Care Home: Hunters Lodge

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What the care home does well The manager carefully ensures that the home could meet the needs of new people properly and that they would fit in with people living there before they move in. Each person at the home has a plan showing their care needs, wishes and goals. They help staff know the support people need to meet their needs and achieve their goals. People can make choices about their lives and what they do every day and staff respect their individuality. They are encouraged to express their views and concerns. Staff enable people to take part in activities they enjoy and go out in the community. They support them to keep in touch and meet up with their families and friends. People have good support with their health and personal care. If anyone is not able to manage their own medicines then staff do so for them safely. Hunters Lodge offers the people who live there a safe and comfortable home that has a lovely rural setting. The accommodation is all on one level and is suitably adapted and equipped to provide good access and assist people with mobility difficulties. Staff are trained about how to keep the home and people safe and most also have a social care qualification. This should help them protect people and do their job better. What has improved since the last inspection? People`s care plans have been reviewed and updated to show their current needs and risks and focus on their personal goals. This means that staff can support them to achieve their goals, develop life skills and manage any possible risks to them better. Each person has a health action plan showing their health needs and issues so staff can monitor their health and support them to stay healthy. The home has input from health care professionals to help them manage their special needs and behaviours better. The staff team is more stable with better team working, communication and morale. This menas they are more involved in improving the service for people living there. Staff had training about the special needs of people using the service. This has helped them understand and know how to manage their difficulties more effectively. Ways of ensuring the quality of the service develops have progressed, as the leadership and management support for the home has also improved. What the care home could do better: Some parts of the building need decorating and to have new flooring and furnishings to make them nicer and more homely for the people living at the home. Key inspection report Care homes for adults (18-65 years) Name: Address: Hunters Lodge Hunters Lodge Bryngwym Manor Wormelow Hereford Herefordshire HR2 8EQ     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Christina Lavelle     Date: 2 8 1 0 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 30 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) 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 Care Homes for Adults (18-65 years) Page 3 of 30 Information about the care home Name of care home: Address: Hunters Lodge Hunters Lodge Bryngwym Manor Wormelow Hereford Herefordshire HR2 8EQ 01981541352 01981540762 hunterslodgehome@tiscali.co,.uk Voyagecare.com Voyage Ltd Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Ms Celia Ann Morgan Type of registration: Number of places registered: care home 10 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability mental disorder, excluding learning disability or dementia physical disability sensory impairment Additional conditions: The maximum number of service users who can be accommodated is: 10 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: Mental Disorder, excluding learning disability or dementia (MD) 10 Learning Disability (LD) 10 Physical Disability (PD) 10 Sensory Impairment (SI) 10 The service may admit service users within the Physical Disability category who have Aquired Brain Injury. Care Homes for Adults (18-65 years) Page 4 of 30 Over 65 0 0 0 0 10 10 10 10 Date of last inspection Brief description of the care home 0 3 1 1 2 0 0 8 The provider Voyage has run services for people with learning disabilities and a range of other challenging, complex needs and behaviours since 1987. Ann Morgan was appointed as manager in June 2008 and is now registered manager. Hunters Lodge provides accommodation with personal care for ten adults. People using the service may need care due to learning disabilities, mental disorder, sensory impairment and physical disabilities (including acquired brain injury). People living at the home often have complex needs and may use behaviours that challenge care services. The home is in the village of Wormelow, about seven miles from Hereford city centre. The home is on a bus route and there is a shop, post office and a pub within walking distance. The property is set in the lovely grounds of a former country house. It has large gardens and an internal courtyard. All the accommodation is on the ground floor and the premises are adapted for people with mobility difficulties who could be wheelchair users. Bedrooms are all single with en-suite facilities that include a shower wet room or bath. One bedroom is a self-contained flatlet that could offer more independent living to its occupant. The house has a large sitting room, separate dining room, kitchen, lobby and utility room for everyone to use. There are two offices, a staff sleep in room, storage areas and a training/meeting room on the first floor. Information about the service is produced in a statement of purpose and service users guide documents. The guide is available from the home and Voyage. The fee level and any extra costs are set out in a service agreement. These are based on the individual needs of each person using the service and are agreed with them, their family or advocate (if appropriate) and their funding authority, before they move in to live. Care Homes for Adults (18-65 years) Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This is a key inspection of the service provided by Hunters Lodge. This means all the standards that can be most important to people using care services are assessed. A range of evidence is used to make judgements about the quality of the service. We visited the home for seven hours during one day without telling staff or people living there beforehand. An Expert by Experience (called the Expert in this report) helped with our inspection. This is someone with relevant personal experience who is trained to help inspectors on visits to care services. The Expert observes what happens in homes and talks to staff and people living there about their lifestyle and to get their views of the service. They make a report of their findings. The Expert spent three hours at the home and comments from his report are included in our report. We sent out surveys asking peoples views of the service. They were returned by eight people who are living at the home, seven of their relatives, six staff and two social care Care Homes for Adults (18-65 years) Page 6 of 30 professionals. All the feedback obtained is referred to in this report. We discussed how the service is being run, changes made since the last inspection and plans to improve the service with the manager. We also spoke with two care workers individually about their role, training and support. We looked at some records that care homes must keep about people using the service and about staff and other aspects of the service. We also had a tour of the communal parts of the building. An annual quality assessment form (AQAA) was completed by the home, as required. The AQAA asks managers to say what their service does well and could do better, what has improved in the last 12 months and about their plans for further improvements. All other information we received about the home since the last inspection is also considered. This includes events that had effected the health, welfare and safety of people in the home (we call these notifications). Care Homes for Adults (18-65 years) Page 7 of 30 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking Care Homes for Adults (18-65 years) Page 8 of 30 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 30 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident the home could support them. This is because a full assessment is made of their needs so the home knows about their needs and wishes by involving them and people close to them in their assessment and admission. Evidence: There has not been a new person move into Hunters Lodge since before the last two inspections. We confirmed however through discussion with the manager that people will not be admitted to the home until a full assessment of their needs has been carried out, which would follow Voyages assessment and admission policy. The manager confirms that Voyage first receives referrals and relevant information about prospective service users and makes an initial assessment to identify a possible placement. Care homes are given this information and the manager and deputy manager of Hunters Lodge then visit people at their current residence to meet and find out about them, assess their needs and give them information about the home. Introductory visits are arranged next including overnight stays whenever feasible, Care Homes for Adults (18-65 years) Page 11 of 30 Evidence: followed by a trial stay at the home. It is clear the manager would also ensure that new people would integrate and get on well with people who already live at the home. We discussed examples of people who have been referred since the last inspection but were not offered a place at this stage because of their incompatibility. Prospective service users relatives and their care managers are always involved in their assessment and admission process and in review meetings held at the end of their trial stays. The suitability of placements is then discussed and a decision made about them remaining at the home. At which time a contract is agreed between Voyage and their funding authority about the service to be provided and the fee. Two local authority care managers indicate in their surveys that the homes assessment arrangements usually ensure accurate information is gathered and the right service is planned. One comments they have made the persons needs their priority. Care Homes for Adults (18-65 years) Page 12 of 30 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Everyone living at the home has a care plan that they and people close to them are involved in making. Plans show their needs, wishes and goals and support they need to meet or achieve them. Risk assessments are carried out to keep them safe. People can make decisions about their daily lives and staff promote their rights and choices. Evidence: Each person living at the home has a plan of their care. We looked at a sample of peoples care records and it is good that their plans have been reviewed and updated since our last inspection. They now reflect their strengths, preferred daily routines, interests, likes and dislikes as well as their current needs and goals. Plans are drawn up in an appropriately person centred way, which means they focus on identifying individuals goals and how they can be enabled to achieve them whilst also promoting their choices and independence. Any particular needs associated with their culture or disabilities are included. Peoples relatives mostly indicate in their surveys that peoples agreed needs are being met by the home and one comments Care Homes for Adults (18-65 years) Page 13 of 30 Evidence: Hunters Lodge works very well with a difficult clientele. Their families have also attended and been involved in their care planning meetings and reviews. Plans appropriately involve direct input of people living at the home and they agree and sign their plans if they can. When necessary they are supported to express their views and their plans include communication needs. It is good that staff are attending training to help them communicate better with one person who uses a sign language. The Expert says it is great that communication is seen as a priority. One social care professional comments in their survey the home enables my client to take the time they need to talk through any issues. Staff are appropriately trained to do this. Keyworkers from the staff team are chosen by and allocated to people at the home. They spend more time with them so they know and can advocate for them better. They have monthly meetings together when plans, goals, activities etc are reviewed. People living at the home and staff confirm they are able to make decisions about what they do each day and make other lifestyle choices. Daily reports are made at the end of each day showing what people have done, eaten and their health etc. These provide helpful information but as the Expert noted could be used more to plan what people will do the next day. Regular meetings are also arranged when people discuss activities, social events, the environment and aspects of day-to-day life at the home. Relevant risk areas for each person had been reviewed and reassessed; some with input from health care professionals e.g a psychologist. In view that some people have complex needs due to their mental health and other disabilities this is appropriate. Management plans have been put in place as a result, which should ensure staff know and deal with peoples behaviours and difficulties more effectively and consistently. Care Homes for Adults (18-65 years) Page 14 of 30 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home are treated as individuals and their rights and privacy are respected by staff. They can take part in activities that meet their personal interests and go out in the community. Their independence is encouraged and they can lead their chosen lifestyle. Staff also support people to maintain links with their family, friends and representatives and the home provides healthy meals they choose. Evidence: The manager and staff recognise that people living at the home should be enabled to develop their social and independent living skills. Whilst some people choose not to take part in regular activities because of their particular difficulties efforts have been made by the home since our last inspection to seek and offer them educational, social and leisure opportunities and to encourage them to mix more in the community. Plans show peoples interests and they all have a weekly activities schedule. These Care Homes for Adults (18-65 years) Page 15 of 30 Evidence: now include their goals and how their independence could be promoted better, such as managing their finances. Each person also has a file with photographs of their activities. Some people attend college courses such as cookery and others have music lessons, art therapy, horse riding, swimming, shopping, go to a gym and out for meals. The Expert discussed with two people the support they are getting from their keyworkers to do things they enjoy as hobbies. One person says staff spend a lot of time with me although two others would like more 1 to 1 time with their keyworkers. Daily reports record what people have done and where they have been each day and their activities, outings, holidays etc. are regularly discussed and reviewed with their keyworkers and in house meetings. Although these meetings are held one person told us that staff dont always acknowledge what people want. The Expert comments that the home should ensure their meetings are effective for eveyone and also suggests that the dates of these meetings should be clearly displayed. Two staff are now designated activities co-ordinators. We spoke to one of them and it is good that they are actively seeking local events and facilities to offer people. They also arrange outings, holidays and social events in the home and at other Voyage care homes. During this visit the home had been decorated for a Halloween party. Staff appear to afford people privacy and respect their choices. People living at the home can choose when to get up, go to bed etc and if they wish to spend time alone. Bedrooms are viewed as their personal space and they hold keys to lock them if they wish. Staff comment in surveys that there is an atmosphere of mutual respect and belonging and staff have a great awareness of service users rights. The Expert and two social care professionals also feel the home seems to respect service users privacy and dignity. The Expert comments that people who showed him around the home felt comfortable doing this and it shows they have ownership over their home. People are supported to keep in touch with family and they told us about their visits to see them and how the home provides transport. Some people have friendships and personal relationships, which staff facilitate and support. Family and friends are invited to social events and care reviews, if people wish. Most relatives surveys show the home always or usually keeps in touch and updates them about important issues. Staff encourage people living at the home to take responsibility for household tasks such as keeping their bedrooms tidy and their laundry. Some people also choose to be involved in other tasks and gardening and staff encourage them to help with meal preparation and cooking. The expert comments it was good to see a particular man was given responsibility over something he has a clear interest in. Care Homes for Adults (18-65 years) Page 16 of 30 Evidence: Regarding food provided by the home people are involved in choosing menus. Weekly meals are chosen with everyone selecting one of their favourite main meals. A menu board is used, which the Expert feels is good as it clearly shows what food is on offer for each meal of the day by using a combination of easy words and pictures. The manager has attended courses on nutrition and checks that meals are balanced. The staff team are also aware of the importance of a healthy diet. Most meals are home made and they use fresh vegetables, some grown organically in the homes garden. Food is also prepared in a specified way for two people with eating difficulties, as advised by a speech therapist. We saw that food was being kept properly and there was plenty of fresh fruit and vegetables, low fat and healthy products in stock. The inspector was invited to have lunch with everyone in at the home. People living there and staff ate together and it was a very social, relaxed occasion. The meal of a jacket potato with a variety of home made fillings and salad was very tasty. It was good that people clearly felt comfortable to join in or to ask for an alternative meal. Several people comment in their surveys that the food at the home is good. Care Homes for Adults (18-65 years) Page 17 of 30 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at the home receive the support they need and prefer with their personal care. Their physical and emotional health care needs are being met and there are procedures in place for staff to follow. Peoples medicines are managed by them, if they can, and if not staff manage them safely in the home on their behalf. Evidence: Peoples plans show the support they need and their preferred daily routines in respect of their personal care. This includes gender of carer and for staff to encourage their independence and self care. People told us they can choose and buy their own clothes and go shopping for them with their keyworkers if they wish. Where necessary protocols are in place for any supervision and support people need. For example for people with epilepsy and physical disabilities. Staff are trained in moving and handling and to use hoists. The home is adapted for people using wheelchairs. Aids and equipment are provided and use of bedside rails risk assessed. Each person now has a health action and end of life plans. These plans are in a suitable easy read format and have pictures to help people understand and be Care Homes for Adults (18-65 years) Page 18 of 30 Evidence: involved in them better. They include details of individuals medical history and an assessment of their current health and issues. Plans appropriately cover their physical and mental health as well as relevant areas such as diet, lifestyle and medication. People access health care services from the local GP surgery. They are all supported to have an annual health check and attend routine appointments with health care professionals such as dentists and opticians out in the community. It is good that since the last inspection the manager has sought and obtained more input from health care specialists such as a psychologist. Whenever needed risk assessments have been carried out and support/behaviour management plans put in place for staff, which have also been set up based on advice and input from other professionals. Two care managers confirm in their surveys that the home usually reviews and meets health care needs properly and always seeks their advice and acts on it. Health action plans include records made by staff of any appointments people attend with the outcomes. Records show that staff monitor and follow up identified health related problems. They use body charts to show any injuries or marks people sustain and incidence of seizures. People also have a hospital passport showing their current health and medication to take with them if they are admitted to hospital. Regarding peoples medication an appropriate policy is provided by the home, which is accessible to staff. People living at the home who are able to manage their own medicines do so and if not they are asked to consent to staff managing them for them. We looked at relevant medication records during our visit and they are maintained appropriately. This includes medicines being checked and signed for when brought into the home and weekly audits. When necessary there are protocols for staff when any medicines can be given as and when required. We observed staff administering medicines and two staff are involved to check and sign it is given correctly. There are suitable and secure storage arrangements for medication in the home. Staff designated to administer peoples medicines undertake a formal training process on safe handling medicines and the manager has done an accredited managers course. Care Homes for Adults (18-65 years) Page 19 of 30 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home feel able to express their views. Most feel that if they have any concerns the manager and staff will listen and deal with them and their complaints properly. The home safeguards people from abuse, neglect and self harm. Evidence: Voyage provides a formal written complaints procedure. This is also available in a user-friendly format with details of advocates and others who would support people. Each person living at the home has been given a copy of these. The home keeps a record of complaints made with details of their investigation, actions taken, outcome and their response to complainants. We looked at this log and it is good that all concerns raised, however minor are being recorded and dealt with. We saw that management, staff and people living at the home have an open, positive rapport. The Expert was also happy about the relationships he saw between them. People confirm they all know who to speak to if they are not happy and how to make a complaint. Staff say in their surveys they would know what to if any concerns are raised with them. Whilst two relatives are unsure about the homes formal procedures they all say their concerns have always been dealt with appropriately. Policies and procedures are provided in respect of whistle blowing and safeguarding vulnerable adults. The home also has a copy of local multi-agency safeguarding procedures. Staff are instructed about how to recognise signs of abuse and Care Homes for Adults (18-65 years) Page 20 of 30 Evidence: report/refer any suspicion or incidence. This is part of their induction through an inhouse interactive programme. Staff also receive training on crisis intervention methods to help them manage behaviours that can be aggressive and/or challenging. Care Homes for Adults (18-65 years) Page 21 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Hunters Lodge have a safe and reasonably well kept home that is comfortable, pleasant and kept clean, which promotes good hygiene. Evidence: Hunters Lodge has a rural location in Wormelow village, seven miles from Hereford city centre. Wormelow is on a bus route and has a shop/post office and pub in walking distance of the home. The expert feels this could be difficult for some people who live there saying it is a little remote and difficult to access the local community. The home is situated within the grounds of a former country house and has its own large and lovely gardens. The accommodation is all on the ground floor and both the house and garden are accessible to wheelchair users. Other aids and equipment are also provided to meet some individuals needs. We looked around some parts of the building. The sitting and dining rooms are well furnished and our overall impression of the environment is pleasant and comfortable. However there are a number of areas that still need redecorating and/or upgrading. The expert comments I noticed that it could do with a bit of work. Despite the need for some work on the decor the home appeared comfortable. Care Homes for Adults (18-65 years) Page 22 of 30 Evidence: Improvements needed include decor and flooring in the corridors, which also have no window coverings and so look bare and not homely. kitchen unit doors need replacing, which was recommended by an Environmental health Officer in their inspection earlier this year. Some staff and people living at the home told us the decor is one aspect of the home that could be better and they also mention potholes in the driveway. The AQAA and manager told us that improvements to the premises are included in this years annual plan for the service, which hopefully will be done soon. All the bedrooms have en-suite facilities and it is good that people can have their own things and use them as their private space. The expert was shown two peoples rooms by them and comments that each room was personalised. During our look around the home we noticed there was a wasps nest in the garden. This was restricting peoples movements in this area and we hope that this will have been sorted out because it does pose a potential risk to people. All the areas we visited were clean, tidy and warm. Staff have cleaning schedules and necessary checks are made and recorded in respect of such as fridge and meal temperatures. Most people say in their surveys the home is always clean and fresh. There are infection control policies and procedures in place for staff to follow, Staff are provided with disposable gloves and aprons and we saw them being used. There is liquid soap and paper towels in the communal bathrooms and wash hand facilities and all visitors are being asked to wash their hands before entering the home. This should all help to promote good hygiene and reduce any risk of infection in the home. Care Homes for Adults (18-65 years) Page 23 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have safe, appropriate support and there enough qualified staff on duty at all times. Their needs are met because staff get the right training and support. They can have confidence in staff because checks are made to help ensure they are suitable. Evidence: We checked staff rotas and found there are always six or seven care workers on duty during the day (plus the manager and/or deputy manager) and two staff on waking nights. The staff team is stable, only two staff having left within the last 12 months, and there are currently no staff vacancies. Two staff indicate in their surveys there are always enough staff to meet peoples needs and four usually. The Expert comments levels of support offered by all staff seemed appropriate and of a high standard. Most of the staff team have achieved an NVQ (National Vocational Qualification) in social care, which reflects positively on their competence. It is good that several staff have now completed LDQ (Learning Disability Qualification). Efforts have also been made to provide more training for the team in relation to the special needs of people who can use this service. This includes autism, mental health and communication. Further training on strokes and person centred planning is booked. Two staff have also trained to become in house trainers on moving and handling. Care Homes for Adults (18-65 years) Page 24 of 30 Evidence: Regarding staff recruitment previous inspections and the AQAA confirm that Voyage have robust polices and procedures in place and new staff are not confirmed in post until their Human Resource Team have checked that these have been followed. All staff in their surveys confirm they had necessary checks, including a criminal records bureau (CRB) and two written references, taken up before they started working at the home. Whilst copies of the actual checks and references are not kept in the home a checklist is kept, which the manager sees, signs and verifies as satisfactory. People living at the home are now appropriately involved in interviews and selection of staff. New staff have to complete a satisfactory probationary period before their appointment is confirmed. Voyage has a comprehensive accredited induction programme, which they complete during this time. Most staff say in surveys that their induction covered everything they needed to know well. One new staff also told us they had worked shadow shifts and been through all the homes policies and procedures. They feel well supported by management but have not been allocated a mentor. Voyage has a training team and each care home has a training plan, which should make sure that all staff receive necessary training and updates. Staff also identify their training and developmental needs through individual supervision. The staff team seem to be well motivated and their comments and surveys reflect this. One said everyone at Hunters Lodge is friendly and helpful and make staff (especially new members) feel appreciated and supported. We saw and staff told us that team working has improved and that ways of communication between care workers and management mostly work well. They say they receive enough support and have the knowledge and experience to meet peoples needs. Most meet their manager often or regularly for support and to discuss how they are working. Care Homes for Adults (18-65 years) Page 25 of 30 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can have confidence in the service provided by the home because it is run and managed appropriately. Practice is monitored and reviewed so the service runs well and will develop how people living there want and/or for their benefit. The environment is safe for people because staff carry out good health and safety practices. Evidence: The manager (Ann Morgan) was appointed in June 2008 by Voyage and has since been registered. Ms Morgan has 15 years care experience and has achieved a care management qualification. She is clear about the role and responsibilities and has clearly worked hard to provide a more personalised service for people living at the home and to offer them and the staff team encouragement and support. The homes management team also comprises a deputy manager and two senior support workers who are allocated particular duties and responsibilities. Staff report they feel better supported and that team working and morale has improved. They are clear about the areas of the service that still need to be developed and are well Care Homes for Adults (18-65 years) Page 26 of 30 Evidence: motiviated to achieve them and to meet the homes aims and objectives. Voyage operate a formal system to review and assure service quality. This includes their required monthly visits when relevant aspects are checked and/or audited and some people at the home interviewed. There is also an annual service review carried out when a development plan is set up with actions specified to improve the service. The views of people livng at the home, their families and other professionals have also been sought, as they must be, to be incorporated in the development plans. The AQAA gives a clear picture of what the service does well and the areas that still need to improve. These include promoting peoples independent living skills; helping them to set and achieve their goals and to be more involved in the way the home is run. Also to continue to offer staff more training opportunities. Regarding health and safety in the home staff receive training in all the mandatory areas such as fire safety, first aid, food hygiene, infection control and moving and handling. We previously confirmed that Voyage provide comprehensive policies and procedures for staff to inform them and follow in their working practices, which we saw they do. The AQAA confirms that necessary risk assesments are in place; checks made on the fire safety and water system and the heating and call bell systems are services regularly. The only potential hazard we saw was a wasps nest in the garden. Care Homes for Adults (18-65 years) Page 27 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 28 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 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 24 Work to improve aspects of the building should be carried out to make the home look nicer and be more homely for the people living there. Care Homes for Adults (18-65 years) Page 29 of 30 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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