Care Home: George Lane, 103

What the care home does well Residents are enabled to lead independent lifestyles. Three residents spoke to the inspector, and said that they are happy in the home, and have good support from staff. They said that the staff and manager are friendly and help them when they need it. The residents’ needs are assessed with their input, and care needs are formally planned for and reviewed. Good links are maintained with health and social care professionals, counsellors, and family. Staff are enthusiastic about working at the home, and creative in helping residents to achieve do the things that they want to. The home listens to residents and when activities are no longer enjoyed by residents other activities are quickly found to replace them. Care staff communicate well with residents using formal sign language when needed. The home was warm and homely in appearance, and the routines of the home are led by the residents. The home was clean and tidy.George Lane, 103DS0000025621.V377571.R01.S.docVersion 5.3 What has improved since the last inspection? The home’s information about the service provided has been improved so that residents are able to know the cost of the care and support provided. Contracts and Tenancy agreements have been updated to show the details of the cost of support and other charges made for individual residents living at the home. How staff help residents to keep their bedrooms clean and well decorated has been written into their care plans so that all residents now have a comfortable bedroom. One resident’s bedroom has been much improved to be more homely and comfortable. A number of areas of the home have been redecorated, including some residents bedrooms. The information about staff recruitment and training is now up to date for all staff, which helps residents to feel that they are safely supported by able and competent staff. What the care home could do better: Residents care plans must be signed and dated by them or their representatives following each review. Residents contracts/terms and conditions for living at the home must be signed and dated by them or by someone who represents them to show their agreement. When reviewing the care and support guidance which show staff how to support residents, these must show the date of review, who took part or completed the review and any changes to be made. Risk assessment reviews should include more information about who was involved in these reviews. The homes management should show that they have involved other important people in the decision to lock one resident’s wardrobe and review this decision at each care review. The homes complaints policy should be reviewed to show details of the Care Quality Commission and their correct role in the complaints process. The correct up to date Care Quality Commission Registration Certificate showing the current responsible person must be displayed at the home and aGeorge Lane, 103DS0000025621.V377571.R01.S.docVersion 5.3copy of the 5 year electrical certificate must be kept at the home as proof that it is up to date. Key inspection report CARE HOME ADULTS 18-65 George Lane, 103 Catford London SE13 6HN Lead Inspector Sean Healy Key Unannounced Inspection 24th August 2009 09:00 George Lane, 103 DS0000025621.V377571.R01.S.doc Version 5.3 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care home adults 18-65 can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. George Lane, 103 DS0000025621.V377571.R01.S.doc Version 5.3 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address George Lane, 103 DS0000025621.V377571.R01.S.doc Version 5.3 Page 3 SERVICE INFORMATION Name of service George Lane, 103 Address Catford London SE13 6HN Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 020 8265 8671 0208 778 6145 lawrenceo@plus-services.org PLUS (Providence & Linc United Services) Manager post vacant Care Home 4 Category(ies) of Learning disability (4) registration, with number of places George Lane, 103 DS0000025621.V377571.R01.S.doc Version 5.3 Page 4 SERVICE INFORMATION Conditions of registration: 1. 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 needs on admission to the home are within the following categories: 2. Learning disability - Code LD The maximum number of service users who can be accommodated is: 4 27th August 2008 Date of last inspection Brief Description of the Service: 103 George Lane is a converted Victorian house situated on a quiet road between Lewisham and Catford. It is one of a group of homes for adults with learning disabilities, all of which are in the London Borough of Lewisham. It is close to shopping centres, local transport and a range of public amenities. The Registered provider, Providence Project, has merged with another other care organisation in April 2006, to form PLUS (Providence, Linc, United Services). The organisation has now made appropriate amendments to the registration/certification with the Commission for Social Care Inspection to reflect this change. The building is owned and maintained by London & Quadrant Housing Association. The home accommodates four adults with learning disabilities. It aims to provide a comfortable, homely atmosphere in a safe and clean environment. Each service user has their own bedroom, and shares communal facilities, which includes lounge, kitchen/diner and garden. At the time of this inspection, there were two men and two women resident at the home. Information about the service provided is made available to current and potential service users in the homes Statement of Purpose and Service Users Guide. Each resident has been given a copy of these documents. The recent CSCI report is currently kept in a file in the hallway cupboard and is accessible to residents. George Lane, 103 DS0000025621.V377571.R01.S.doc Version 5.3 Page 5 At 24/8/09 the homes fees for the residents are set at between £885.05 and £1,202.00 per week for support and accommodation, and are paid directly to Lewisham council. This charge includes food provided. The local authority as part of a block contract pays for support costs. The care provider has now broken the cost down to show support costs for individual residents and a letter regarding this is kept on each resident’s individual file. Residents have to pay for other personal expenses such as hairdressing, transport and personal shopping. The home does not have an email address. George Lane, 103 DS0000025621.V377571.R01.S.doc Version 5.3 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 Star. This means that the people who use this service experience good quality outcomes. This inspection site visit took place over two half days on 24th and 25th August 2009. The inspection was unannounced, and was facilitated by the Manager, who has now applied to CSCI to become registered care manager. During the inspection three residents were observed being helped by staff. Three residents planning files were examined. Three support staff were interviewed and five staff files were examined to see recruitment, supervision and training records. The inspection included examination of records and policies and procedures, and a tour of the building. All of the eight requirements made at the previous inspection have now been met. Residents seem to be very happy at this home, and there has been much improvement in the care and management provided. The atmosphere was relaxed and friendly. The manager and staff involved Residents and spoke with them regularly. What the service does well: Residents are enabled to lead independent lifestyles. Three residents spoke to the inspector, and said that they are happy in the home, and have good support from staff. They said that the staff and manager are friendly and help them when they need it. The residents’ needs are assessed with their input, and care needs are formally planned for and reviewed. Good links are maintained with health and social care professionals, counsellors, and family. Staff are enthusiastic about working at the home, and creative in helping residents to achieve do the things that they want to. The home listens to residents and when activities are no longer enjoyed by residents other activities are quickly found to replace them. Care staff communicate well with residents using formal sign language when needed. The home was warm and homely in appearance, and the routines of the home are led by the residents. The home was clean and tidy. George Lane, 103 DS0000025621.V377571.R01.S.doc Version 5.3 Page 7 What has improved since the last inspection? What they could do better: Residents care plans must be signed and dated by them or their representatives following each review. Residents contracts/terms and conditions for living at the home must be signed and dated by them or by someone who represents them to show their agreement. When reviewing the care and support guidance which show staff how to support residents, these must show the date of review, who took part or completed the review and any changes to be made. Risk assessment reviews should include more information about who was involved in these reviews. The homes management should show that they have involved other important people in the decision to lock one resident’s wardrobe and review this decision at each care review. The homes complaints policy should be reviewed to show details of the Care Quality Commission and their correct role in the complaints process. The correct up to date Care Quality Commission Registration Certificate showing the current responsible person must be displayed at the home and a George Lane, 103 DS0000025621.V377571.R01.S.doc Version 5.3 Page 8 copy of the 5 year electrical certificate must be kept at the home as proof that it is up to date. 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. George Lane, 103 DS0000025621.V377571.R01.S.doc Version 5.3 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection George Lane, 103 DS0000025621.V377571.R01.S.doc Version 5.3 Page 10 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1,2 and 5 Quality in this outcome area is Good This judgement has been made using available evidence including a visit to this service. Residents’ are now in possession of all of the information they need to help them to make informed decisions about where they live. Prospective residents’ individual aspirations and needs are being assessed by the home. Residents have contracts or statements of terms and conditions informing them of their rights and responsibilities, however, these documents need to be signed and dated. EVIDENCE: A requirement was made at the last inspection to include information about charges for support, accommodation and food in the home’s Statement of Purpose. This has been done and this requirement has been met. The home has an up to date Statement of Purpose and Service Users Guide. These contain all of the required information and these have been given to residents and are used when any new referrals are made. Fees and charges made at the home are included and the services provided and staff arrangements and qualifications are included. The home principally provides George Lane, 103 DS0000025621.V377571.R01.S.doc Version 5.3 Page 11 for adults with Learning Disability support needs using person centred approaches. I examined three residents care assessments. All residents have been placed by Lewisham local authority. Three residents have been living at the home for many years and one had moved in 2 years ago. All had a care assessments provided which were detailed in the care and support needed in health care and social care and personal development. These were used to develop care plans and risk assessments for each resident which in turn were used for care reviews. All had care reviews carried out in June and July 2009. There was a requirement made at the last inspection to include information about charges for support, accommodation and food in the resident’s contracts or statements of terms and conditions. The support element had been missing from the information provided at the last inspection. This has now been done and the fees homes fees for the residents are set at between £885.05 and £1,202.00 per week for support and accommodation, and are paid directly to Lewisham council. This charge includes food provided. The local authority as part of a block contract pays for support costs. The care provider has now broken the cost down to show support costs for individual residents and a letter regarding this is kept on each resident’s individual file. Residents have to pay for other personal expenses such as hairdressing, transport and personal shopping. There is a separate Tenancy agreement in place between the Housing Association and each resident. However these contracts have not been signed and dated by the residents or by the homes management. The registered provider and manager must ensure that efforts are made to have these documents completed by the residents or their representatives. (Refer to Requirement YA5) George Lane, 103 DS0000025621.V377571.R01.S.doc Version 5.3 Page 12 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 and 9 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Residents can be sure that all of their assessed needs and personal goals are reflected in their individual plan, and they do get help to make decisions about their lives. They are supported to take assessed risks, which enable them to be more independent. EVIDENCE: There was a requirement made at the last inspection for the home to ensure that the behavioural management strategies for one resident be reviewed with input from this resident and from social services to ensure that her rights were protected. This was done and a number of important changes were made to her bedroom to make it more homely and less restrictive. This requirement has been met now although there is one remaining issue of attaining formal agreement on the locking of a wardrobe. (See Recommendation Standard 19) George Lane, 103 DS0000025621.V377571.R01.S.doc Version 5.3 Page 13 I examined three residents care plans and risk assessments. These were well organised and reflected the needs of these residents well. Each of these residents has a personal profile and a personal care plan, which has been regularly updated. There is also a ‘life plan’, which is their personcentred plan. This allows the residents to have a better voice in their care planning. All have had an annual review during the period of January to June 2009 and were attended by the resident, social worker, the resident’s keyworker, the registered manager and the service manager. There was also involvement from relevant GPs and other health care professionals such as psychology speech and language in some cases. The notes taken from these reviews are very detailed and show that previous aims of service users have been reviewed and new aims for achievement or activities have been set. One care plan said that a re-referral should be made regarding dementia support after 6 months. This overdue and it was recommended that the home follow this up. (Refer to Recommendation YA6) The residents are able and independent, and some are involved actively in the organisation’s service users’ speaking up group. One resident is on the organisation’s Board of Management. Two residents described their work on the speaking up group and said that they carry out monthly interviews with service users in other homes, asking for their views about how their home is run. Both of these residents said they are very happy in doing this work and are able to feed back the views of service users in many homes to the Board of Management. A range of guideline for support of some residents in areas such as personal care, travel in the community and personal care did not have any record of review dates although staff interviewed felt that necessary changes when needed. The home should ensure that there is a record of these being reviewed during the cycle of the rest of the care plan reviews and dates recorded. In addition to this efforts should be made for care plans to be signed and dated by each resident or their representative after each review. (Refer to Requirement YA6) Excellent systems are in place to enable residents to fully make independent decisions about their lives. Three out of the four residents ask the home to safeguard their money; the other resident is totally independent in managing his money. Within the home, two of the residents ask for views about how the home is run, and feed these comments back to the home’s manager. Each resident has a full range of risk assessments, which have been reviewed as part of the care planning review process. There are many risk assessments and all are being regularly reviewed at least every six months by the home. The last reviews took place between May to July 2009. This shows good George Lane, 103 DS0000025621.V377571.R01.S.doc Version 5.3 Page 14 attention to protecting and safe guarding residents and staff. It is recommended that the home include more clearly on the review of risk assessments the names of those involved in the reviews. (Refer to Recommendation YA9) George Lane, 103 DS0000025621.V377571.R01.S.doc Version 5.3 Page 15 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): This is what people staying in this care home experience: 12,13,15,16 and 17 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Residents have appropriate activities and are part of the local community. They have good relationships with family and friends, and their rights are respected and responsibilities are recognised in their daily lives. A healthy diet is provided for and meals are provided at times which suit residents best. EVIDENCE: I spoke with three residents and three staff about the opportunities residents have for leisure, education and for contact with their families and friends. I also asked about the processes for shopping and cooking in the home. As at the last inspection I found all of these areas to be very well planned and organised by the home and that residents felt that they were able to have a George Lane, 103 DS0000025621.V377571.R01.S.doc Version 5.3 Page 16 full and active life including having opportunities for improving their education, employment and to have full personal and family relationships. The following observations made at the last inspection are still relevant: All residents have assessments that clearly state their interests and preferred activities that were in place when they moved into the home. These include education, training and leisure activities. Care plans reflect these activities, and these include residents’ views on desired new activities. Three residents have voluntary jobs, for which they receive a small payment. These jobs include working at the Salvation Army shop, office cleaning and acting as resident’s representatives on the speaking up group. There are also good links with the local adult education system and a number of residents attend classes. All residents have full access to activities in the local community and further afield in London. Staff provide support when necessary but also enable residents to go out independently when they are able to. Daily records showed that staff do work well and creatively to involve residents in the daily running of the home, in order to foster their abilities as much as possible. Activities include going to public houses, cafes, boating in Surrey Docks, gardening and attending service users’ groups and day centres. One resident said she goes out every day, and really enjoys her job on the speaking up group. She said that she gets to meet lots of people in other homes, and sees her family and boyfriend regularly, all of whom are welcomed into her home. Three residents said the staff and manager are very nice and helpful and support them to get out to meet other people. All residents have regular family who come to see them. One resident visits her sister each Saturday and another visits his mother who lives very near by. Three residents said that they see their family as much as they like, and that the staff help them to do this. I observed staff working in supporting a resident in preparing to go out and there was excellent communication about where they were going and what they were going to do. All residents have their own rooms for which they have their own key. Staff respect service users’ right to privacy and only enter the room with permission. Two residents said “Staff are very respectful and don’t come into my room without being asked.” Three out of four residents have a key to the front door, and the fourth asks the staff to look after her key. Residents are involved fully in shopping and cooking and are offered choices of food on a daily basis. Good records of menus are kept, and the manager reviews these to see that good food is being offered. Three residents spoken to said they choose what they want to eat, and the food is good. George Lane, 103 DS0000025621.V377571.R01.S.doc Version 5.3 Page 17 George Lane, 103 DS0000025621.V377571.R01.S.doc Version 5.3 Page 18 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Residents receive personal support in the way they prefer and their needs are being met in all other areas. Support with medication is appropriate for the service users’ assessed needs. EVIDENCE: I examined the personal care plans and health and medication records for three residents and found these to be well organised with detailed plans showing the care to be provided in these areas. All Residents’ files examined showed health care needs are well managed with good input from a range of health care professionals. Residents are registered with a GP and regularly attend a dentist and chiropodist. A dietician is also involved in providing advice in the management of diet and weight. There is support provided by psychology and psychiatry in the area of communications George Lane, 103 DS0000025621.V377571.R01.S.doc Version 5.3 Page 19 and motivation. Residents files showed pictures are used to help residents understand documentation if they were unable to read, and also used in weekly activity plans. Healthcare and medication is being reviewed by the home every six months. The last reviews took place between January and June 2009. All of the residents have learning disability support needs and more than half need support in washing and dressing. There are also communications support needed for some residents. There are some challenges presented in providing support in personal care and dressing and keeping bedrooms in a good state of repair. The personal care plans are well written showing what residents need support with and what they should be left to do for themselves. All of the staff showed a good knowledge of these areas, and the care plans for residents in how to provide the support needed are very detailed. This enables a very good level of understanding by staff in the support needed. I observed staff providing support for three residents and they were very competent and communicated very well with the residents always reassuring them, and competently using Makaton signing with one resident. A visiting health care professional commented that the home works well in developing and improving communications for residents and worked well in partnership with his team to implement speech and language and dietary and challenging behaviour plans. It was recommended that one resident who has her wardrobe locked in order to avoid unnecessary damage to her belongings should have this formally discussed and agreed as part of a best interests meeting as this may represent a restriction on her freedom. (Refer to Recommendation YA19) The home has a written Medication policy that is clear and up to date. Four residents are using prescribed medication and no controlled medication is being used. Medication is stored in a locked room in a private area, and this is safe and secure. The Boots Pharmacy blister pack is used to administer medication. Records are well maintained with minimal omissions recorded. The Boots pharmacist attends the home twice a year and medication is delivered every 28 days. All of the care staff have been trained in administration and management of medication. No controlled drugs are being used at the home. The manager feels that staff are competent in administering medication and in understanding its effect on residents. George Lane, 103 DS0000025621.V377571.R01.S.doc Version 5.3 Page 20 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is a complaints procedure in place, and staff do record complaints brought to their attention and action taken to address them. Procedures and training on safeguarding vulnerable adults are in place to help protect people living in the home EVIDENCE: The home has a good complaints policy in place that was last reviewed in 2006. There is a good relationship between the staff and residents, and the staff spoken to showed a good awareness of how to deal with complaints. There have been no complaints since the last inspection. All staff have had training on how to deal with complaints. Residents spoken to said they felt able to speak with staff and the manager if they were unhappy in any way. The policy needs to have up to date information included about the Care Quality Commission as this organisation came into being since the policy was last reviewed. Otherwise the policy is adequate. (Refer to Recommendation YA22) There have been no adult protection issues since the last inspection. Copies of the organisations procedures and social service procedures are available in the home, and these were last reviewed in May 2007. George Lane, 103 DS0000025621.V377571.R01.S.doc Version 5.3 Page 21 All staff working in the home had received training in relation to safeguarding adults as part of the staff induction and there are regular training updates in relation to this area. Three staff interviewed showed a good understanding of this policy and their own responsibilities in protecting vulnerable people. Overall safeguarding and protection of residents is well managed. George Lane, 103 DS0000025621.V377571.R01.S.doc Version 5.3 Page 22 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 24, 26 27 and 30 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The environment is safe, comfortable, homely and clean and resident’s bedrooms are suitable for their needs. EVIDENCE: 103 George Lane is a converted Victorian house situated on a quiet road between Lewisham and Catford. It is one of a group of homes for adults with learning disabilities, all of which are in the London Borough of Lewisham. It is close to shopping centres, local transport and a range of public amenities. The home is not wheelchair accessible but none of the current residents need a wheelchair and there are no vacancies. All of the residents have lived at the home for a number of years and three of them said they are very happy there. The home is well furnished and residents have been able to choose the decoration of their own rooms and other areas in the home. George Lane, 103 DS0000025621.V377571.R01.S.doc Version 5.3 Page 23 The premises are clean and generally well maintained. There is one bathroom with a WC and sink, and a separate ground floor WC. The residents do cleaning with support from staff and there is a rota for doing this. There is no clinical waste. A maintenance book is being used and a repairman provided by the Registered Provider carries out any repairs needed. The premises are suitable in design and layout for the needs of the residents. Accommodation is provided for four residents, all of who have individual rooms. There was a requirement made at the last inspection for the home to make plans for improvements needed regarding repair and upkeep in a number of communal areas. This has now been done and this requirement is now met. One resident’s room has been redecorated and the window covering has been removed and more suitable bedding has been provided. There are also nice personal photos on the walls which it is recognised is a positive achievement. In another room a cabinet and lighting had been replaced. The kitchen and living room areas are well maintained. Overall the maintenance of the home is now clean and well maintained and the residents said they like it there and that their rooms are comfortable. George Lane, 103 DS0000025621.V377571.R01.S.doc Version 5.3 Page 24 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards inspected: 32,33,34,35 and 36 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are qualified and there are enough of them to ensure they meet the needs of residents effectively. Residents are now protected by the homes recruitment practices. Staff have been trained to ensure that residents individual and joint needs are met, and they receive regular supervision. EVIDENCE: The current staff team consists of a manager and six and a half care staff, four of whom are women and one man. There are 1.5 other posts, which are vacant, and the home intends to recruit to one of these. The gender of this staff group equally represents that of the residents. The cultural backgrounds of the residents are not equally reflected in the make up of the staff team, but staff receive equal opportunities and diversity training to increase awareness of residents cultural support needs. The staff levels provide support each day as follows: • 8am to 5pm three care staff George Lane, 103 DS0000025621.V377571.R01.S.doc Version 5.3 Page 25 • • 5pm to 9pm 2 care staff with a third sometimes for evening activities 9pm to 8am one sleepover staff with support from on call management As at the last inspection the staff say that they feel they are able to do their job with this level of staffing although they feel that it is busy. They said the manager is available to provide extra support a number of days a week and also does shift work with the residents about three days a week. I interviewed three staff who showed they understood the care needs of the residents and all were trained in using Makaton sign language to aid communications. There were three requirements made at the last inspection regarding the need to make improvements in recruitment practices and record keeping. I inspected five staff files and interviewed three staff and this confirmed that these requirements had now been met. Two satisfactory references are now on file for all staff and identification such as copies of passports and birth certificates are also being taken up. Enhanced CRB disclosures are also being taken up before commencement of employment. Staff said that they had been formally interviewed and that they felt they had a good induction and training opportunities were good. There were two requirements made at the last inspection about improvements needed in record keeping regarding induction and training. These requirements are also now met. The homes records showed that all new staff underwent a structured Learning Disabilities Framework induction and that records of these are being kept. Training and development plans are now being agreed with each member of staff and there is a training plan showing training scheduled. The home has good detailed forms available which have largely been completed recording the information about staff recruitment, police and POVA checks, references, and health checks. There are detailed induction schedules completed for each member of staff and held on the file, showing a good and detailed induction has taken place. The staff employment information held that the home has improved significantly and now is of a good standard, and better protects residents. A separate inspection of some staff employment information at the provider’s head office showed that staff records on recruitment and CRB checks is now at a safe level and better protects the interests of residents. It is recommended that the home consider doing updated CRB checks on staff every three years as a matter of good practice as a number of files inspected had CRBs taken up in 2003/2004. (Refer to Recommendation YA34) Interviews with three staff, and examination of three staff files showed that the good level of training is provided for staff which is appropriate to the needs of the residents. Training in skills teaching, safeguarding adults and visual impairment are now included in the training for all staff. A broad range of “statutory required training” is provided and the home now has a good George Lane, 103 DS0000025621.V377571.R01.S.doc Version 5.3 Page 26 standard of training provided to all staff which is specific to the needs of the residents. Staff confirmed that they are receiving regular supervision from the homes manager at least every six weeks but usually more often. Examination of staff files showed that this is the case and good detailed supervision note are being maintained which had been agreed by the supervisee. George Lane, 103 DS0000025621.V377571.R01.S.doc Version 5.3 Page 27 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards inspected: 37,39 and 42 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents do now benefit from a well run home and they are consulted by the management and staff regarding their views. The health and safety of residents are now protected by the homes practices. EVIDENCE: Management at the home has been stable now for more than three years. The manager of the home is experienced and has substantial training in working the people with learning disabilities and in the management of staff. He also has the NVQ4 qualification in care and management appropriate to this post. Feedback from residents and from staff and from health care professionals who George Lane, 103 DS0000025621.V377571.R01.S.doc Version 5.3 Page 28 visit the home stated that the home is well managed by a manager who is able to listen, and was willing to act to sort out any problems quickly. Staff are consistently supervised and said that they feel well supported by the manager to do their work. The manager has now applied to be registered with the Care Quality Commission. Monthly visits to the home are now carried out by a person appointed by the registered provider, and reporting are kept at the home showing a reasonable level of detail of what was looked at and what needs to be done to make necessary improvements. The home carries out surveys of residents and their families’ views on how the home is run and a number of residents are part of the organisations and local authority’s Speaking Up Group and two of these residents told me that they are very happy with how the home is run. The Care Quality Commissions Certificate of Registration currently displayed in not correct and shows the previous Person in Control incorrectly as still being the responsible individual for the home. The manager and provider must get a copy of the correct document and ensure that it is displayed at the home. (Refer to Requirement YA37) The management of staff recruitment has been improved and the documentation required to show that this is happening safely regarding CRB checks, is now available at the home. (See Standard 34 of this report) There is a written development plan in place showing proposed improvements to the home which the manager has produced. Finance inspections are carried out by an external manager every two months and records kept at the home of their findings. Health and safety within the home is well managed, and all residents have appropriate risk assessments in place for their protection. There is good clear documentation in place regarding health and safety, fire safety, food hygiene, staff training, and electrical and gas certification. All of this documentation is up-to-date. There were no health and safety incidents or concerns raised by residents or staff. The five year electrical certificate for the home was not available and the manager said he was confident it was done as there was a letter on file showing it was planned. The management must ensure that a copy of this certificate is available at the home. (Refer to Requirement YA42) George Lane, 103 DS0000025621.V377571.R01.S.doc Version 5.3 Page 29 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 X 4 X 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 X Version 5.3 Page 30 George Lane, 103 DS0000025621.V377571.R01.S.doc No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA5 Regulation 5.1 Requirement The registered provider and manager must ensure that residents contracts or statements of terms and conditions be agreed and signed by them or their representatives. This is in order to protect their rights. The registered provider and manager must ensure that where possible residents care plans be agreed and signed by them or their representatives following each review. This is in order to protect their rights and involve them in their care. The registered provider and manager must ensure that all residents care and support guidelines for staff be recorded as reviewed as part of the care plan review process showing dates of review for each. This is in order to ensure that these guidelines are up to date and reflect appropriate support for residents The registered provider and manager must ensure that the correct details are shown on the DS0000025621.V377571.R01.S.doc Timescale for action 31/03/10 2 YA6 15.2 31/03/10 3 YA6 15 30/06/10 4 YA37 7 31/03/10 George Lane, 103 Version 5.3 Page 31 5 YA42 13.4 (a) home’s CQC Certificate of Registration as discussed in this report. This is to ensure that residents and others are fully aware that the home is correctly registered The registered manager and provider must ensure that the 5 year electrical certificate is up to date and is available at the home. This is to show the home to be safe and to protect residents and staff 28/02/10 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard YA9 Good Practice Recommendations The registered provider and manager should record more clearly the names and roles of those who participate in the review of risk assessments as discussed in this report The registered provider and manager should consider arranging a formal consultation involving social services and relevant health care professionals about the locking of one resident’s bedroom wardrobe to ensure her rights are fully protected. The registered provider and manager should include up to date details about the Care Quality Commission when reviewing the home’s complaints policy The registered provider and manager should consider updating CRB checks for long term staff employed possibly every three years as discussed in this report YA19 3 4 YA22 YA34 George Lane, 103 DS0000025621.V377571.R01.S.doc Version 5.3 Page 32 Care Quality Commission Care Quality Commission Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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