a choice of food that they like. People are supported to do the things they enjoy and staff support people to develop their interests. People are helped to keep in contact with their family and friends so they can maintain relationships that are important to them. Staff support people well with their personal care to help them to feel comfortable and good about themselves. Staff work well with other health professionals to benefit the people living there and help to meet their health needs. The home is well decorated and furnished so it is homely and comfortable for people to live in. Bedrooms are personalised and reflect the tastes and interests of the individual. Equipment is provided to help people be as independent as possible and to help staff to move people safely. Staff have the training they need so they know how to help the people living there. The manager has the skills and knowledge to run the home in the best interests of the people living there. Equipment in the home is regularly checked so that it is safe to use. What has improved since the last inspection? Staff ensure that people have their prescribed medication at the right time so ensuring their health and well being. Staff make sure that medication is stored properly so it is effective in meeting people’s health needs. Most staff have had training in the Mental Capacity Act so that the people who live are supported to make decisions when needed and that these are in their best interests. The dining room table and chairs have been replaced so that the people living there and the staff supporting them can sit comfortably at mealtimes.Elliot LodgeDS0000062618.V378064.R01.S.docVersion 5.3Some flooring has been replaced in bedrooms so they are clean and comfortable for the people living there. Some rooms have been redecorated so they are cleaner and the home is more comfortable. There is now funding to provide the snoozelen (sensory room) so that this is safe and can provide a relaxing room for people to spend time in. The temperature of the water is not too hot so that the people living there are not at risk of being scalded. What the care home could do better: All care plans should be updated when there have been changes so that staff continue to know how to support people to meet their needs. People should be supported to go on holiday every year if they are able to and want to go so they can see different things and have different experiences. The qualified nursing hours should be reviewed to ensure there is sufficient staff to meet the needs of the people living there. Key inspection report CARE HOME ADULTS 18-65 Elliot Lodge 4 Newholmes Off Southern Drive Off Monyhull Hall Road Kings Norton Birmingham B30 3QF Lead Inspector Sarah Bennett Key Unannounced Inspection 6th October 2009 09:40 Elliot Lodge DS0000062618.V378064.R01.S.doc Version 5.3 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care home adults 18-65 can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Elliot Lodge DS0000062618.V378064.R01.S.doc Version 5.3 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Elliot Lodge DS0000062618.V378064.R01.S.doc Version 5.3 Page 3 SERVICE INFORMATION Name of service Elliot Lodge Address Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 4 Newholmes Off Southern Drive Off Monyhull Hall Road Kings Norton Birmingham B30 3QF 0121 444 0187 South Birmingham Primary Care Trust Ms Janet Milutinovic Care Home 6 Category(ies) of Learning disability (6), Physical disability (6), registration, with number Sensory impairment (6) of places Elliot Lodge DS0000062618.V378064.R01.S.doc Version 5.3 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. A qualified nurse must be working in the home at all times and must not have responsibility for any of the other Newholmes bungalows. Six people with a learning disability under 65 years in receipt of nursing care. 11th October 2007 Date of last inspection Brief Description of the Service: Elliot Lodge is a purpose built care home, on the site of the former Monyhull Hospital. The home is owned by Family Housing Association and the care and staffing is provided and managed by South Birmingham Primary Care Trust. The accommodation comprises of a communal lounge, dining room, kitchen, shower room, assisted bathroom, toilet, laundry, and six single bedrooms. A qualified nurse is on duty across the twenty-four hour period. They are supported by a minimum of three care staff during the day and one care staff at night. The home is conveniently located for Kings Heath and Kings Norton. There are good public transport links. The home has a vehicle towards which the people living there contribute financially. The statement of purpose stated that each person pays £130.27 per week to Family Housing Association as their contribution to their fees. Our last report is available in the home for those who wish to read it. Elliot Lodge DS0000062618.V378064.R01.S.doc Version 5.3 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is three stars. This means the people who use this service experience excellent quality outcomes. This inspection was carried out by one inspector in one day; the home did not know we were going to visit. This was the homes key inspection for the inspection year 2009 to 2010. The focus of inspections we, the commission, undertake is upon outcomes for people who live in the home and their views of the service provided. This process considers the care homes capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provision that need further development. Prior to the fieldwork visit taking place a range of information was gathered to include notifications received from the home and an Annual Quality Assurance Assessment (AQAA) completed by the manager. This provides information about the home and how they think it meets the needs of the people living there. We case tracked the care received by two people living there. This involved establishing individual’s experience of living in the care home by meeting and observing them, discussing their care with staff, looking at care files, and focusing on outcomes. Tracking peoples care helps us understand the experiences of people who use the service. We looked at parts of the home and a sample of care, staff and health and safety records. The people living there were not able to communicate their views due to their needs so we spent time observing the way that staff supported and interacted with them. We spoke to the manager and the staff on duty. What the service does well: Staff know the people living there well. Staff support people in they way they want and need to ensure their well being. People have the information they need before they move in to hep them make a choice as to whether or not they want to live there. Staff have the information they need so they can support people to meet their needs and achieve their goals. Elliot Lodge DS0000062618.V378064.R01.S.doc Version 5.3 Page 6 People have the food they need to help them keep well. They are given a choice of food that they like. People are supported to do the things they enjoy and staff support people to develop their interests. People are helped to keep in contact with their family and friends so they can maintain relationships that are important to them. Staff support people well with their personal care to help them to feel comfortable and good about themselves. Staff work well with other health professionals to benefit the people living there and help to meet their health needs. The home is well decorated and furnished so it is homely and comfortable for people to live in. Bedrooms are personalised and reflect the tastes and interests of the individual. Equipment is provided to help people be as independent as possible and to help staff to move people safely. Staff have the training they need so they know how to help the people living there. The manager has the skills and knowledge to run the home in the best interests of the people living there. Equipment in the home is regularly checked so that it is safe to use. What has improved since the last inspection? Staff ensure that people have their prescribed medication at the right time so ensuring their health and well being. Staff make sure that medication is stored properly so it is effective in meeting people’s health needs. Most staff have had training in the Mental Capacity Act so that the people who live are supported to make decisions when needed and that these are in their best interests. The dining room table and chairs have been replaced so that the people living there and the staff supporting them can sit comfortably at mealtimes. Elliot Lodge DS0000062618.V378064.R01.S.doc Version 5.3 Page 7 Some flooring has been replaced in bedrooms so they are clean and comfortable for the people living there. Some rooms have been redecorated so they are cleaner and the home is more comfortable. There is now funding to provide the snoozelen (sensory room) so that this is safe and can provide a relaxing room for people to spend time in. The temperature of the water is not too hot so that the people living there are not at risk of being scalded. 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. Elliot Lodge DS0000062618.V378064.R01.S.doc Version 5.3 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Elliot Lodge DS0000062618.V378064.R01.S.doc Version 5.3 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 4 People using the 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 have the information they need and their needs are assessed so they can be sure that the home is right for them. EVIDENCE: The statement of purpose included the relevant and required information about the home so that people would have the information they need about the home. It was updated in July this year and was written in a way that was easy to understand. The service user’s guide was written in a way that was easy to understand. It stated that it can be provided in other formats if needed. This ensures that all people would have the information they need to make a choice as to whether or not they want to live there. The AQAA stated that prospective residents have a comprehensive needs and risk assessment completed to assess whether or not their needs can be met there. We looked at the records for a person who had moved in during the last year. These included a detailed assessment of the person’s needs to ensure that they could be met at the home. The person, their relatives and other Elliot Lodge DS0000062618.V378064.R01.S.doc Version 5.3 Page 10 health professionals working with the person were involved in the assessment. This helped to give a clearer picture of what the person would need and if they could be met at the home. Due to their health needs the person was not able to visit the home before they moved in. Staff visited the person in hospital and people significant to the person visited the home on their behalf. Elliot Lodge DS0000062618.V378064.R01.S.doc Version 5.3 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff have the information they need so they know how to support the people living there safely and in the way they choose to meet their needs. EVIDENCE: The records of two of the people living there were looked at. These included an individual, detailed care plan. This ensures that staff know how to support the person to meet their needs and achieve their goals. Care plans were person centred and stated what action staff needed to take to help the person achieve their goal and ensure their needs were met. People have annual reviews of their plan to which their relatives and other professionals involved are invited where appropriate. A monthly review of the plan is held with the person, their named nurse and key worker to ensure it is meeting the person’s needs in the way they want. Elliot Lodge DS0000062618.V378064.R01.S.doc Version 5.3 Page 12 One person’s care plan for how they were to be supported to keep their skin healthy and free from pressure from sitting down etc stated that they did not have a wheelchair. The person now has a wheelchair so this needs to be updated to ensure that staff know how to support them with this. The AQAA stated that staff support the people living there to access advocacy services where needed to help them make decisions about their lives. The AQAA stated that the people communicate verbally and non - verbally and staff interpret this and act upon people’s wishes. This was observed throughout the day. Staff were observed to be very good at interpreting how people were feeling and what they wanted from looking at their body language and facial expressions. It was obvious that staff knew the people living there very well and what they liked and disliked. Care plans included how people had been supported to make choices and how staff should support people to do this. Staff had regular meetings with the people living there. Minutes of these showed that they talked about holidays, day trips, furniture and decoration of the home, information about how to make complaints and about services for the people living there and the garden. The AQAA stated that they had improved how people are involved in the running of the service by nominating a member of staff to act as Patient Advice Liaison Service (PALS) representative for the people living there. A member of staff also attends bi monthly Patient Group Network meetings on behalf of the people living there. Records sampled included individual, detailed risk assessments. These stated how staff are to support people to minimise the risks to their safety when doing things such as bathing, using a hoist, using the shower trolley, eating and drinking, travelling by minibus and when sitting in their wheelchair. Risk assessments had been reviewed monthly and updated when needed. Elliot Lodge DS0000062618.V378064.R01.S.doc Version 5.3 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): This is what people staying in this care home experience: 12, 13, 14, 15, 16, 17 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported to experience a meaningful lifestyle that meets their individual needs so ensuring their well being. EVIDENCE: Records sampled showed and it was observed that staff support people to do activities that they enjoy and want to do. This can sometimes be limited because of people’s health needs. Staff showed that they are flexible to adapt activities to how the person is that day. Two people went out for a drive to a park and then to do some shopping with two staff. One person had to be brought back as they had an epileptic seizure. Later, the other person also had to be brought back as they were unwell. Staff had not been able to do the food shopping so they took another person who was well that day to do this, which the person seemed to enjoy. Elliot Lodge DS0000062618.V378064.R01.S.doc Version 5.3 Page 14 Staff said that one person usually goes to a day centre during the week but they were not able to go as they were waiting for a new sling so they could be moved safely. They were being involved in activities within the home such as listening to music, sitting looking out at the garden and watching and talking to staff while they were cooking. Staff said and records showed that each week therapists come into the home to do activities. This includes massage, music session and exercise session. Records sampled showed that people enjoyed this. The home has been successful in obtaining funding to install a snoozelen room in what was the office, which has moved to the room off the lounge. This will include sensory lighting and equipment and give the people living there another space to relax in. Staff said that there is one staff who is employed for activities and as a driver. There are two other staff who can drive the minibus to help people to access the community. The AQAA stated that they will continue to try to recruit a volunteer driver for weekends and evenings to offer people greater community access at these times. One person has an interest in Princess Diana. Staff supported them recently to visit Althrop Estate. The person’s key worker wrote to Clarence House asking for a photo of Princess Diana. The person was sent a programme from the memorial concerts in 2007 and a letter which is now framed on their bedroom wall. Staff also had some photos from the programme enlarged to portrait size and framed for the person’s birthday to go on their bedroom wall. This person’s health has deteriorated so some days they can spend a lot of time resting in their bedroom. It is good that they have the things around them that they enjoy and are important to them. The AQAA stated that the people living there receive support and spiritual guidance from a local vicar and a local priest. Records sampled showed that staff support people to attend church if they wish to. The manager said that it has been difficult to arrange holidays for the people living there due to their health needs, finding suitable accommodation and paying for staff to accompany them as the provider does not pay for the extra staffing that the people living there would need. They have supported people to go on day trips. They also hope to plan short holidays to Blackpool soon to see the illuminations for people who are well enough to go. The AQAA stated and records sampled showed that staff support the people living there to maintain close links with their family and friends. This may be through them visiting the home or staff support the people who live there to visit people important to them. Records sampled showed and it was observed that staff keep in contact on behalf of individuals through telephone calls. Elliot Lodge DS0000062618.V378064.R01.S.doc Version 5.3 Page 15 The AQAA stated and records sampled showed that staff promote people’s independence and empowerment by encouraging them to become involved in daily household tasks. All the people who live there have difficulty in swallowing. An industrial blender has been purchased to improve the food preparation for people. Some people have their food through a tube and staff have received training in how to do this so that people get the nutrition they need. Some people need food supplements to ensure they get the nutrition they need. Space has been limited in the fridge to store these at the right temperature. They plan to remove part of the kitchen work top and purchase a large fridge/freezer to accommodate these. The AQAA stated that the menus are regularly reviewed and staff observe people’s reaction to foods to help them to find out what foods people like and dislike. Food records sampled showed that people are offered a varied and healthy diet that includes fresh fruit and vegetables. Food shopping bought on the day included a lot of fresh fruit. Food records sampled showed that the meals were appropriate to the cultural background of the people living there. The AQAA stated that people are also offered foods from different cultural backgrounds so they can explore different tastes. Staff were observed sitting to assist people to eat their meals and have their drinks at a relaxed pace. A table has been specially made for the dining room so that people can sit at the table in their wheelchairs. Appropriate music was put on for people while eating their tea to make the mealtime more enjoyable for them. Elliot Lodge DS0000062618.V378064.R01.S.doc Version 5.3 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 People using the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff support people well so that their health and personal care needs are met so ensuring their well being. EVIDENCE: Care plans sampled included how staff are to support the person with their personal care. The people living there were well dressed in individual styles that were appropriate to their age, gender, the weather and what activities they were doing. Staff were observed to take people to be changed as needed during the day to ensure their comfort and dignity. It was observed that attention had been paid to people’s personal care so ensuring their well being and self esteem. Care plans sampled stated how staff are to support the person to meet their health needs. Each person has an individual health action plan. This is a personal plan about what support a person needs with their health and what health services they need to access. These were detailed, were easy to Elliot Lodge DS0000062618.V378064.R01.S.doc Version 5.3 Page 17 understand and included pictures. They showed that people were encouraged to attend annual health checks so that any underlying health needs could also be detected. Records showed that people had regular eye and dental checks to ensure their needs could be met. Care plans were regularly reviewed and updated as people’s needs changed. Staff said and records showed that a range of other health professionals are involved in the care of individuals. Health professionals told us that staff always follow their advice. Advice from other professionals was written into care plans so staff knew what to do. Records sampled showed that staff support people to attend health appointments and advocate on their behalf where needed to ensure they get the support they need. Staff adapted the day around the people living there and their health needs. As previously stated staff adapted going out around the health needs of two people. Another person was asleep in the lounge and seemed unwell so staff supported them to go to bed. They regularly checked on the person to ensure they were comfortable. Another person spent most of the day in bed and again staff regularly checked them and sought the advice of a health professional who visited to ensure their well being. Staff assessed whether or not people were at risk of being poorly nourished which would affect their well being. Where needed advice was sought from the dietician and speech and language therapist. People ware weighed regularly either at home or at the weight clinic. Weight records showed what the person’s goal weight was. Staff monitor whether or not the person has lost or gained weight. This is good as a significant loss or gain of weight can be an indicator of an underlying health need. Records sampled included guidelines on how to keep the person comfortable and safe at night. This was detailed, for example for one person it said, ‘I sleep on my side with my bed at a 30 degree tilt.’ This shows staff exactly how to support the person to help them to sleep well so ensuring their well being. To ensure that people’s health needs are met they sometimes need support from the qualified nursing staff that can be invasive to their privacy and dignity, such as, having an enema so they do not become constipated. The people who live there are not able to give consent to have this done. The manager had discussed this with the relevant health professionals. They had used a consent form agreed by the Department of Health where the health professional and the manager had signed to say that it was in the person’s ‘best interest’ for each procedure to be given when needed. Records sampled showed that not only the physical health needs of individual’s are considered but also their mental and emotional needs. Consideration is given when discussing input from health professionals as to how this may affect the quality of life of the person. Elliot Lodge DS0000062618.V378064.R01.S.doc Version 5.3 Page 18 The manager said that all the qualified staff are booked on ‘Deteriorating Health Needs’ course and most staff have had training in dementia. This helps staff to know how to meet the specific needs of the people living there. Health professionals told us that staff are very good at monitoring people’s health needs and they keep professionals updated with any issues. They said that staff are experienced, proactive and take on board what the professionals say for the good of the people living there. Records sampled included a care plan as to what support they needed with their medication. This included how they like or need to take it particularly with their difficulties in swallowing. It also stated what each medication is for and what possible side effects there may be so that staff could monitor these. Where the person’s medication had changed this was documented so that staff were aware of this. Some people are prescribed as required (PRN) medication. Individual protocols were in place for these so that staff knew how, why, when and how much of the medication to give to ensure this is given only when needed. The qualified nurses give the medication to the people living there. Medication is stored in a locked cabinet that is tidy and organised which helps staff to know what medication to give to whom. At the front of each person’s Medication Administration Record (MAR) there were details of how the person takes their medication. There is also a photo of the person so that unfamiliar staff would know who to give it to. Staff had signed the MAR sampled appropriately indicating that medication had been given as prescribed. The pharmacist from the Primary Care Trust had audited the medication recently. The manager said that they were awaiting the pharmacist’s report but had already started liaising with the Practice Nurse at the GP surgery to ensure that recommendations made were being met. Elliot Lodge DS0000062618.V378064.R01.S.doc Version 5.3 Page 19 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Arrangements ensure that the views of the people living there are listened to and they are protected from harm. EVIDENCE: The complaints procedure was included in the service user’s guide and displayed in the home so that people had this information. The manager said that they are planning to improve the area in the home where information is available so that relatives and visitors will have all the information they need to raise any concerns they have and have more say in the running of the home. The people living there have monthly meetings with their key worker and named nurse and there are regular house meetings. This gives people opportunities to say what they think about the home and raise any concerns they may have. The AQAA stated that staff have training in dealing with concerns and complaints and have details of advocacy services to contact if people need help to raise their concerns. The home has not received any complaints in the last twelve months. We have not received any complaints about the home since our last visit. Elliot Lodge DS0000062618.V378064.R01.S.doc Version 5.3 Page 20 Staff training records sampled showed that all staff had training in safeguarding the people living there from abuse. Some staff had not had this recently. The manager said they are doing some in house safeguarding refresher training. All staff are given a copy of the safeguarding policy to read and have to sign to say they have read this. This ensures that they are aware of how to keep the people living there safe from harm. A member of staff has been nominated for the role of Safeguarding Champion within the Trust that manages the home. They are to be a link between the home and the organisations safeguarding representative. They will provide advice and coaching and ensure assessments are carried out on any safeguarding issues. Training records sampled showed and the AQAA stated that all but one member of staff have completed training in the Mental Capacity Act legislation. This ensures that staff know the implications of this legislation for the people living there. Records sampled showed that assessments had been completed to see if the running of the home impacted on people’s liberty in line with the recent legislation of Deprivation of Liberty Safeguards (DOLS). For example, one person’s records showed that staff and health professionals had considered if having the front door locked was depriving the person of their liberty. It was concluded that the reasons for locking the door was to keep people safe from others entering the home so was not restrictive. Therefore, a referral to the Council Best Interests Team for a DOLS assessment was not needed. All staff have attended training in this legislation. The manager is the appointee for all the people living there but this is being looked into as due to people’s needs they have not been able to give their consent to this. Finance records sampled showed that each person has their own bank account that their benefits are paid into. Money withdrawn from these has to be authorised by a senior manager. Money was held safely in the home. All monies are checked at the handover of each shift and one member of staff is nominated as being responsible for people’s money on each shift. Records sampled matched the amount of money held for the person. Records showed how the person’s money is spent. These showed that the money is spent on things for the person and receipts are kept of all purchases. Elliot Lodge DS0000062618.V378064.R01.S.doc Version 5.3 Page 21 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 24, 26, 29, 30 People using the 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 homely and comfortable environment that meets their individual needs. EVIDENCE: The home was well decorated and maintained so it is comfortable and homely for people to live in. There were a number of contemporary ornaments and furnishings in communal areas making it homely. Since our last visit a dresser, chairs and table had been bought for the dining room. The table had been designed specifically at a suitable height to enable the people living there to be able to sit at the table in their wheelchairs. The kitchen cupboards were in good condition. A larger fridge/freezer is being provided so that there is more space to accommodate the foods that the people living there need. The fly screens are being replaced to make the Elliot Lodge DS0000062618.V378064.R01.S.doc Version 5.3 Page 22 kitchen more hygienic. The manager said that new blinds are being fitted to improve security. The AQAA stated and the manager said that they have put in a bid for a summer house in the garden. The people living there do not have a room other than their bedroom where they can meet in private with their family and friends so this will provide an alternative. Some people are sensitive to sunlight so this will also enable them to access the garden. Staff said that people enjoy being in the garden so it would be good for them to be able to use it more. Some people were observed sitting looking out over the garden and they seemed to be enjoying this. The manager said they have applied for funding to get a new green house as the one they were getting was not in good condition. They are also consulting with a horticultural college to re-vamp the garden and approaching businesses to help fund this. This will make the garden more accessible and useful to the people living there. Bedrooms were personalised according to individual needs, tastes and interests. New flooring and blinds had been fitted in bedrooms to make them more comfortable. Since we last visited the storage in people’s bedrooms had improved so there was more space for their possessions. The AQAA stated and the manager said that they have secured funding for a snoozelen room to be fitted within the home. Work was due to start on this soon after our visit. They plan to provide a water bed, have an overhead hoist fitted, replace the flooring with a ‘sparkly floor’, and have sensory equipment and projector to provide sensory lighting. This will provide a room where the people living there can relax and where their senses can be stimulated so helping to meet their needs. An accessible bath is provided that all the people living there are able to use. There is also a level access shower so that the people living there have a choice of having a bath or shower. The home was clean and there were no offensive odours making it pleasant for people to live in. A cleaning schedule is in place and there are regular audits to monitor the cleanliness of the home. There is a policy on infection control and all staff have had infection control training so they know how to minimise the risks of cross infection. There is a separate laundry room. Soiled laundry does not have to be taken through areas where food is prepared, stored or eaten helping to minimise the risks of infection. The AQAA stated that to improve the home further they are having the carpets cleaned. They are going to continue to request funding to purchase a carpet cleaner, which will make it easier and more cost effective to keep the carpets clean. Elliot Lodge DS0000062618.V378064.R01.S.doc Version 5.3 Page 23 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35, 36 People using the 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 arrangements for staffing, their support and development ensure that the needs of the people living there are met. EVIDENCE: All of the staff have achieved National Vocational Qualification (NVQ) level 2 in Care. Since our last visit three staff have achieved NVQ level 3 and one member of staff has achieved NVQ level 4. Other staff are working towards achieving NVQ level 3. This exceeds the standard so ensuring that staff have the skills and knowledge to meet the needs of the people living there. The AQAA stated and staff records sampled showed that there is an established team of nursing and care staff. Rotas sampled showed and staff said that when bank cover is required, shifts are covered by permanent staff or retired staff who have worked there for many years so know the people living there well. One member of staff has left in the last year so one staff has Elliot Lodge DS0000062618.V378064.R01.S.doc Version 5.3 Page 24 increased their hours to full time to help cover this vacancy. Staff said that the staffing levels are better and all staff know what they are doing and the people living there. It was observed during the day that staff know the people living there well and how to meet their needs. A Development Nurse has just started working at the home. This is a nurse who has recently completed their training and will be at the home for six months to develop their skills and knowledge. The manager said that the nurse also has experience of Person Centred Planning so will be able to develop this in the home. Student nurses have placements at the home and there was a student on duty when we visited. This also helps the staff to keep updated with recent best practice and staff said they found this useful. Rotas sampled showed that there is always a qualified nurse on duty and when the manager is on duty they are in addition to the qualified nurse. The AQAA stated that budgets are being reviewed with a view to increase qualified nursing hours. We observed that despite there being the manager, a nurse, four care staff and a student nurse on duty they were very busy because of the needs of the people living there. Therefore, an increase in staffing should be considered. Staff meeting minutes showed that there had been at least six meetings in the last year. This helps keep staff updated with how to meet the needs of the people living there, changes within the organisation and with ‘best practice’. The records of four of the staff that work there were looked at. These included the required recruitment records including evidence that a satisfactory Criminal Records Bureau (CRB) check had been completed. This helps to ensure that ‘suitable’ people are employed to work with the people living there. The AQAA stated and records sampled showed that staff have had specific training in how to meet the individual needs of the people living there. Training records showed that they have the required training so they know how to meet people’s needs and are kept updated with current legislation. Staff records sampled showed that they had regular supervision with their manager. During supervisions they discussed the needs of the people living there and the training they needed to do to develop their knowledge and meet these needs. Staff were set objectives to meet between supervisions so that they are focussed in their role to benefit the people living there. Elliot Lodge DS0000062618.V378064.R01.S.doc Version 5.3 Page 25 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42 People using the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management arrangements ensure that the home is run in the best interests of the people living there and their health, safety and welfare is promoted and protected. EVIDENCE: Since we last visited the manager has achieved the Registered Managers Award to help her to have the skills and knowledge to manage the home. We observed throughout the day that the manager communicates well with the staff and the people living there so they are clear about what is happening and how people should be supported. Elliot Lodge DS0000062618.V378064.R01.S.doc Version 5.3 Page 26 The manager completed the AQAA when we asked for it. This contained clear information about how the home has improved and what further improvements are being made to the home for the benefit of the people living there. We found that the information given in the AQAA was accurate so we can be confident that the manager has the best interests of the people living there as a priority in managing the home. The AQAA stated that a representative of the Trust and Family Housing Association visit the home regularly to complete an audit of how well the home is meeting people’s needs. Reports of these visits sampled showed that detailed audits were completed that were based on how well the needs and choices of the people living there were met. The AQAA stated that fourteen staff have achieved NVQ 2 in Health and Safety. The AQAA stated and records sampled showed that all equipment in the home is regularly serviced and tested to ensure it is well maintained and safe to use. The fire risk assessment is reviewed regularly and updated where needed. This ensures that action can be taken to minimise the risks of there being a fire. There were individual procedures for each person that stated how staff would need to support them if there was a fire. These were reviewed every six months and updated where needed. Fire records showed that staff test the equipment regularly to make sure it is working. There are regular fire drills so that staff and the people living there would know what to do if there was a fire. An engineer regularly services the fire equipment to ensure it is well maintained so would work if there was a fire. Staff have regular updated training in fire safety. Staff test the temperature of the water regularly to make sure it is not too hot which could put people at risk of being scalded. Records showed that temperatures were at the recommended safe level to reduce this risk. The manager said that an engineer had reported recently that two valves needed replacing on the taps to ensure that temperatures are regulated and these are to be fitted. The hoist and slings that are used to move people around are regularly serviced. All slings had recently been replaced to ensure that people are safe when using hoists. Elliot Lodge DS0000062618.V378064.R01.S.doc Version 5.3 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 X 4 3 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 4 27 X 28 X 29 3 30 2 STAFFING Standard No Score 31 X 32 4 33 2 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 2 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 4 3 X 4 X 3 X X 4 X Version 5.3 Page 28 Elliot Lodge DS0000062618.V378064.R01.S.doc No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard YA6 YA14 YA33 Good Practice Recommendations All care plans should be updated when there have been changes to ensure staff know how to support people to meet their needs. People should be supported to go on holiday every year if they are able to and want to go so they can see different things and have different experiences. The qualified nursing hours should be reviewed to ensure there is sufficient staff to meet the needs of the people living there. Elliot Lodge DS0000062618.V378064.R01.S.doc Version 5.3 Page 29 Care Quality Commission West Midlands Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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