Care Home: Empress Lodge

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What the care home does well They continue to work well with external professionals in ensuring that service users health and well-being is prioritised. The impact of this is demonstrated through the long periods of stability and personal development that service users enjoy. The service has sound leadership in the registered manager, who has the backing of a flexible, dedicated, well-trained and motivated staff team. Service users continue to have a high level of involvement in the running of the home and in determining what is best for them. This includes having access to a wide range of activities and opportunities for engagement in all aspects of their life. The registered persons also ensure that service users enjoyment, is seen as an integral part of the community in which they live. What has improved since the last inspection? The manager has been registered with the Commission. A four- bedded extension has been developed to the rear of the building to provided care and support for service users aspiring towards greater Independence. There has been considerable improvement works to both the internal and external aspects of the home, which includes fixtures and furnishings. Risk management plans were of a better quality and were in place for all service users. A greater intensity was placed on training for staff including that of safeguarding training. There has been a change in the management structure in that the home now has two deputy managers, which runs alongside the fact that the registered manager is now the `Director of Care` for the company. The home has achieved an award ISO 9001 for - Quality Administration Systems. There is a clear development plan in place involving service users and staff aimed at enhancing the quality of service provision at Empress Lodge. What the care home could do better: The registered persons must ensure that accurate records are maintained for all service users with regards to the recording on their medication administration charts. Key inspection report Care homes for adults (18-65 years) Name: Address: Empress Lodge 448-450 Green Lane Seven Kings Ilford Essex IG3 9LF     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Stanley Phipps     Date: 0 5 1 0 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 31 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 31 Information about the care home Name of care home: Address: Empress Lodge 448-450 Green Lane Seven Kings Ilford Essex IG3 9LF 02085976996 02082529884 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Empress Care Limited Name of registered manager (if applicable) David Farirai Chimhini Type of registration: Number of places registered: care home 17 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of service users who can be accommodated is: 17 The Registered Person may provide the following category of service only: - Care home only - Code PC to service users of the following gender: Either whose primary care need on admission to the home is within the following category: Mental Disorder, excluding learning disability or dementia - Code MD Date of last inspection Brief description of the care home 17 Over 65 0 Care Homes for Adults (18-65 years) Page 4 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This was a key inspection of Empress Lodge, which was carried out between the 29/9/09 and 5/10/09 and was unannounced. It involved discussions and interviews with: the manager, service users, staff and external professionals. It also involved an assessment of records required by regulation to include:health and safety, policies and procedures, medication, staffing rosters and recruitment, menus, activities, service user plans and risk assessments, finance, complaints/compliments, quality assurance, and maintenance. Observation was carried out on medication practices and the engagement between staff, including the manager, and service users. Observation was also carried of the relations between the manager staff and external professionals. An assessment of the internal and external aspects of the facilities including the environment, was also undertaken. Care Homes for Adults (18-65 years) Page 5 of 31 What the care home does well: What has improved since the last inspection? 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. Care Homes for Adults (18-65 years) Page 6 of 31 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 7 of 31 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 8 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users are not only assured that the home carries out a robust screening assessment prior to their admission, but also that any decision around admission is based on the premise that the home has the resources to meet their needs. Evidence: The assessment details of five of the most recently admitted residents were examined and were quite detailed. Each of the admissions could be audited from the referral stage right up to when each service user is admitted to the home. The assessment information took into the consideration all aspects of each of the service users needs to include their specialist needs, which in this case is primarily related to those of mental health. This is routinely done to determine the suitability of the home in providing for the full range of needs that are identified. In most of the cases seen, service users and/or their relatives are actively involved in the assessment process, which also includes opportunities for service users to try out the home with short stays e.g. overnights and weekends followed by a twelve week trial period. As a matter of course key information such as; copies of Care Programme Care Homes for Adults (18-65 years) Page 9 of 31 Evidence: Approach(CPA) reports, psychiatric and social-worker reports are obtained prior to, and as part of the admissions process. Assessments are generally carried out by the manager who is suitably qualified to so do. Final decisions were made to admit the service users under consideration, only when the service user and/or his/her representative is confident that the service could meet their needs, and conversely when the homes management is satisfied that they have the resources to meet identified needs. Care Homes for Adults (18-65 years) Page 10 of 31 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. Service uses continue to have the benefit of comprehensive plans being developed with their needs in mind, and the registered persons continued to develop them further. Sound evidence remains in place to demonstrate that they receive as far as possible, very good support in determining what is best for them. Improvements in the maintenance of risk management plans now ensure that all service users are safely supported to maintain their independence. Evidence: Five service user plans were examined and it was clear that the home continued to focus on the individuality of each person. Individual needs and aspirations were clearly set out and in each of the cases seen, service users signed up as part of their involvement in the process. The plans were also updated and current, reflecting in some cases where reviews or in others where changes have taken place. Service user plans were more reflective of diversity issues such as sexuality, as good examples were seen not only of individuals gender, but also their sexual orientation including the support requirements that were put in place for them. The same was true for the Care Homes for Adults (18-65 years) Page 11 of 31 Evidence: religious affiliations and mental health needs of service users. This included relapse triggers, indicators and crisis plans for individuals. In this way service users could be best supported to preserve their dignity, independence, and avoid the need for recall to hospitals when they become unwell. Staff were well- attuned to the support and management strategies for service users. More importantly, while the mental health issues are seen as an integral part of the whole person and it was not treated as the only aspect of the service users being. All service users spoken to were happy with their individual plans, which were well maintained by the home. A sound system of key-working is in pace to support service users in every aspect of their lives. In this respect service users meet with individually appointed staff to review their care and discuss issues or developments on a regular basis or as they arise. Service users also have good access to advocacy services, which some make use of, while others use the support of relatives or their representatives as appropriate. This was clear throughout the inspection from observation, talking to service users and members of staff that service users are very involved in decisionmaking at Empress Lodge, particularly as it relates to their life ambitions. Evidence of this could be drawn from the fact that some service users take responsibility independently for various aspects of their well-being such as, handling their finance and medication. Others receive varying levels of support in this respect. What was important is that everyone was working towards some goal or life ambition and the staff were pivotal in enabling and supporting them with this, albeit at varying degrees. This has become much more visible now, given the introduction of the new flats that serves up to four service users with lower support needs. This new area serves as a key link for those wishing to go on to either independent or more semiindependent living. Regardless of where individuals were placed, all service users knew their key-workers and could describe the relationships they held with them. There was an improvement in the quality and maintenance of risk assessments in the home, as in all of the cases sampled - updated information was available on how service users were enabled to maintain their independence while limiting the risk of coming into harm. Risk assessments were linked to each of the service users plan and staff spoken to showed a good awareness of them. It was clear that they were used as working tools during engagement with service users. Four of the service users spoken to expressed the view that their risk assessments gave them more confidence to try and do more for themselves. They also felt that the manager and staff were very supportive in trying with them to take greater control and responsibility for their lives. One individual summed it up by saying; They do let you get on with things here even when it is not your best day. Care Homes for Adults (18-65 years) Page 12 of 31 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. Service uses continue to actively participate in their community and benefit from a good range of social and developmental activities. They are supported to maintain their personal networks and are respected and treated in a dignified manner by all staff. Meals are provided in line with their nutritional and cultural interests and needs. Evidence: From interviews held with service users and records viewed, it was evident that most individuals carried on with most of the activities that they had an interest in, be it for leisure, educational or practical development. One individual was enrolled in an Assertiveness and Developing Interpersonal Skills course. This individual was also engaged in voluntary work for two days in a charity shop, while another is engaged for one day. Another individual was engaged with the Beeches for one day a week, where he is able to develop some practical and general cleaning skills. Staff continued to work exceptionally well with enabling service users to pursue their interests and in Care Homes for Adults (18-65 years) Page 13 of 31 Evidence: this respect, they made positive links with a wide range of community resources. A programme of activity is in place for each service user. Attention is given to the detail around individuals personal interests, culture, religion, gender, sexuality and sexual orientation in their pursuits. Service users have access to a computer to develop their information technology skills. During Divali celebrations staff supported two individuals to attend a temple in East London. Service users have a strong community presence and most, are well known by neighbours, as the registered persons have managed to maintain good relations with them. A significant number, engage with their community independently, while others do so semi-independently including: going to the shops, banks, post office, cafes, their local GP, religious establishments, the library, bingo hall, and bowling alley to name a few. Where possible, service users are encouraged to use the transport links available to them. Individuals are able to move freely in and out of the home to attend their personal engagements. It was reported that the home plans to participate in a local bowling competition, in October 2009. This is a competition that they have won on two previous occasions and were runners up in 2008. As such, they continue to enjoy being an active part of their community, and are well-supported to so do. In discussion with service users, they confirmed that they are encouraged to maintain their friends and family networks, which is supported by a well-established visiting policy. One individual spoke positively of his friends that he regularly visits in the community, as well as the visits that he regularly makes to see his family. He spoke vividly of having a girlfriend and was in negotiation with the manager, for her to join them on the five day holiday planned for service users. It was positive to see consideration being given to the individuals request, the outcome of which is unknown at the time of writing this report. He summed up his satisfaction with the service by statting: I just love it here, as they help you with your problems, but also- to enjoy life. The home is noted for recognising and celebrating service users birthdays with their consent. Relatives and friends are usually invited. Other events are also held such as barbecues, of which two were held prior to the inspection. At the time of the visit, plans were underway for a Halloween party. Records of the activities and events held in the home, demonstrated that service users do have the benefit of maintaining their family and friends networks. Staff engagement with service users was observed and on all occasions, including the handling of complex situations,which were positive. The staff on duty displayed a good understanding of individual service users needs and their interventions were of a high standard i.e. promoting service users dignity and respect through engagement. Service users spoken to were adamant about the way in which staff treated them - Care Homes for Adults (18-65 years) Page 14 of 31 Evidence: being second to none. Feedback from external professionals confirmed that the staffing engagement with service users was both effective, and of a high standard. The standards exhibited have been instilled through a very good programme of induction and further training in areas such as; equality and diversity and safeguarding. There was evidence of regular staff meetings and staffing supervision which reinforce values. Service users benefit from working with a staff team that places a high value on upholding their dignity and respect. Examples of this included: service users opening their mail, being called by their preferred names, support to maintain their religious and cultural practices while showing appreciation for others and actively encouraged to participate in all aspects of their living. All service users have access to advocacy services and opportunities to participate in civic processes, should they wish to. This is another strong area of the homes operations. On the first day of the inspection the evening meal was observed, which was spaghetti bolognese. One individual had a Kosher diet reflecting his cultural preference and for desert service users had a choice, including fresh fruit and ice cream. The activity was very relaxed with service users being able to eat when and where they chose to. Appropriate support is given to those on special diets e.g. low calorie or low sugar diets. Service users are actively encouraged to prepare their breakfast and lunch, enabling some to develop their culinary skills and their independence. Most individuals spoken to were quite happy with the meal arrangements. A good supply of dry and frozen food was in stock, including fresh fruits and vegetables. Service users were observed helping themselves to drinks and light snacks as and when they needed them and took responsibility for tidying up on a daily basis. Only two service users did not fully complete their meal and in discussion with them, it was explained that they satisfied with the quantities they consumed. Menus including take aways, were available for inspection. Food storage in the home was generally good. Care Homes for Adults (18-65 years) Page 15 of 31 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. Service users are receiving personal support in line with their needs and wishes. The management and staff work exceedingly well in meeting their physical and emotional needs. While there many aspects of good practice in the support provided to service users with their medication, more needs to be done through the accurate recording of medication to evidence that all service users receive the best level of support in this area. Evidence: Service user plans were individualised and used as working tools. Service users personal preferences and needs were detailed and so staff were very clear about the way and level of support that each person required. A good example could be drawn from the sexual health care plan of one service user, which contained the specifics around his sexual health. Staff was observed engaging with the individual in a respectful and dignified manner. The flexibility of the staff was also pivotal to achieving positive outcomes for service users as in some cases, although staff were aware of service users preferences - at times they were inappropriate for example wearing a favourite jacket when it is dirty and inappropriate for the weather. Care Homes for Adults (18-65 years) Page 16 of 31 Evidence: Service users were empowered to change their minds or make alternative choices, which they valued and spoke positively of. The communication and negotiation skills of the staff on display were exemplary in achieving the best possible outcomes for service users. There was also evidence of good team work in cases where service users were difficult to engage or unresponsive to agreed plans for personal support. It was clear that they pride themselves on achieving positive outcomes for service users as a team, which is reflected in the overall service outcomes for Empress Lodge. During the course of the inspection staff were observed in one to one sessions with service users either in the kitchen, staff office or one of the lounges. The type and level of support offered in these instances varied from practical to counselling and/or the diffusing of situations. Staff were very good in recognising and dealing with service users when they became stressed, distressed and/or unsettled. Having clear guidelines and indicators for each individual, enabled them to pre-empt and make timely interventions in supporting service users. Since the inspection it is known that one of the placements had broken down and feedback received from the care coordinator involved, indicated that there was nothing that the staff and management failed to do in supporting the service user concerned. In discussion the care coordinator indicated that it is one of the best mental health services that she has been in contact with to the point that negotiations were on the way for the individual to receive further mental health care and support from Empress Lodge. There was extremely good evidence to support the view that the management and staff have been engaged with external professionals and agencies to obtain the best possible physical, psychiatric and and psychological support for service users. Some of the professionals involved in providing emotional and physical health care support included: the GP, dentist, gastro-enterologist, occupational therapist, chiropodist, community psychiatric nurses including input from the Assertive Outreach Team and where appropriate, the psychologist. Service users in most instances get good support with their medication including opportunities to independently manage them. At the time of the visit two individuals were self-medicating, while one was in the process of being prepared for this. A sound medication policy was in place to guide staff and service users in relation to medication and their health care. Some service users had a good understanding of what drugs they were on, the intended benefit/s and the side effects. Risk assessments were in place for those individuals aspiring towards managing their medication independently and up to eleven staff handling medication had appropriate training in this respect. Care Homes for Adults (18-65 years) Page 17 of 31 Evidence: There was evidence that medication audits take place monthly, as part of quality monitoring and a daily audit of medication is carried out. However, a clear pattern was observed around lack of recording of both; medication refused, and in some cases medication actually administered. Service users therefore do not have full assurances that their health care needs are best provided for. The situation was discussed with the manager during the course of the inspection and he gave the assurance that he would deal with the shortcomings straight away. Monthly audits are carried out by the external pharmacist while medication storage was in line with the requirements of this standard. Care Homes for Adults (18-65 years) Page 18 of 31 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 management and staff have a positive approach in dealing with complaints, which is reassuring to service users and their relatives. Sound safeguarding protocols and practices ensure that service users and protected from the risk of, or harm from abuse. Evidence: The complaints procedure remains available to service users, staff, external professionals and relatives. All service users spoken to and this included more recently placed individuals demonstrated an understanding of their right to complain. The complaints record was examined and a clear audit trail was available of how each complaint was handled including the outcome. Staff spoken to had a good understanding of their role in supporting service users to complain should they become unhappy with any aspect of the service. The manager uses concerns and complaints as a mechanism for evaluating and improving the service and so concerns are picked up and treated just as important as complaints. Service users have various forums to raise concerns and complaints to include; direct or indirect approaches to the manager or staff, through a representative, through their service user meetings or during quality assurance monitoring of the home. The staff training records were examined and all staff did have safeguarding training. Through discussion with some of them, it was clear that they had a good understanding of their role in safeguarding service users. They also demonstrated an Care Homes for Adults (18-65 years) Page 19 of 31 Evidence: understanding of safeguarding as it relates to whistle-blowing and their duty of care to take affirmative action should any service user be at risk of, or come to harm from abuse. The manager reported that he is on the Redbridge Adult Safeguarding Committee and so, was not only aware of the local authoritys safeguarding protocol, but also demonstrating his commitment to safeguarding as a whole. This is an area that is covered as at induction for all staff and an updated policy was in place to guide them in relation to safeguarding vulnerable adults. Recruitment practices in the home are robust, which also acts as a safety net in protecting service users from coming into contact with individuals who may be unsuitable to work with them. There were no safeguarding issues in the home. Care Homes for Adults (18-65 years) Page 20 of 31 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. Service users continue to enjoy an home in which due consideration is given to maintaining and developing it, with their comfort and safety in mind. Their safety is enhanced through a good system of hygienic practices that is promoted in the home. Evidence: On the day of the visit the home was clean, airy, relaxed with service users engaging in various aspects of their daily activity. It must be said that they seemed quite comfortable in doing so, Since the last inspection, it was the first opportunity to assess the quality of the extension i.e. the four bedded flats to the rear of the home. This area was decorated to a high standard and three of the service users occupying that area spoke highly of their individual accommodation. The rear of the building was also well-developed in terms of smoking areas and garden facilities with partly turfed and part wooden-decked areas, which service users were observed enjoying. In this respect they seemed to have more options to relax and engage in something different if they so wished. There were some redecoration works that were carried out for example: re-carpeting of some areas that gave the original part of the home a welldeserved lift. Service users now also have the benefit of a large fish tank, a large screen television, a computer and, a video and book library. One individual stated The home is really nice and you could find a comfortable space almost anywhere. All service users spoken to were very pleased with the environment and the facilities. Care Homes for Adults (18-65 years) Page 21 of 31 Evidence: There were areas requiring some replacements/repair works and the manager was aware of the need to carry out the remedial works required. On both visits, the home was clean and well-maintained and to this end service users make an active contribution through a cleaning roster. Some of the service users spoken to expressed the view that they felt taking part in the cleaning was a good thing as it helped them to take responsibility and maintaining a key aspect of their daily living skills. Updated policies and procedures were in place to promote and maintain health and safety in the home. There was also evidence of good safety signage throughout the home along with hygienic facilities for hand washing, which were used by both service users and staff. The laundry facilities were appropriate for the service and this area was also well-maintained. Sound arrangements were in place for handling soiled linen. Service users are supported and encouraged to use these facilities as much as possible and from observation, good guidance and support was in place for them to so do. Staff spoken to demonstrated a good understanding of health and safety generally and in relation to the laundry area. The home continues to comply with the Water Supplies Regulations 1999. Care Homes for Adults (18-65 years) Page 22 of 31 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. Service users continue to benefit from having a staff team that is well-trained, skilled, well- supported and motivated to work with them. Sound recruitment practices ensure that service users remain in safe hands at all times. It must be noted that the manager is constantly seeking to develop the service with the view of enhacing outcomes for the all service users living at Empress Lodge. Evidence: Throughout the course of the inspection staff were observed interacting and engaging service users in a positive manner, even in cases where some individuals proved a bit more difficult to engage. All staff spoken to had a good understanding of the service user needs and the interventions required and plans that were in place to support and empower them. Despite the range of complex needs service users views were complimentary regarding the staffing input in meeting their individual objectives. Regardless of the challenge/s presented by service users, staff were adept to the strategies required and so there was an air of confidence which brought about a sense of calm in the home. From the records seen staff have engaged the services of a wide range of professionals in promoting the health and welfare of all the service users living at Empress Lodge. Every detail is captured even in telephone logs that are maintained Care Homes for Adults (18-65 years) Page 23 of 31 Evidence: for each individual regarding their welfare. Feedback obtained from external professionals confirmed that the staff bent over backwards to ensure that service users get the best possible support and this included working closely with relatives. One professional summed up the staffing input even with the placement breaking down as: Excellent. It was noted that over sixty per cent of the staff had achieved at least an NVQ Level 2 in care with a significant number completing the Level 3 qualification. This continues to be a strong area of the homes operations. A random sample of three of the staffing recruitment files were assessed. They bore evidence that the registered persons continued to carry out robust practices when recruiting staff, including volunteers. All relevant information was on file for example: completed application forms, a minimum of two satisfactory references, satisfactory Criminal Records Bureau checks including Safeguarding of Vulnerable Adults (SOVA) First Checks, identification verifications, health declarations and others to include where appropriate the right to work in the United Kingdom. Staff spoken to did confirm that they attended interviews as part of seeking employment at Empress Lodge. They were also subject to a probationary period that was in line with the requirements of this standard and the combination of the above practices ensured that only staff that are suitable - get the opportunity to work with the client group. Staff once employed are provided with a copy of the General Social Care Councils code of conduct to ensure that they are made more aware of the key principles underpinning the provision of good quality care. There was evidence that a staff training and development plan was in place detailing the specifics of the training and the dates undertaken. It was clear that although the training is geared towards ensuring that the specialist mental health needs of the service user group are met, it is also designed to ensure that the organisational objectives are met. To this end a training needs analysis is designed involving the staff, which enables them to take responsibility for their learning and development. At the time of the inspection, all staff did have a thorough induction and their mandatory training. It was also noted that a new structure was in place and as such there are now two deputy managers, along with the senior support workers, support workers and an activities person. This change has provided a bit more depth and responsibility amongst the staff group as a whole, which is positive, particularly in light of the manager having additional responsibility as the Director of Care for the company. A good system of supervision is in place and records indicated that staff were having regular support to carry out their role and functions. Monthly supervision sessions were targeted for senior staff Care Homes for Adults (18-65 years) Page 24 of 31 Evidence: with two-monthly sessions for support staff. To this end new supervision contracts were reportedly given out. From assessing the homes action plan, arrangements were being made for the deputy managers to enrol for the National Vocational Qualification Level 4 in Care to enhance their competency levels in management. Sound arrangements were therefore in place to equip staff to provide an enhanced service at Empress Lodge. Care Homes for Adults (18-65 years) Page 25 of 31 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users continue to enjoy living in a home that is well-run and managed with their best interests at heart. Good quality assurance systems including monitoring systems, are in place to ensure that the service is developed in line with service users needs and wishes. Sound health and safety practices promote the safety, best interests and welfare of service users and staff. Evidence: Since the last inspection the current manager has been successfully registered with the Commission. From all accounts i.e. both internally and externally he has continued to command the respect for his leadership of the service. Along with his managerial responsibilities at Empress Lodge, he has been appointed as the Director of Care for the company that employs him. During discussions with the registered manager it was widely accepted that his understanding of the service objectives were clear, one of which is to drive up the standards of care to the highest possible level. In this respect he has completed the Registered Managers Award along with a range of other training, which is geared towards developing the service, the staff team and indeed his professional development. Care Homes for Adults (18-65 years) Page 26 of 31 Evidence: Some of the training that he has undertaken included: Team Building, Achieving Excellence in Care, Supervision, Bereavement, Equality and Diversity, Safeguarding and Risk Management. One of the key strengths is his ability to communicate effectively with the staff team, service users, relatives and external professionals. The impact of this can be seen in the general improvement in the quality of services provided at Empress Lodge. Staff and service users spoken to, expressed positive experiences with the manager and from the staffing contributions overall, it is envisaged that the service would continue to provide improved outcomes for those individuals living there. There was a range of quality assurance mechanisms in place for monitoring and developing the service. Service users progress and development is measured through regular reviews and they are actively involved in developing the service. In this respect service user surveys were carried and considered alongside feedback obtained from regular service user meetings. Monthly audits take place on the home, medication, along with the monthly provider monitoring (Regulation 26) visits. A selfassessment on Infection Control was carried out on 12/1/09 with the results and actions recorded. An annual development plan was in place for the home, which is outcome focused with service users and staff being significant to the core. Working closer with the multi-disciplinary team to enable service users to choose therapeutic pathways, building on service users strengths seeking to improve their quality of life, and committing to staff training and development are just some of the key outcomes being worked on.The manager provided evidence of an achievement i.e. ISO 9001 for quality administration systems which is positive. There was also evidence that the views of relatives and external professionals are sought with as part of quality monitoring. Staffing views are richly considered in improving and developing the service.This is an area that is continually growing at Empress Lodge. A number of health and safety records were assessed during the course of the inspection, which included; food hygiene, fire safety, infection control, pest control, risk assessments - both specific and generic, emergency lighting, portable appliance testing, health and safety audits, gas, and electrical safety reports and certificates.They were all found to be in order and updated and it was noted that the service received a three-star rating in Food Safety from the London Borough of Redbridge. It was positive to see that risk assessments were carried out for activities outside the home, as the service users do get out and about quite frequently. All levels of staff received health and safety training, and health and safety policies were updated. As such the health and safety practices and protocols ensure that service Care Homes for Adults (18-65 years) Page 27 of 31 Evidence: users and staff live and work in a safe and comfortable environment. Care Homes for Adults (18-65 years) Page 28 of 31 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 29 of 31 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 20 13 The registered manager is 23/05/2010 required to ensure that staff accurately record on the medication administration charts the action taken to support service users with their medication at all times. To evidence that they are providing the best possible support to service users with their healthcare. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 30 of 31 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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