Care Home: Elm Park Lodge

Similar services:

• Townley Road, 2-3
• Foxley Lane (121a)
• Tudor Lodge
• Stacey Street Nursing Home
• Delrose House Ltd
• Clovelly House Residential Home Ltd
• Abbey Road [53]
• Cherry Tree House

What the care home does well Elm Park Lodge provides an excellent quality service for people with severe and enduring mental health problems, that enables them to live in the community in a safe and supportive environment. This is confirmed by complimentary letters we saw from the Community Mental Health team, (CMHT). The ethos of the service is one of developing the residents potential so that they can live more independently. The service has a good history of achieving these goals and is highly regarded by mental health professionals, who place people in the home. Several people have successfully moved on to more independent living schemes. The home employs an art therapist and music/yoga facillitator, both of whom provide very stimulating activities which are highly regarded by residents who participate in the sessions. The residents sign that they have received important documents when they move in to the home, includng the Statement of Purpose, the service contract and the complaints form. Care plans are clear for staff to follow and residents are involved with their key workers in reviewing the care plans regularly. Residents are supported to maintain good health through regular appointments with the G.P and the CMHT. The staff are well trained in health and safety, mental health and safeguarding people from abuse. Several major improvements have been made to the property which has added to the comfort of the residents and better working conditions for staff. What has improved since the last inspection? The home ensures that a record is maintained of all visitors to the home. This is for the purposes of health and safety and security for staff and residents. As part of a healthy diet, fresh fruit is available in the home. All staff now receive regular, formal supervision. A thorough fire risk assessment of the home has been be carried out and an emergency plan prepared in case of a major incident affecting the safety of residents and staff. A more appropriate facility has been provided for residents who smoke so that those who do not smoke are protected. A procedure has been drawn up for residents who are able to self medicate as part of their rehabilitation. What the care home could do better: We have made requirements and recommendations regarding the administration of medication. A proper cupboard for storing medicines must be provided to meet Pharmaceutical Guidelines. Staff must sign for all medication that is administered. Where medication is not given, an appropriate explanation must be recorded on the MAR sheet. The home should ask the pharmacy supplier to identify the days of the week on the blister packs to prevent errors occurring and the staff should highlight any medication allergies on the residents MAR sheets. All of these measures will reduce the risk of errors and better protect the wellbeing of the residents. We have also made a requirement regarding staff recruitment; the manager must ensure when recruiting new staff, that at least one reference is obtained from the person`s last employer. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Elm Park Lodge 2-4 Elm Park Road Finchley London N3 1EB     The quality rating for this care home is:   three star excellent 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: THOMAS McKERVEY     Date: 2 6 0 8 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 30 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 30 Information about the care home Name of care home: Address: Elm Park Lodge 2-4 Elm Park Road Finchley London N3 1EB 02083492388 02083716988 elmparklodge@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) : Mr Kam Choy Lim care home 27 Number of places (if applicable): Under 65 Over 65 0 mental disorder, excluding learning disability or dementia Additional conditions: 27 4 specific service users who are currently resident in the home and are over 65 years of age can reside in the home. This condition will need to be reviewed when any of the service users vacate the home. Date of last inspection Brief description of the care home Elm Park Lodge is a privately run care home which is registered to provide care and support for a maximum of twenty seven younger adults who have a mental disorder. The home is authorised, as a condition of its registration, to accommodate four residents who are over the age of sixty-five. Prior to November 2003, the service consisted of Elm Park Lodge, a large three-storey detached house, and The Lindens next door, which accommodates four residents in two flats. Both properties are now registered as one home, i.e. Elm Park Lodge. The bedrooms, all of which are single, are located on three floors. There are two communal lounges on the ground floor, and there is a conservatory which is a Care Homes for Adults (18-65 years) Page 4 of 30 Brief description of the care home designated smoking area. Another conservatory is dedicated as an arts/crafts room. There is a space at the front of the home for car parking, and there is a large, very attractive garden and patio at the rear of the premises. There is also a newly-built office adjacent to the activities building. The stated aim of the home is to maintain the quality of life for service users by promoting their independence, dignity, rights, privacy, choice and welfare. The fees for the service range from £460 to £1000 per week depending on teh needs of the residents. Copies of this report and the homes Statement of Purpose are available from the manager of the home. Care Homes for Adults (18-65 years) Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent 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 unannounced inspection was carried out as part of the Commissions inspection programme and to check compliance with the key standards. The inspection was completed in a period of seven hours. The proprietor/manager was present during the inspection and offered every assistance with the process. We visited all areas of the home and spoke to residents and staff to seek their veiws about the service. Prior to the inspection, we sent out surveys to residents and staff. The comments we received were generally very complimentary about the home. We also received an Annual Qualtiy Assurance Assessment, (AQAA), from the home when we asked for it. This is a self assessment in which the home identifies areas where they believe they do well and areas where they need to improve. The AQAA and the surveys we received are referred to in relevant sections of this report. Care Homes for Adults (18-65 years) Page 6 of 30 The inspection process also included an examination of residents and staff records and other documents relating to the management of the home. What the care home does well: What has improved since the last inspection? What they could do better: We have made requirements and recommendations regarding the administration of medication. A proper cupboard for storing medicines must be provided to meet Pharmaceutical Guidelines. Staff must sign for all medication that is administered. Where medication is not given, an appropriate explanation must be recorded on the MAR sheet. The home should ask the pharmacy supplier to identify the days of the week on the blister packs to prevent errors occurring and the staff should highlight any medication allergies on the residents MAR sheets. All of these measures will reduce the risk of errors and better protect the wellbeing of the residents. We have also made a requirement regarding staff recruitment; the manager must ensure when recruiting new staff, that at least one reference is obtained from the persons last employer. Care Homes for Adults (18-65 years) Page 8 of 30 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 30 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are very close contacts between the home and the Community Mental Health Team to ensure that residents are placed in a service that fully meets their needs. Comprehensive assessments are carried out before residents are admitted and they are encouraged to visit the home before moving in. The residents can be confident about having a copy of the Service User Guide and a contract to explain what service they can expect from the home. Evidence: We examined the case files of the last four residents who were admitted to the home since the last inspection. There was evidence that they had been able to visit the home before moving in. The residents we spoke to, were able to name their key workers. The case files contained comprehensive assessments by the Community Mental Health Team, and the manager and deputy of the home completed their own assessements. Various risk assessments were documented, for example self harm, smoking and for people who sometimes go missing overnight. Regular reviews under the Care Programme Approach by the mental health Care Homes for Adults (18-65 years) Page 11 of 30 Evidence: professionals were recorded in case files. The files also contained service contracts, which were signed by the residents. As is good practice, the residents are given an induction pack, including the Service User Guide, which they sign to confirm their acceptance to the terms and conditions of residency. There are follow up visits by Community Psychiatric Nurses to ensure that residents are settled in the home. We noted that one person had been assessed under the Mental Capacity Act as having poor insight which put them at risk. Although this persons liberty can be restricted under the Act, we were informed that this had resulted in few restrictions being necessary to safely meet the persons needs. The Court of Protection manages this residents financial affairs. The manager stated that receipts for purchases on the residents behalf are sent to the Court and are reimbursed to the home. We were informed that three residents were currently being assessed to move on to supported living schemes. The AQAA states; We have a proven track record of successfully supporting clients through relapses in their mental health. We have several service users previously referred to as resolving door patients that have not had a hospital admission for a number of years. Feedback from the mental health teams involved in the service users direct care has been consistently positive. We employ staff members from different countries who are able to converse in different languages, with different religious preferences and belief systems. The staff team reflects diversity, race and gender. Elm Park Lodge does not discriminate against sexual orientation. Staff training through NVQ skills for life as well as in house training ensures staff team are aware of all the above. Care Homes for Adults (18-65 years) Page 12 of 30 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. All residents have an individual care plan in which they are involved and which sets out how the person prefers their needs to be met. Residents can be confident of being supported to be as independent as possible within a framework of thorough risk assessment, and they are encouraged to be involved in how the service is delivered. Evidence: We examined four care plans at random. Residents mental and physical health were covered in the care plans. The care plans were reviewed regularly by the key worker and the resident. Overall care is also reviewed at regular CPA meetings with the Community Mental Health Team. The care plans describe residents behaviours in the context of their mental health and provide guidelines for staff about how to support residents most effectively. We saw several care plans that the resident had signed which indicated their knowledge and agreement about what was written about them. Care Homes for Adults (18-65 years) Page 13 of 30 Evidence: The residents we met, spoke highly of the staff and the way they cared for them. These are examples of comments from residents in our surveys; The home makes me happy and look after me well. It is a happy place to be. The care staff are excellent. They are always willing to listen and help whenever they can. My keyworker approaches me regularly to see whether I have any issues to discuss. If I have problems they are always available. The staff we spoke to were very knowledgeable about residents needs and told us they valued the training on mental health provided by the manager. There was evidence that potentially dangerous incidents were appropriately dealt with by urgent appointments with the Community Mental Health Team. The home also informs the Commission about such incidents. The homes ethos is to enable people with mental health problems to achieve as much independence as possible. The company also provides move on facilities such as The Lindens next door to Elm Park Lodge, and community supported living services nearby. The success of the service is evidenced by the fact that several people moved on to these facilities. During the inspection, we met an ex resident who had moved into their own flat in the community and was doing very well. She often visits the home to maintain friendships she had developed during her stay at Elm Park Lodge. Care Homes for Adults (18-65 years) Page 14 of 30 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The residents can be confident of having a range of stimulating and therapuetic activities to choose from and they are supported to live as independently as possible. The menus offer a wholesome diet, and there is an open visiting policy with few restrictions. Evidence: All the residents we spoke to, said they had autonomy in all areas of their lives regarding freedom of choice about meals, activities and coming and going, as long as they kept the staff informed. We saw minutes of meetings that are held between staff and the residents committee. The home also conducts an annual survey of residents views about the service. There is an arts and crafts facilitator who provides sessions three times a week. This service is very appreciated by the residents who can enjoy one to one sessions or as a group. An exhibition of their work was on display. Care Homes for Adults (18-65 years) Page 15 of 30 Evidence: We interviewed the therapist who explained that this activity enabled residents to express their feelings and develop skills through art. She produces regular eports to the staff on each persons progress. The therapist expressed a wish to attend staff meetings at which her input would be valuable. The manager agreed to invite her to future meetings. The home also employs someone to provide yoga and music sessions twice a week which we were informed was also very popular. Some residents attend a day facility run by Richmond Fellowship and one person works as a volounteer at a nearby Oxfam shop. The activities are generally well documented n the daily records. We found in discussions with residents that they receive visits by family and friends and often spend time overnight and weekends with them. Visitors to the home sign the visitors book. Some household tasks are carried out by residents on a rostered basis, including shopping, cooking some meals and we saw one person washing up in the kitchen. Residents are expected to clean their own rooms. All residents have a key to the front door and their rooms are protected by a keypad entry system. Each person has a small safe in their room to keep valuables in. The menus we saw, indicated a good variety of food was provided and we noted that fresh fruit was available. The residents told us they were satisfied with their meals and there were facilities for making hot drinks at any time. We were satisfied that there were ample stocks of food in the home which were stored safely and appropriately labelled. According to the AQAA; Residents from ethnic minorities are encouraged to support the new chef with his menu planning to reflect the needs of these particular groups. We have introduced a cultural lunch for the staff team once a month. This is an opportunity for the staff members to prepare food from their country and share it with the team. Care Homes for Adults (18-65 years) Page 16 of 30 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is very good liaison with the Community Mental Health Team and G.P to ensure that the residents psychological and physical health needs are met. More care must be taken in the administration and recording of medication to protect residents wellbeing. Evidence: All of the residents are able bodied and provide for their own personal care needs, though occasionally they may need reminding by the care staff. Healthcare assessments were documented in the case files and there was evidence of regular appointments with the Community Mental Health Team, including CPA meetings, for emotional and psychological support. Several residents are seen in the home and in clinics by Community Psychiatric Nurses if they require regular injections of medication. Other healthcare appointments were documented, for example with the G.P, hospital, dentist and optician. The residents weights are checked monthly. We were informed that there was concern about one resident whose mobility was deteriorating through osteoporosis. We looked at their records and noted that they had been seen by a specialist and was waiting to be assessed by an occupational therapist. Care Homes for Adults (18-65 years) Page 17 of 30 Evidence: We also noted that this person has a downstairs bedroom and does not need to climb stairs. One other resident has recovered from a serious illness which resulted in them having a stoma. We spoke to this person who explained how they are managing the stoma by themselves. However, they showed the inspector the abdominal area from which there was an exudate. The inspector expressed some misgivings about the lack of input by the district nurse but the resident and staff told the inspector that the G.P was satisfied with how the resident they were coping. We learned that the resident was soon to have an appointment with the consultant, after which, we advised the staff to reassess the situation and take whatever action is necessary. Most of the residents in this home smoke. However, since the last inspection, the home has made one of the consrevatories which is well ventillated, the only designated area where smoking is allowed. This protects those who do not smoke. The residents told the inspector that they were very happy with this improvement. We looked at the medication standards in the home. Quantities of medication coming in and those returned to the pharmacy were recorded. Since the last inspection, a large cupboard has been installed in the office to store medication. However, this cupboard is not satisfactory as it does not comply with pharmaceutical regulations, so a requirement is made for the home to provide an appropriate storage cabinet. The home has a written policy about self medication. We noted that two residents administered their own medicines and are expected to fill in their own MAR sheet to record this. However, we found some errors in these residents MAR sheets. For example, it was recorded that three medications had been destroyed, but the tablets were still in the blister pack. In the other case concerning self-medication, a tablet was recorded as being taken, but it was still in the persons blister pack. We recommend that staff do regular, weekly spot checks to ensure that these residents are taking their medication as prescribed and are recording this accurately. We also noted another medication error in the MAR sheets for which there was no explanation for the absence of staff signatures. We were concerned that the days of the week are not shown on the blister packs which could explain some errors in recording. We noted on one MAR sheet that a resident was allergic to Penicillin, We recommend that this is highlighted with a marker pen to make it clearer. We drew the staffs attention to all these issues. Residents wishes in relation to end of life care were recorded in their files. Care Homes for Adults (18-65 years) Page 18 of 30 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The residents can be confident that any complaints will be taken seriously and responded to and there are good systems in place to protect residents from abuse. Evidence: All new residents are given a copy of the homes complaints procedure which they sign for. We looked at the complaints book which showed that complaints were recorded properly and were dealt with within reasonable timescales. All the people we spoke to, said they were confident that any concerns would be taken seriously. One person told the inspector that they had lost some money which they suggested might have been stolen. They said they had not reported this to staff. The inspector asked the manager to investigate this and respond to the resident. The written comments from residents and their relatives indicated a high level of satisfaction with the care in the home. For exmple; The care the staff show is excellent. A friend wrote; Just a note to say how pleased I am that N is so well looked after. I often worry about him but I can see there is no need. A member of the Community Mental Health Team wrote a letter to the manager, of which this is a synopsis; I know that on a day to day basis, your staff support our clients with a range of ongoing complex needs. Please accept our thanks for your work. As a team, we are all very appreciative of your efforts. The deputy manager is an accredited trainer on the subject of adult protection and she trains the staff in this subject during their induction. We spoke to staff about Care Homes for Adults (18-65 years) Page 19 of 30 Evidence: safeguarding issues and we were satisfied that they were very aware and knowledgeable about this subject and their responsibility to report any suspected abuse of residents. Care Homes for Adults (18-65 years) Page 20 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can be confident that they live in a home that is clean and well maintained. Their rooms are comfortable and promote their independence. Evidence: A tour of the main home was carried out, including all communal areas and one bedroom. We found that the home was well maintained and was comfortably furnished. We noted that several improvements to the property had taken place and contractors were working in the home during the inspection. Recent improvements to the environment included; new thermostats to radiators and new flooring in all bedrooms, a new wide screen television, new beds and bed linen, new office layout and new smoking area upgraded. The manager told us that more upgrades are underway, including redecoration of the kitchen and new units and the cellar is being replastered. A new therapy room and office have also been built in the garden area. The proprietor is commended for these improvements for which the residents expressed their appreciation. The large garden was well maintained and contained several pieces of garden furniture. The home was clean and tidy throughout and smelled fresh. Only one resident was willing to show the inspector their bedroom. This was Care Homes for Adults (18-65 years) Page 21 of 30 Evidence: attractively decorated and comfortably furnished. Each bedroom is protected by a coded entry system, the code being known only to the individual and the staff. Each resident is provided with a safe for keeping valuables in. All the people we spoke to were happy with their rooms and the overall accommodation. We saw a letter from a residents parents which stated; Thank you very much for the amazing transformation you have wrought on Js room. We realise what a difficult task this must have been. We also realise that when there is a T.V. and chair in the room and one or two more of Js embellisments, it will be hard to keep it so pristine, but we shall cherish the memory! We were once again struck by the kindness, care and compassion shown throughout Js care plan meeting. Care Homes for Adults (18-65 years) Page 22 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The residents can be confident that there are sufficient numbers of staff to meet their needs and the staff receive appropriate training and supervision to meet those needs. Residents interests are generally safeguarded by the homes recruitment procedures, but these need to be more thorough by ensuring that at least one reference is obtained from the persons last employer. Evidence: The registered manager is supported by a deputy and an administrator. In addition to the care staff, there is a cook, a cleaner and a maintenance person. The manager and deputy are on call in rotation. The staff rotas we looked at, showed two staff on duty during the day in addition to the manager and deputy. At night, there is one waking member of staff and one staff who sleeps in. The staff who were spoken to, said they were satisfied with the level of staffing provided. According to the AQAA, residents are encouraged to participate in the selection process for new staff. It is also stated in the AQAA that over half the staff team have successfully completed NVQ level 2, and four members are considering doing level 3. The manager is a National Vocational Qualifications assessor and the deputy manager has NVQ Level 3. We examined the recruitment records of the last three staff to be recruited. Their records were generally satisfactory and contained references and proof of identity. Care Homes for Adults (18-65 years) Page 23 of 30 Evidence: Satisfactory checks had also been made with the Criminal Records Bureau, (CRB). However, in one staffs case, there was no reference from the persons last employer, which is a requirement under the regulations. We have drawn the managements attention to this matter. We noted in staff records that they undergo a thorough induction in the homes policies and procedures when they start working at the home. They also have appropriate training in health and safety, medication and first aid. The manager, who is a qualified mental health nurse, provides training in mental health issues. We were satisfied that staff receive regular one to one supervision which was confirmed in their records and in our discussions with the staff. Care Homes for Adults (18-65 years) Page 24 of 30 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in the home can be confident that it is well managed and the environment is relaxed and homely . The residents are consulted about the runniung of their home through regular meetings and there are robust procedures ensure that their best interests are protected. The health and safety of residents and staff is safeguarded by regular maintenance and safety checks. Evidence: The registered manager, who is also the proprietor, is a qualified mental health nurse and is very experienced in managing this home for many years. The residents and staff we spoke to during the inspection, hold the manager in high regard and said that they were able to express their views at regular meetings with the manager and staff. We saw the records of these meetings. The home also carries out a formal quality assurance survey of residents and other stakeholders, the results of which we were shown. The outcome of the survey indicated a high level of satsfaction. It was evident at this inspection that the proprietor has made significant investments in upgrading and improving the facilities in the home which are much appreciated by Care Homes for Adults (18-65 years) Page 25 of 30 Evidence: the residents we spoke to. The manager always demonstrates an openess to constructive criticism and a committment to improving the service for the residents. The home does not manage any residents personal money. As referred to elsewhere in this report, one persons finances are under the Court of Protection which reimburses the home when they submit receipts for any purchases on the residents behalf. At the time of the inspection, there was a friendly relaxed atmosphere in the home and the staff described their morale as very good. We noted that all case files, records and documents were well structured and easy to access. Policies and procedures had been updated, for example the medication procedure. We sat in at the staff handover and we were impressed at the in depth discussion about each residents progress. For example, as part of a specific residents rehabilitation, the staff discussed the gradual steps needed to support this person to manage public transport. The home keeps always informs the Commission about serious incidents. Since the last inspection, the home has produced a written fire risk assessment of the building. We saw records of weekly fire alarm tests and regular fire drills. There were current certificates of safety for gas, fire and electric installations, and staff have been trained in health and safety. An up to date employers liability insurance certificate was on display. Care Homes for Adults (18-65 years) Page 26 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 27 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 19 13 Staff must sign for all medication that is administered. Where medication is not given, an appropriate explanation must be recorded on the MAR sheet. To protect residents from being given incorrect doses of medication. 14/09/2009 2 19 13 A proper medication cupboard must be provided that meets Pharmaceutical Guidelines. To provide approptiate security of medication stock. 30/09/2009 3 34 17 The manager must ensure 30/09/2009 when recruiting new staff, that at least one reference is obtained from the persons last employer. o ensure that residents are protected from potential abuse. Care Homes for Adults (18-65 years) Page 28 of 30 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 19 The home should ask the pharmacy supplier to identify the days of the week on the blister packs to prevent errors occurring. The staff should highlight any medication allergies on the residents MAR sheets. 2 19 Care Homes for Adults (18-65 years) Page 29 of 30 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. Care Homes for Adults (18-65 years) Page 30 of 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!