Care Home: Helene Lodge

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What the care home does well Helene Lodge provides a comfortable, spacious, clean and pleasant environment for people to live in. Mr and Mrs Stevenson aim to promote a family-type atmosphere within the home which is something that is valued highly by people who use the service. Mr and Mrs Stevenson have an excellent knowledge and understanding of the individual needs of people who use the service and we heard that they communicate well with relatives to ensure that people`s needs are met. People who use the service are involved in making choices and decisions about the running of the home and their everyday lives. They enjoy a positive lifestyle both inside and outside the home with access to a range of occupational and leisure pursuits. People receive the support they need with their personal care and they are enabled to access health care services as appropriate. People told us they had `no complaints` about the service and spoke positively about the way Mr and Mrs Stevenson respond to any issues that arise. People feel able to approach Mr and Mrs Stevenson with any issues they wish to discuss and have confidence that they will deal with any concerns promptly and effectively. There is consistent staffing within the home to enable continuity of care and people were very satisfied with the support they receive. Helene Lodge has benefited from consistent management since it registered as a care home with Mr and Mrs Stevenson being central not only to the running of the home but also being fully involved in the provision of day-to-day care. The home has sustained an excellent track record in relation to the support they provide with residents` best interests being at the heart of service provision. People who have contact with the service spoke highly of the care and support given to people by Mr and Mrs Stevenson. Comments we received included; `Never had any complaints at all...they go that extra mile`; `X is very, very happy there...Max and Joan are absolutely brilliant...couldn`t wish for better. X has matured and come on so much since being there`; `Couldn`t get a better place...I am always very pleased with what they do`; `It is marvellous...we are extremely happy`. What has improved since the last inspection? The home has sustained excellent outcomes for people who use the service since the last inspection. What the care home could do better: We have made recommendations in respect of four of the National Minimum Standards as a result of this inspection. These are based on good practice and should be given serious consideration by the provider. Although Mr and Mrs Stevenson have a very sound knowledge of people`s health needs and can give a verbal account of health appointments they have attended, we have recommended that the outcome of each appointment is clearly documented in people`s records. Medication procedures are in place within the home but there are some areas which could be made more robust in line with best practice. This includes reviewing the information available about people`s medication needs in care plans, including information about creams and lotions, so that it provides a detailed account of the support that individuals require in these areas. We have also recommended that the home introduces a competency framework for agency workers to be able to evidence that they understand, and are following, the home`s medication procedures. As the home uses agency staff on a regular basis to supplement the day-to-day support that is provided by Mr and Mrs Stevenson, we have recommended that there is a clear protocol in place by which agency workers are introduced and inducted into the home and that there is clear documentation available to evidence this. There are some areas in relation to health and safety practice which should be reviewed to ensure risks are fully minimised. Mr and Mrs Stevenson have already told us of some of the action they are taking to address this. Key inspection report Care homes for adults (18-65 years) Name: Address: Helene Lodge 115 Talbot Road Bournemouth Dorset BH9 2JE     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: Heidi Banks     Date: 2 3 0 4 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 32 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 32 Information about the care home Name of care home: Address: Helene Lodge 115 Talbot Road Bournemouth Dorset BH9 2JE 01202389901 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): stevenson80@ntlworld.com Mrs Joan Pauline Stevenson Name of registered manager (if applicable) Type of registration: Number of places registered: care home 5 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: Date of last inspection Brief description of the care home Helene Lodge is registered to provide accommodation and personal care for up to five people with learning disabilities. The home is situated within walking distance from the local shops and amenities of Winton and has access to the main bus routes for other parts of the town. All residents have their own bedrooms which are individually decorated and styled. The communal space is very generous with two lounges, a conservatory and a large kitchen / dining room. There is a garden and patio area to the rear of the property and a gravelled area providing ample private parking at the front. The proprietors, Mr and Mrs Stevenson, and one of their family members live at Helene Lodge and share the communal spaces with the other residents. Mr and Mrs Stevenson Care Homes for Adults (18-65 years) Page 4 of 32 Over 65 0 5 Brief description of the care home provide most of the care and support to people who use the service on a 24-hour basis with some use of agency care workers. Care Homes for Adults (18-65 years) Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced key inspection of Helene Lodge which took place as part of our routine inspection schedule. The inspection was carried out to assess how well the home is meeting the needs of people who live there and whether they are meeting the National Minimum Standards for care homes for younger adults. The inspection took place over six hours on one day in April 2010 and was carried out by one inspector. The term we is used throughout the report to show that the report is the view of the Care Quality Commission. As part of the inspection process we were able to look at a range of documentation within the home including information about people who use the service and information about agency staff who work at the home. We were able to talk to Mr and Mrs Stevenson and meet all five of the people who live there. We also took a tour of the premises. Following the inspection we contacted some relatives of people who use the service by telephone to obtain their views about the service. Mr and Mrs Stevenson Care Homes for Adults (18-65 years) Page 6 of 32 sent us their completed Annual Quality Assurance Assessment when we asked for it which gave us some written information about the home and some numerical data. Before the inspection took place we sent some surveys to the home for completion by people who use the service. Five surveys were completed and returned to us. Information from all of the above sources is reflected throughout this report. Up-to-date information about fees charged by the service can be obtained directly from Mr and Mrs Stevenson at Helene Lodge. Care Homes for Adults (18-65 years) Page 7 of 32 What the care home does well: What has improved since the last inspection? What they could do better: We have made recommendations in respect of four of the National Minimum Standards Care Homes for Adults (18-65 years) Page 8 of 32 as a result of this inspection. These are based on good practice and should be given serious consideration by the provider. Although Mr and Mrs Stevenson have a very sound knowledge of peoples health needs and can give a verbal account of health appointments they have attended, we have recommended that the outcome of each appointment is clearly documented in peoples records. Medication procedures are in place within the home but there are some areas which could be made more robust in line with best practice. This includes reviewing the information available about peoples medication needs in care plans, including information about creams and lotions, so that it provides a detailed account of the support that individuals require in these areas. We have also recommended that the home introduces a competency framework for agency workers to be able to evidence that they understand, and are following, the homes medication procedures. As the home uses agency staff on a regular basis to supplement the day-to-day support that is provided by Mr and Mrs Stevenson, we have recommended that there is a clear protocol in place by which agency workers are introduced and inducted into the home and that there is clear documentation available to evidence this. There are some areas in relation to health and safety practice which should be reviewed to ensure risks are fully minimised. Mr and Mrs Stevenson have already told us of some of the action they are taking to address this. 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 32 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 32 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. The home has sound systems in place to ensure people have a smooth transition when they come to live in the home and their needs can be met by the service. Evidence: The home has told us in their Annual Quality Assurance Assessment that they have a comprehensive and person-centred admissions procedure. There has been one person admitted to the home in the past twelve months. We looked at the paperwork in place to ensure that the individuals needs had been assessed before they came to live in the home. We found that there was appropriate paperwork in place including evidence that they had been reviewed by the funding authority following admission to check that they were settling in to their new home. Records were in place to show that the person concerned had several opportunities to visit the home in the four months before they moved in which included both day and overnight visits to enable them to make a decision whether this was the right place for them. We spoke to the person during the inspection who told us they had settled in well and liked living at Helene Lodge. Care Homes for Adults (18-65 years) Page 11 of 32 Evidence: The home has told us in their Annual Quality Assurance Assessment that they are aware they could do better at producing information in a format that is accessible to people who use the service. This forms part of their plans of improvement for the next twelve months. Care Homes for Adults (18-65 years) Page 12 of 32 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are empowered to express their needs and choices and are consulted about issues that are important to them. Peoples ability to be independent is respected by the service and they are enabled to take appropriate risks with due regard for their safety. Evidence: We looked at the care plan for one person who uses the service. This gave some clear information about the support needed by the individual in relation to their personal care needs including what they can do for themselves and tasks where assistance is needed. The care plan also contained basic information about how the individual choses to spend their leisure time, their relationships with other people and information about how they manage their money. Four out of the five people who live in the home have been there for several years with Mr and Mrs Stevenson as the main source of their day-to-day support. It was evident from discussion with Mr and Mrs Stevenson that they are very aware of the Care Homes for Adults (18-65 years) Page 13 of 32 Evidence: specific needs of each person who lives in the home. The homes Annual Quality Assurance Assessment indicates that further development of documentation within the home, including care plans, is needed to make them more accessible to people who use the service. We agree with this view as enabling people who use the service to have more control over the content of their care plan will ensure a fully personcentred approach. Mr Stevenson told us following the inspection that four out of five people who use the service have an Essential Lifestyle Plan, the only individual without one being the person who was most recently admitted to the service. We were told that house meetings are held on a regular basis involving all the people who live in the home where their views are sought on a range of topics. We looked at some minutes of recent meetings and saw that peoples views had been obtained about future holiday plans, suggested activites, the homes redecoration, meal choices and issues affecting all service users including changes to health services in the local area. We spoke to some of the people who use the service during the inspection. They all told us about choices they made in their daily lives and how this was very important to them. We looked at risk information on record in relation to one person who lives in the home. There was sufficient information around specific risks including epilepsy and activities and how risks could be minimised. It was clear from discussion with Mr and Mrs Stevenson that they are keen to promote peoples independence and ability to carry out activities of their choice. Care Homes for Adults (18-65 years) Page 14 of 32 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 who use the service are supported to live ordinary and fulfilling lives in their home and community. They enjoy positive social networks and maintain regular contact with their families. Evidence: The majority of people using the service who returned surveys to us indicated that they are able to make decisions about what they do each day and all said they could make decisions about what they could do at the weekends. Mr and Mrs Stevenson told us how each resident accesses community-based services during the week including local day services, a horticulture project and adult education classes. We talked to some of the people who live in the home during the inspection who were keen to tell us about the activities they enjoyed doing both on weekdays and in their leisure time. This included attending local clubs for people with learning disabilities. Minutes of house meetings showed evidence of various activities being proposed including Care Homes for Adults (18-65 years) Page 15 of 32 Evidence: bowling, swimming, crazy golf and boating and we found that people are supported to have an annual holiday. Following our visit to the home we spoke with some of the relatives of people who use the service all of whom talked positively about the opportunities available to their family member. Comments we received indicated that Mr and Mrs Stevenson have been proactive in identifying opportunities in the local area for individuals to participate in and that people lead busy and fulfilling social lives; They are always out and about doing things; They are very good at arranging the social side. People who live in the home told us that they had regular contact with their family, this being confirmed by relatives we spoke with. One relative told us that Mr and Mrs Stevenson had actively promoted contact by providing transport where necessary. Relatives told us that they always felt welcome in the home on the occasions when they visited their family member there. In discussion with Mr and Mrs Stevenson both demonstrated a strong commitment to promoting individuals rights to lead an ordinary life at Helene Lodge and in the community. Although Mr and Mrs Stevenson live in the home, they were very clear about Helene Lodge being the residents home. It was evident from discussion that people who live in the home are treated very much as individuals and that the providers promote a person-centred approach to their care. Mrs Stevenson spoke to us about meals that are provided in the home and how they aim to ensure people have a varied and healthy diet. Snacks are available to people at all times and individuals are enabled to help themselves and make choices about what they eat with appropriate support and guidance. The people who live in the home told us they enjoyed the meals they were offered and confirmed that they were able to make choices. We observed people helping with meal preparation during the inspection which promotes the homely and family-type atmosphere that Mr and Mrs Stevenson aim to create within the service. Care Homes for Adults (18-65 years) Page 16 of 32 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 who use the service benefit from positive and consistent support in relation to their personal and health care needs and have good access to health care services. Medication procedures are in place and work well for the people who use the service although there are some areas which could be made more robust to ensure people are fully protected. Evidence: In discussion with Mr and Mrs Stevenson it was evident that they have an excellent knowledge and understanding of individuals requirements in relation to their personal and health care. Mrs Stevenson reported that she has attended courses in order to gain a better understanding of specific health conditions in order to be able to provide effective care to people who use the service. We looked at a sample of paperwork to see how information was recorded. The documentation we looked at contained some basic information about peoples needs. We identified that there were some areas of the plan which would benefit from greater detail for example, information about administration of medication and application of creams and eye lotions so that the individuals needs and preferences are clear in Care Homes for Adults (18-65 years) Page 17 of 32 Evidence: these areas. We looked at health appointment records for one individual who uses the service. Although these had been recorded and it was evident that they had been supported to attend a range of health care appointments to meet their needs, the outcome of appointments was not always documented in detail. We looked at information on file in relation to two people who have epilepsy. This information was very clear with evidence of sound records being maintained in relation to their seizures. Both people were reported to receive external support from the community nursing team in relation to their epilepsy. Medication was seen to be stored in a lockable cupboard which is attached to a wall. Medication is delivered in monitored dosage systems to the home by a local pharmacy with medication administration record (MAR) charts also being printed by the pharmacy for use in the home. Out of three charts we looked at, two indicated that the person concerned did not have any known allergies. The third chart we looked at was blank in this area. We have recommended that the home ensures this information is clearly specified. Mrs Stevenson told us that one person who uses the service self-administers their medication and arrangements are in place to support them with this. Their medication administration record showed evidence of medication being handed over to them on a weekly basis. We saw that a homely remedies list is in place for people who use the service and a recording system has also been implemented for this purpose. For one individual who has been prescribed a PRN (as required) medication we found that information was in place with regards to this and administration of the medication had been clearly recorded with the time it had been given. For another person who uses creams and lotions on a regular basis we saw that the MAR chart was not being used to record their application and we have made a recommendation that this is implemented so that there is a clear audit trail to evidence that creams and lotions are being given as prescribed. Mr and Mrs Stevenson were both aware of the most recent medication policy issued by Bournemouth and Poole Primary Care Trust and told us that a reference copy was available in the home. Care Homes for Adults (18-65 years) Page 18 of 32 Evidence: We looked at the training records for three agency staff who are employed to work in the home for evidence that they had attended suitable training in the administration of medicines. All three staff profiles contained this information. We advised Mr and Mrs Stevenson to consider implementing a competency framework for care workers who are employed to work in the home so that they can be confident that they understand and follow the homes procedures and meet service users needs. Mr Stevenson agreed to liaise with the agency in relation to this issue following the inspection. As part of our inspection we spoke with people who use the service and their relatives to find out whether they were satisfied with the care and support they received. Service users told us that they were always treated well by the managers and staff. A relative gave us an example of how the providers had been vigilant about the health of their family member and had identified and responded promptly to a specific concern when it had arisen. Other people commented; I dont think X could be in a better place...they understand X...they are very caring (relative); Very kind people...couldnt get a better place (relative). Care Homes for Adults (18-65 years) Page 19 of 32 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 who use the service are listened to by the people who support them. There are sound procedures in place to respond to any concerns that arise. Evidence: The home has told us in their Annual Quality Assurance Assessment that they have comprehensive procedures in place to respond to complaints from people who use the service and their representatives. The home has also told us they have not received any complaints about the service in the past twelve months. People who live in the home who responded to our survey told us that they knew how to make a complaint if they needed to and that the managers and care staff always listened to them and acted on what they said. All the residents we spoke with during the inspection told us that they would speak to Mr and Mrs Stevenson if they had any grumbles or worries. Regular house meetings are held, the minutes of these meetings showing that people who use the service are given the opportunity to voice any concerns during the meeting. Following our inspection we contacted some of the relatives of people who use the service. All of them told us that Mr and Mrs Stevenson were very approachable and they would have no hesitation in talking to them about any concerns they had. They felt communication between the home and themselves was good and had confidence that the service would respond effectively if they raised any concerns; They are always willing to sit and listen. Care Homes for Adults (18-65 years) Page 20 of 32 Evidence: There have been no safeguarding alerts in relation to the service in the last twelve months. This was confirmed by Mr and Mrs Stevenson at the inspection. Mrs Stevenson told us she had recently attended training in safeguarding for managers with the local authority. We also noted that abuse was a subject that had been discussed at a recent house meeting with residents to raise their awareness. We looked at a sample of training records for agency staff at the home, all of which showed that care workers had attended training in abuse awareness. Care Homes for Adults (18-65 years) Page 21 of 32 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at Helene Lodge find the home a clean, pleasant and comfortable place to live in and value the family-type atmosphere that is promoted within the service. Evidence: The home has told us in their Annual Quality Assurance Assessment that they aim to provide a homely, comfortable and safe environment for the people who live there. They have told us that they do this through a planned programme of redecoration in the home and ongoing maintenance and renewal of furnishings. During the inspection we were able to take a tour of the home and, with the permission of the people concerned, were able to view some of the bedrooms. The home is spacious, bright, airy and decorated to a high standard. People who live in the home have been able to personalise their bedrooms. The home was very clean and in good order, all residents telling us in surveys that the home is always clean and tidy. Relatives told us that they were very satisfied with the home environment and we heard how, in their view, one of the main strengths of the service is the homely, family-type atmosphere that is promoted which they felt suits their family members and enables them to lead an ordinary life. People who live in the home have access to all communal areas within the home including the kitchen, two lounges and a Care Homes for Adults (18-65 years) Page 22 of 32 Evidence: conservatory which gives them a choice of where they spend their time. People can access their bedrooms at any time. People we spoke with during the inspection told us how much they liked their home and how they enjoyed living there. Care Homes for Adults (18-65 years) Page 23 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service benefit from consistency and continuity of care and enjoy positive interaction with the people who support them. Evidence: Mr and Mrs Stevenson own and manage Helene Lodge and also live on the premises. They are also responsible for providing most of the care to people who use the service. This provides consistency and continuity of care for the people who live in the home. It was clear from discussion with Mr and Mrs Stevenson that they have an excellent knowledge and understanding of the needs of each resident. It was also evident from our discussion that they keep themselves up to date with training and current developments in the care sector. Mr and Mrs Stevenson told us in their Annual Quality Assurance Assessment that, although they do not directly employ care workers to work in the home, they do use agency workers on a regular basis in order to give themselves a break. They told us that they liaise closely with one specific agency to ensure that consistent care workers are provided as they feel this is important for their residents and for the smooth running of the home. We saw that the agency had supplied written profiles to Mr and Mrs Stevenson which outline the recruitment checks that had been undertaken and training that has been provided for each worker. We talked to Mr and Mrs Stevenson Care Homes for Adults (18-65 years) Page 24 of 32 Evidence: about the importance of them receiving enough information about each agency worker before they come to work in the home so they can make a judgement about their suitability for their role. Mr and Mrs Stevenson confirmed that they would talk to the agency about the information they require to ensure this is provided at all times. They told us that they are currently using a core group of agency workers and that workers always shadow a shift at the home before they are expected to work alone. We have recommended that Mr and Mrs Stevenson document the shadowing that takes place and also put in place a framework by which they can evidence that each agency worker has been introduced to, and understands, the procedures within the home. Mr and Mrs Stevenson confirmed that they are always available on-call for the home and indeed, are often present in the home when agency staff are working. Mrs Stevenson told us that the use of a small group of agency workers on a regular basis in the home had been viewed by people who use the service as a great success as it had enabled them to build relationships with people other than the providers and enjoy a more diverse range of activities. We spoke to relatives of people who use the service who confirmed that their family members were enthusiastic about having different people working with them, often of a similar age group, and that in their contact with the agency workers they had presented as charming and very helpful. One relative told us that they had confidence that Mr and Mrs Stevenson would be very careful who they allowed to work in the home. All the people who use the service indicated in surveys that care staff in the home always treated them well. Care Homes for Adults (18-65 years) Page 25 of 32 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. The home continues to be managed effectively and in the best interests of people who live there. People have confidence in the running of the service. Evidence: Following discussion with Mr and Mrs Stevenson it was evident that they run and manage the home on a day-to-day basis and are fully involved in the care of people who use the service. This was confirmed by people who live in the home whom we met during the inspection and by their relatives who spoke highly of the way the home is run. Both Mr and Mrs Stevenson reported that they are members of the local learning hub for providers which helps enable them keep up-to-date with developments in the care sector. The home has a quality assurance process in place and it was evident from this that people who use the service and their relatives are asked for their views about the home on a regular basis. As already mentioned in the report, Mr and Mrs Stevenson meet with people who use the service on a monthly basis to discuss their wishes and needs as a group and to ensure they are consulted about events in the home. One Care Homes for Adults (18-65 years) Page 26 of 32 Evidence: relative we spoke with told us that they thought one of the main strengths of the home was that everyone is consulted and asked for their opinion on decisions to be made. We looked around the premises at the inspection. We checked some of the window openings on the first floor of the home and found that most of them were suitably restricted to minimise the risk of falls. One window, however, was not restricted. Mr Stevenson told us that this window, which led out onto a small roof area, had not been restricted on the previous advice of the fire service. We asked Mr Stevenson to confirm this with the fire service and we sent him the current guidance from the Health and Safety Executive on window restriction. Mr Stevenson has since consulted with the fire service and a decision made by the home to restrict the window opening. We saw suitable recording of practice fire evacuations within the home. The sample we looked at showed that fire evacuations take place in the late afternoon and early evening. We would recommend that the home considers holding the fire evacuations at variable times of the day to ensure that people who use the service are accustomed to evacuating the premises at different times. We saw that refrigerator and freezer temperatures are monitored and recorded on a regular basis and a system is in place for checking the homes smoke alarms. Mr Stevenson confirmed that they had completed a fire risk assessment which was updated in 2009. We noted at the inspection that fabric hand towels were in place at communal handbasins in the toilet and kitchen sink. We discussed with Mr and Mrs Stevenson that it would be good practice to review this as disposable paper towels would be preferable in terms of preventing cross-infection. Mr and Mrs Stevenson stated that they are keen to ensure the service retains its homely atmosphere although they will give this consideration. Mr and Mrs Stevenson confirmed that hot water outlets are fitted with thermostatic valves to ensure safe water temperatures for people who use the service. At the time of the inspection there was no system in place for recording water temperatures in the home as means of checking that the thermostatic valves are working properly. We have recommended that this is put in place. We have not received any notifications from the home in the past twelve months. We confirmed this information with Mr and Mrs Stevenson who told us that there have been no accidents or incidents occurring in the home that have required notification. Care Homes for Adults (18-65 years) Page 27 of 32 Evidence: Care Homes for Adults (18-65 years) Page 28 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 29 of 32 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 19 You should ensure that health appointments for people who use the service are recorded in greater detail to include the outcome of the appointment. They should include visits to the home by health professionals. You should ensure that there is sufficient information available in each individuals care plan about how they take their medication and the application of any creams or lotions they require. You should ensure that the application of creams and lotions is clearly recorded. You should ensure that information about allergies is clearly recorded on each individuals medication administration record chart or none known stated where appropriate. You should implement a framework by which agency care workers can be deemed competent to administer medication to people who live in the home by demonstrating their understanding of procedures and safe practice. 2 20 Care Homes for Adults (18-65 years) Page 30 of 32 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 3 34 You should ensure that you always have all the information you require for agency workers to be able to make a judgement about their suitability to work in the home. You should consider implementing a documentary framework to evidence the shadowing that agency workers undertake in the home before they are expected to lonework and to demonstrate that they understand the homes policies and procedures. 4 42 You should restrict window openings on the premises in accordance with your risk assessment process and to ensure the safety of people who use the service. You should ensure practice fire evacuations of the premises take place at variable times of the day. You should review infection control procedures in the home to ensure the home is compliant with best practice. You should implement a system for checking and recording hot water temperatures in the home to ensure that thermostats are working properly and people are fully protected from risks of scalding. Care Homes for Adults (18-65 years) Page 31 of 32 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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