Care Home: Fenham Lodge

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What the care home does well Fenham Lodge provides a very homely and comfortable environment for the people who choose to live there. The premises are clean, well decorated and well maintained. Residents are encouraged to personalise their rooms as they choose. Efforts are made to provide a relaxed atmosphere so that residents feel it is their home. Residents are supported to maintain their independence in daily living tasks as far as they are able, for example dealing with laundry, tidying their rooms, choosing what to wear, what to do and to go shopping for their food and clothes. A small kitchen facility enables residents who are able to cook some of their own meals with staff supervision. The gardens are well tended and accessible to wheelchairs with lawns and a patio area that can be utilised for suitable leisure facilities for service users. There is a person centred approach to care planning. Residents and their representatives are fully involved in their care planning and reviews. Reviews are undertaken every six to eight weeks with the manager, the resident and their key worker and changes made accordingly to their care plan. Residents have a full social programme and attend college courses, leisure activities, therapeutic activities, work experience and one resident has paid employment. Most residents have full weekly programmes with some continuing into the evening. There is good access to healthcare services for example GPs, physiotherapy, occupational therapy, speech and language therapy, dentists and advocacy. Residents are supported to attend GP surgeries and outpatient clinics. There is low staff turnover with some staff and management having worked at the home since it was first registered. Recruitment is robust with appropriate checks obtained prior to appointment. The interview process ensures that staff with the right values and beliefs are appointed. Residents are involved in the recruitment of new staff. Staff work well as a team and are well supported through staff training, regular team meetings and supervision. There is good communication and consultation with residents and their representatives. Regular meetings are arranged for residents who are encouraged to fully participate in life at the home. Advocacy services are arranged as needed. What has improved since the last inspection? There were no requirements or recommendations from the previous key inspection. However it is evident that the service is continually reviewed and that residents` views and suggestions are listened to acted upon to improve the service. For example resident`s proposal to change the venue for one of their annual holidays has been actioned. Policies and procedures are kept under review and other documentations regularly updated. There is increased staff supervision which is now provided twelve times per year and more robust documentation developed. A new staff appraisal system has been developed. Staff have received training in the Mental Capacity Act & Deprivation of Liberty and assessments have been undertaken. Due to funding more local courses have been sourced for residents to attend which has proved successful, for example one resident has enjoyed taking part in tai chi classes. During 2009 a large patio in the rear garden was relayed and a new floor provided in the annexe toilet. The visitor`s toilet, main bathroom, lounge, dining room, kitchen, hallway and corridor in the main house were all redecorated. One bedroom was also redecorated and coved. A new kitchen table that seats seven residents and three staff has been purpose made and enables all the residents to eat together. In addition new dining chairs, a new tumble drier and two new beds and mattresses have been purchased, kitchen equipment replaced, carpets cleaned and the annex toilet decorated. What the care home could do better: Whilst there is evidence of good consultation with residents and their representatives, there is no formal quality assurance programme in place. This should therefore be developed to provide evidence of consultation with residents, their representatives and other stakeholders and to develop an annual plan for the home. Medication room storage temperatures should be monitored to ensure that medicines are stored safely. Key inspection report Care homes for adults (18-65 years) Name: Address: Fenham Lodge The Street Hatfield Peverel Essex CM3 2EQ     The quality rating for this care home is:   three star excellent 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: Diana Green     Date: 1 3 0 1 2 0 1 0 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 29 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 29 Information about the care home Name of care home: Address: Fenham Lodge The Street Hatfield Peverel Essex CM3 2EQ 01245381550 01245381069 julie_fenhamlodge@talktalk.net Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Miss Julie Sanderson care home 7 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability physical disability Additional conditions: The home accommodates seven people with learning disabilities who may also have physical disabilities Date of last inspection Brief description of the care home Fenham Lodge is a modern detached bungalow that has been adapted and extended to provide accommodation for seven adults with learning and/or physical disabilities. Accommodation is in single bedrooms, with good communal daily living space (lounge/dining room, kitchen, gardens, etc.). The home is homely and domestic in character, and in keeping with the local community. The home has established good links with the local community, and is within walking distance of the local facilities in Hatfield Peverel that include general shops, library, pubs, and public transport. The registered provider works alongside the registered manager within the home, and the current staff team has a wide range of experience and skills. The registered manager of Fenham Lodge is Matthew Larkin. The fees for living at the home range from £540 to £804 per week. Items considered Care Homes for Adults (18-65 years) Page 4 of 29 7 7 Over 65 0 0 Brief description of the care home to be extra to the fees include toiletries, hairdressing, magazines, papers and leisure activities although the cost of holidays is inclusive. Inspection reports of Fenham Lodge are available from the home and also from the Care Quality Commission website www.cqc.org.uk Care Homes for Adults (18-65 years) Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: 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: The quality rating for this service is 3 star. This means that people who use this service experience excellent quality outcomes. This unannounced inspection took place on 30th December 2009 & 13th January 2010. All of the Key National Minimum Standards (NMS) for Younger Adults, and the intended outcomes, were assessed in relation to this service during the inspection. This report has been written using accumulated evidence gathered prior to and during the site visit, including the homes Annual Quality Assurance Assessment (AQAA). The Annual Quality Assurance Assessment (AQAA), which is required by law to be completed by the service, is a self assessment that focuses on how well outcomes are being met for people using the service. This was completed by the registered provider and returned to us prior to the visit to the home. Information received in the AQAA was comprehensive and provided us with excellent detail to assist us in understanding how Care Homes for Adults (18-65 years) Page 6 of 29 the registered persons understand the services strengths and weaknesses and how they will address them. The inspection process included reviewing documents required under the Care Home Regulations. A number of records were looked at in relation to residents, staff recruitment and training, staff rotas and policies and procedures. Time was spent talking to staff and the manager. Surveys were sent to service users and their representatives, health and social care professionals and staff. The proprietor, manager and staff were welcoming and helpful throughout the inspection. Care Homes for Adults (18-65 years) Page 7 of 29 What the care home does well: What has improved since the last inspection? There were no requirements or recommendations from the previous key inspection. However it is evident that the service is continually reviewed and that residents views and suggestions are listened to acted upon to improve the service. For example residents proposal to change the venue for one of their annual holidays has been actioned. Policies and procedures are kept under review and other documentations regularly updated. There is increased staff supervision which is now provided twelve times per year and more robust documentation developed. A new staff appraisal system has been developed. Staff have received training in the Mental Capacity Act & Deprivation of Care Homes for Adults (18-65 years) Page 8 of 29 Liberty and assessments have been undertaken. Due to funding more local courses have been sourced for residents to attend which has proved successful, for example one resident has enjoyed taking part in tai chi classes. During 2009 a large patio in the rear garden was relayed and a new floor provided in the annexe toilet. The visitors toilet, main bathroom, lounge, dining room, kitchen, hallway and corridor in the main house were all redecorated. One bedroom was also redecorated and coved. A new kitchen table that seats seven residents and three staff has been purpose made and enables all the residents to eat together. In addition new dining chairs, a new tumble drier and two new beds and mattresses have been purchased, kitchen equipment replaced, carpets cleaned and the annex toilet decorated. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 29 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People planning to live at Fenham Lodge can be assured they will have sufficient information made available to enable them to make a decision and that their needs will be assessed prior to admission. Evidence: The home had a statement of purpose and service user guide that were comprehensive documents. Copies of both documents were viewed during the site visit and were seen to meet regulatory requirements. The manager confirmed that these would be made available to potential residents and their representatives. The admission process was discussed with the manager. There had been no new admissions since the previous key inspection, the majority of residents having lived at the home for a number of years. It was therefore not possible to verify the admission procedures. However from discussion with the manager and inspection of the current residents care plans it was evident that a full assessment would be undertaken prior to admission to ensure the residents needs could be met. Care Homes for Adults (18-65 years) Page 11 of 29 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Fenham Lodge can expect to have their care needs met by robust care planning and to be fully supported to take responsible risks and make independent decisions about their lives. Evidence: The AQAA informed us that the aims of the home are to assist each service user to maintain the highest possible level of independence and quality of life. The arrangements for care planning were discussed with the manager and three care files was viewed. Care plans were person centred and included care plans for three key area of need, i.e. health, personal and social care and independent living. Health care plans included individual care plans with guidance for staff in medication, appointment schedules, skin integrity, behaviour, hearing dental care etc. Personal and social care plans included guidance for staff in meeting the residents social needs, activities, communication, family, mobility and confidence etc. Care plans for independent living care included the residents personal hygiene needs, sleeping, domestic duties, management of money etc. and provided clear guidance to ensure staff were aware of Care Homes for Adults (18-65 years) Page 12 of 29 Evidence: residents needs in order to provide appropriate support. All care plans were reviewed monthly. Daily records were very detailed showing the range of activities that residents were involved in and also demonstrated that care staff were monitoring their changing needs. A tutor who completed a survey told us all the carers understand their needs and are very respectful of them. Most residents had a family member that was involved in their care and assisted them in making decisions. Information on advocacy services was also available. One resident was on leave with their family having spent the Christmas holiday with them. All seven people living at Fenham Lodge who completed surveys told us they could always make decisions about what they do each day. One also told us my mum is very involved in my care planning. Fenham Lodge had a risk management strategy in place. The AQAA informed us that residents are enabled to contribute to the daily life and routines of the home, with all risks comprehensively assessed and managed. Risks were assessed and minimised as far as possible without restricting individuals independence. Risk assessments were seen for individual risks, for example going on holiday, into the community, swimming etc. Daily records were very detailed and provided good evidence of how the resident spent their day. This showed that residents were involved in a range of activities and also demonstrated that care staff were monitoring their changing needs and promoting their independence. Care Homes for Adults (18-65 years) Page 13 of 29 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Fenham Lodge are supported to lead a fulfilling life that promotes their independence and is enhanced by a full programme of social and educational activities. Evidence: The home had a pictorial activity board on display for residents information. This detailed daily activities that each resident took part in. The home had a large resource of activities available for residents, including table football, board games, card games, DVDs, Cds, and a large screen television in the lounge with televisions also provided in individual rooms. The weekly programme of activities was viewed and showed that a comprehensive range were available, for example music, videos, shopping, walks, cooking skills, play station, community skills, toys, bowling, woodwork classes, life skills, horse riding etc. The daily records for one resident viewed confirmed they had work experience in a restaurant, did their own ironing, some cooking for themselves, Care Homes for Adults (18-65 years) Page 14 of 29 Evidence: attended a woodwork class, a communication skills class and went bowling. Another resident spoken with told us they enjoyed horse riding and helping with others attending the class. A tutor told us that three people from Fenham Lodge attended their group and said they always arrive on time and are collected promptly at the session end. They are happy, sociable and always well presented and form an integral part of the group. The AQAA informed us that all of the residents are members of Chelmsford Mencap Adult Adventurers Club which provides a full programme of outings and activities during college holidays outings during the last twelve months have included IMEX cinema trip (London), a tour of the BBC, a West End Show, Greyhound racing, trips to Woburn Safari, Howletts Wild animal Park and Bird World, a magic show, karaoke and a pantomime. The residents also attend regular discos, and social events organised by the League of Friends of the Chelmsford Resource Centre as well as organising their own social events. During the visit to the service one person was on leave at their own home, one was on work experience at a restaurant and one was on horticultural work experience. The AQAA informed us that Fenham Lodge has become a valued part of the local community. The residents have become friendly with many of the local people and they feel safe and confident when out and about. Residents are also supported to take two holidays each year which they choose. The statement of purpose included the homes visiting arrangements. There is also a Family and Friends Code of Conduct Policy. We were informed that family members regularly visit the home and are free to visit at any time and can see their relative in private. During the visit to the service a resident was on leave at their own home and others had spent Christmas at home. The home has a domestic size kitchen with a breakfast table and separate utility room. There is a small kitchen in the semi-independent part of the home that is used by two residents for cooking some meals themselves. A lounge/dining room has comfortable seating and a large dining table that accommodates all residents and staff. Staff prepare and serve main meals and residents are responsible for cleaning and tidying their rooms with staff support as they are able. The menus were viewed and comprised a seven week rota with seasonal variations. We were informed that the home had achieved the Gold Food Hygiene Award from the local environmental health department for November 2006 and a recent inspection awarded the home 5 stars. The main meal was served in the evening to accommodate the many activities residents were involved with. The lunchtime meal was observed and was a very relaxed family occasion. Ravioli was served with bread and butter and a chewy bar to follow. The evening meal for the same day was planned to be quiche, Care Homes for Adults (18-65 years) Page 15 of 29 Evidence: salad, chips and coleslaw. Drinks were seen to be provided during the day. Staff were observed to assist residents with eating as needed in a sensitive manner. All residents appeared to be well nourished. Care Homes for Adults (18-65 years) Page 16 of 29 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Fenham Lodge are supported in their personal lives and have good access to healthcare services. The standards for administration of medicines are good but monitoring of room storage will ensure medicines are safely stored. Evidence: The AQAA informed us that Fenham Lodge operates a key worker system to support residents in arranging appointments (chiropody, hairdressing, assisting with finances, purchasing personal items). They also assist them in reviews and attendance at GP or outpatient appointments locally or in London. This was also confirmed in discussion with staff and from the records viewed . From observation and the records viewed it was evident that residents were enabled a choice in what clothes they wore, how they spent their day and the activities they took part in. From discussion with staff, the manager and an inspection of records it was evident that residents had access to GPs, district nurses, physiotherapists, occupational therapists, dentists, community specialist nurses as relevant. We were also informed that links with district nurses had recently been strengthened with training being provided for care staff. A GP who complete a survey told us I am impressed at the Care Homes for Adults (18-65 years) Page 17 of 29 Evidence: quality of care given to the residents of Fenham Lodge. They are all encouraged to lead a full life with excellent attention to health needs. A physiotherapist also told us Fenham Lodge always attend appointments to the physiotherapy department on time. They always have good communication with clients and other health professionals. The medication systems for the home were discussed with a staff member who was designated to give medication. The home had a medication policy and procedures for staff guidance that were kept under review. A list of staff initials and signatures was maintained to enable appropriate follow in the event of an adverse incident occurring. All designated staff received appropriate training and were assessed as competent prior to them being responsible to give medication (also confirmed from the records). Medication is provided by the local pharmacy in a monitored dosage system and individual containers and systems were in place to ensure that medication received and disposed of was appropriately checked. Medication was stored in a cupboard that was fixed to the wall in the managers office. There was no monitoring of room temperatures undertaken to ensure they remained within safe recommended levels (maximum 25 degrees Centigrade). This was rectified without delay once brought to the attention of the manager. The medicines administration records for three residents were viewed. All were accurately completed with no omissions present. However one residents MAR sheet recorded two separate dosages of the same medicine in one dose rather than two as prescribed. This is confusing and prone to error. However action was taken to address this once brought to the attention of the manager. The most recent guidance on medicines available for staff was dated 2003 and the manager agreed to obtain up to date guidance. Care Homes for Adults (18-65 years) Page 18 of 29 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Fenham Lodge are assured they will have their concerns and complaints listened to and acted upon and they will be protected by adult safeguarding policies, procedures and practises. Evidence: The AQAA informed us that Fenham Lodge has a comprehensive concerns and complaints policy of which a copy is given to residents families with a summarised version in appropriate language and format given to each resident and explained to them. The complaints policy and procedure was viewed and seen to include timescales for a response and met regulatory requirements. The procedure was included in the statement of purpose and service users guide. No complaints had been received by the home or the Commission since the previous key inspection. However a compliments folder was viewed demonstrating that people and their families were pleased with the service provided at Fenham Lodge. The Home had a safeguarding policy and procedures and a whistle blowing policy in place to ensure residents were safeguarded from abuse. The records viewed during the visit to the home confirmed that staff received training on abuse during their induction, through NVQ level training and regular updated training was also provided. The home had copies of the Essex Safeguarding procedures available for staff guidance to be used in the event of an allegation being made. We were informed that all updated CRB Disclosures were being requested for all current staff to ensure that residents are appropriately safeguarded. There had been no safeguarding alerts made since the previous key inspection. Care Homes for Adults (18-65 years) Page 19 of 29 Evidence: The systems for supporting residents with their finances were discussed with the manager. The majority of residents had a relative/advocate to assist them. Each resident had a cash box with a key for storage of their personal monies that was kept in a cupboard in the managers office. The systems were checked for two service users. Records, receipts and amounts of cash held were accurate. Care Homes for Adults (18-65 years) Page 20 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Fenham Lodge provides a clean, homely environment for residents that is well decorated, well maintained and comfortably furnished. Evidence: A tour of the premises was undertaken during the site visit. The home is domestic in size and located in a cul de sac and close to local amenities (chemist, shops, doctors surgery etc). The entrance to the home, premises and gardens are secure and wheelchair accessible. The well tended gardens are laid mainly to lawn and shrubs with a patio. The home is clean, well decorated, comfortably furnished and well maintained. The AQAA informed us that residents are encouraged to personalise their own rooms and are involved as far as possible with choosing the decor and furnishings of the home. Some residents individual rooms were seen with their agreement and were well personalised with photographs and personal items. Records confirmed that the home was appropriately maintained and that fire safety practises were in place to meet the requirements of the local fire service. The home was clean and odour free. There were infection control policies and procedures for staff guidance. The utility room was domestic in size and was fitted with two washing machine that had the capacity to carry out sluice cycles (wash at minimum 65 degrees for not less that 10minutes) and a tumble drier. Staff hand Care Homes for Adults (18-65 years) Page 21 of 29 Evidence: washing facilities were provided in the main kitchen but not the small kitchen (used for semi-independent residents) or in bathrooms. This was discussed with the manager and paper towels and liquid soap provided prior to the second visit to the service. Care Homes for Adults (18-65 years) Page 22 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are cared for by well trained, experienced and skilled staff who are clear of their role and are well supported and well supervised. Evidence: The AQAA informed us that the Proprietor and registered manager give the highest priority to the maintenance of a staff team with the qualities, qualifications and training to meet the assessed needs of the people who choose to live at Fenham Lodge and the qualities, qualifications and training required to meet the assessed needs of the people who choose to live at Fenham Lodge and that they have the attitude, commitment and motivation to create a sociable environment with a friendly, positive atmosphere. During the visit to the home staff appeared skilled and experienced and motivated in their work. All staff were observed to treat residents with respect and to listen and engage in conversation with them. We were informed that from a total of 8 care staff, 7 had an NVQ level 2 qualification or above which exceeds the recommended standard for 50 care staff. The manager and proprietor were both on leave but did attend at different time during the visit to the service. There were three care staff on duty. We were informed that with the exception of the semi-independent residents, care staff cooked meals and Care Homes for Adults (18-65 years) Page 23 of 29 Evidence: residents assisted with household tasks and laundry as they were able. Residents appeared well cared for and were well supervised. The AQAA informed us that there was a low staff turnover and low sickness rates and agency staff had never been used. Four of the eight staff and management had worked at the home for thirteen years since it opened. This ensured that residents were cared for by people they knew and who were aware of their care needs. From discussion with staff it was evident that regular meetings were held and handover sessions to ensure staff were appropriately supported and were kept up to date with residents changing needs. Minutes of staff meetings were also viewed and showed evidence of discussion regarding residents needs, for example in health, activities, birthday plans, health and safety. The recruitment records for two staff were viewed including one staff member appointed since the previous key inspection. Both included evidence that the required checks had been undertaken prior to appointment (two satisfactory references,CRB Disclosures, evidence of identification etc.). The AQAA informed us that all of the residents had been involved in the recruitment of new staff member to cover maternity leave. This had proved so successful that at their request the contract had been extended. This shows that residents are empowered to take a full and active part in the running of the care home. The record of training was seen and confirmed that since the previous key inspection regular updated training had been provided in fire safety, manual handling, food safety, health and safety, safeguarding adults, infection control, first aid and medication. The training records for the same staff were viewed and confirmed that both had undertaken manual handling, fire safety, food safety, first aid, and safeguarding adults training. Training sessions had also been provided in care issues relevant to the client group (managing challenging behaviour, catheter care etc.) The AQAA informed us that recommendations from the ECC Quality and Development Team have been implemented to provide a more robust record of the twelve staff supervisions provided for each staff member covering specific areas of work. A new staff performance appraisal has also been developed. Direct observation of practise is also regularly undertaken as both the manager and proprietor work with staff and residents. A record of supervision was seen in both of the staff files viewed. Care Homes for Adults (18-65 years) Page 24 of 29 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can be assured that Fenham Lodge is a well managed care home that has good standards of health and safety that protects them. Evidence: The registered manager has experience of working at Fenham Lodge for a number of years. He holds the Registered Managers Award and is currently undertaking an Open University Course in Health and Social care. From an inspection of the records it was evident that he was skilled and competent and had undertaken recent updated training relevant to a manager of a care home for people with learning disabilities. Throughout the site visit it was evident that the manager operated an open door policy and was available to support staff. There was no formal quality assurance programme in place. We were informed that the previous questionnaires were previously sent to residents and their representatives but due to them receiving questionnaires from the Commission and the local authority, the home did not formally consult with them. However there was clear evidence of ongoing consultation through service user and relative meetings and Care Homes for Adults (18-65 years) Page 25 of 29 Evidence: review of care needs. There were no formal audits of care practises, however it was clear that the service was continually monitored and developed to improve practise. Regular meetings were held for staff, residents where health and safety issues were discussed and actioned. Records held on behalf of residents were kept up to date and were stored safely in secure facilities. Records viewed at this inspection included: the statement of purpose, service user guide, assessments/care plans, medication records, staff meetings, staff recruitment and training records, maintenance records and fire safety records. The home had health and safety policies and procedures that were regularly reviewed. The records confirmed that staff had attended relevant health and safety training. Evidence of a sample of records viewed showed that there were systems in place to ensure the servicing of equipment and utilities and there was evidence of appropriate weekly and monthly internal checks being carried out (e.g. checks on fire equipment fire alarms and emergency lighting etc.). All accidents, injuries and incidents were well-recorded and appropriate action taken. The manager, registered provider and staff all work closely in a very open communicative and positive manner which includes the residents. Care Homes for Adults (18-65 years) Page 26 of 29 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 27 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 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 20 Medication storage temperatures should be monitored to ensure they remain within safe recommended levels. This will safeguard residents. A quality assurance programme should be developed for the home to provide evidence of service user and stakeholder consultation and to demonstrate that the home is run in their best interests. 2 39 Care Homes for Adults (18-65 years) Page 28 of 29 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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