Care Home: Ivy Lodge

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What the care home does well People receive good information about the home, are able to `test drive` the service before they move in, are well assessed and have their needs well met. They receive good security of tenure with a contract of residence. People have their assessed needs well recorded in a plan of care, are encouraged to make decisions and participate in communal life, while taking reduced risks and are confident their lives will remain confidential. People experience a good level of support to develop personally, to take up educational and occupational activities, to join in with community based activities and to maintain a good social life. They enjoy a variety of leisure pastimes, make friends and have relationships with others, and take part in daily routines and are provided with good food. People receive good support with maintaining their personal and health care, are protected or have their independence promoted in respect of taking their medication, and are sensitively approached about ageing and death. People also have good opportunities to make their concerns and complaints known and are listened to. They are protected under the homes systems for dealing with suspected or actual harm or abuse. They enjoy a very safe and appropriate environment in which to live and the standards of the premises are very good. There are well recruited, trained, qualified, skilled, safe and well supported staff, in sufficient numbers to meet people`s needs, working in the home. Finally the day-to-day operations, the ethos of the home, quality assuring the service, maintaining good records and a healthy and safe environment, all combine to ensure the home is run in people`s best interests and to promote and protect their health, safety and welfare. What has improved since the last inspection? This is the very first key inspection of the service since its registration in June 2008 and so there are no previous requirements or recommendations to be checked to determine an improvement in the service. What the care home could do better: The home could make sure every document compiled is signed and dated, so people know when they came into use and who was involved in producing them. One or two seen had not been signed and dated. It could also make sure staff complete infection control training to ensure good practice, or if already completed, it could make sure evidence of this is supplied to the Commission, so people are confident that competent staff are supporting them. The home could make sure at least 50% of care staff undertake NVQ level 2 in Care or an equivalent qualification, so people are confident qualified and skilled staff are caring for them. This target is almost achieved as 8 from 18 staff do have this or a higheraward. It is acknowledged that the home is newly registered and some staff are still in their probationary period, and will enrol for NVQs once finished. It could make sure the quality assurance system is developed to include seeking people`s views of the service. This is so people know robust systems in which they are consulted underpin the future delivery and quality of the service. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Ivy Lodge Houghton Road Thurnscoe Rotherham South Yorkshire S63 0JT     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Janet Lamb     Date: 2 7 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 33 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI 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 33 Information about the care home Name of care home: Address: Ivy Lodge Houghton Road Thurnscoe Rotherham South Yorkshire S63 0JT 01709888500 01709888223 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Ivy Cottage (Ackton) Limited care home 10 Number of places (if applicable): Under 65 Over 65 0 learning disability Additional conditions: 10 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 category: Learning Disability Code LD Date of last inspection Brief description of the care home Ivy Lodge is a newly registered service in June 2008, in the village of Thurnscoe near Rotherham, providing care, support and accommodation for up to 10 people with a learning disability. Local transport is available from the main road through the village to Barnsley and Doncaster and via rail links to Rotherham and Sheffield including the Meadowhall centre. There are shops, pubs, churches etc close by. The premises is an extended exisiting building, which has lounge/dining room, domestic kitchen, laundry, a quiet room and a games room, a managers office, a shift office, and 8 single en-suite bedrooms on the upper floor and 2 on the ground floor. Facilities meet the requirements of the Disability Discrimination Act 1995. There are Care Homes for Adults (18-65 years) Page 4 of 33 Brief description of the care home two secure gardens and a car park for approximately 9 cars, plus a designated disabled parking space and with extra parking on the street. The home is particularly for people who wish to rehabilitate and develop their living skills with the view to moving into independent living accommodation, though a longer term stay is not impossible. The current fees for the home range from £1949.50 to £2475.00 per week and there are four pay bands. This inforamtion was supplied at the time of the inspection. Extra charges may be made for special transport arrangements and for personal hairdressing and toiletries, although normally transport is provided in the form of the homes car and public transport for which people have a free pass. Other information about the home can be obtained in the statement of purpose and the service user guide, available on request from the home. Care Homes for Adults (18-65 years) Page 5 of 33 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: The first ever key inspection of Ivy Lodge took place over a period of time and involved the sending of an annual quality assurance assessment (AQAA) form to the home in September 2008 to complete. This was returned to us in October 2008 and contained information about the service, data about the people living there and staff working in the home, as well as information on the homes practices. We then sent surveys to people and staff in the home asking them what they thought about living and working there. All of this, along with information sent to us in notifications, or brought to our attention by placing authorities, was then considered to determine what it must be like living in the home. Then on 27/01/09 Janet Lamb carried out a site visit to test whether or not Care Homes for Adults (18-65 years) Page 6 of 33 the information and views of life in the home were correct. People living in the home were interviewed or spoken to about their lives and the support they receive, staff were asked about their experiences of being recruited and trained and how well a service they considered they provided, and the manager was interviewed about practices and systems. Some of the communal areas and private areas were viewed with permission from people, and observations of interactions between people and people and staff were also used. This report was then produced showing how all standards were assessed and judged. What the care home does well: What has improved since the last inspection? What they could do better: The home could make sure every document compiled is signed and dated, so people know when they came into use and who was involved in producing them. One or two seen had not been signed and dated. It could also make sure staff complete infection control training to ensure good practice, or if already completed, it could make sure evidence of this is supplied to the Commission, so people are confident that competent staff are supporting them. The home could make sure at least 50 of care staff undertake NVQ level 2 in Care or an equivalent qualification, so people are confident qualified and skilled staff are caring for them. This target is almost achieved as 8 from 18 staff do have this or a higher Care Homes for Adults (18-65 years) Page 8 of 33 award. It is acknowledged that the home is newly registered and some staff are still in their probationary period, and will enrol for NVQs once finished. It could make sure the quality assurance system is developed to include seeking peoples views of the service. This is so people know robust systems in which they are consulted underpin the future delivery and quality of the service. 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 set out 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 33 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 33 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 have good information and experience a good transition into care to enable them to make an informed decision about living in the home. They have their needs well assessed and well met and have the security of good contractual agreements for the protection of their residency. Evidence: Discussion with the manager, people in the home and staff, and viewing of some case files with permission reveals people have good opportunities to get to know the home and service on offer and to try out the goods before they decide to move in permanently. People have satisfactory information available in the form of a statement of purpose and combined service user guide on which to make a judgement about the service and people can spend a reasonable trial stay in the home on which to base a decision to stay or not. The statement of purpose and service user guide document is being considered for review and may soon be put into an interactive computer format for Care Homes for Adults (18-65 years) Page 11 of 33 Evidence: people to view and use, in order to be more user friendly and appropriate. People spoken to say they came to look at the newly built home, chose a room they liked where possible and had tea, then visited several times again before staying overnight. Staff explain people stay for a three month trial period and a placing authority review is held before they decide to become permanent in the home. Evidence of trial stays and initial reviews are held in files. People are very well assessed for needing a placement and in line with the placing authoritys procedures and systems, and copies of community care assessment documents are held in files as evidence. There are also copies of the company assessment document held in files, and these cover medication, diet, activities, communication, background information, likes, circulation, urination, epilepsy, elimination, skin condition, physical ability and mobility, eyesight, hearing, sleep pattern, mental health and offending behaviour. People spoken to remember being included in their assessment and evidence in the form of their signatures is available. Staff are generally well trained in the skills they need to do the job of supporting and caring for people with a learning disability. They are available in sufficient numbers to meet needs and demonstrate an openness and approachability. They are inclusive in their style and enable people to feel valued. They use outside agencies and organisations and seek professional or other advice and information when necessary. Those people that want one have access to an independent advocate, and some people say they do have one. Once it has been established that staff can or cannot meet the assessed needs of people wishing to live in the home, the company headquarters sends out a letter of confirmation to them or their relative, saying so. Copies are held on file. There is evidence of contracts of residence in files as well, which is an agreement between the provider and the person using the service, and which are signed by the person receiving the service and an officer of the placing authority. Contracts between the company and the placing authority are held at headquarters, so were not seen. There is evidence of a placement request though made by placing authorities and one was seen from North Yorkshire Council. Care Homes for Adults (18-65 years) Page 12 of 33 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 experience good opportunities to make their own decisions, to participate in some of the actions for the running of the home and to take reduced risks. There are good care plans and records in place that reflect individual needs and show how they are well met. Confidentiality is well maintained. Evidence: Discussion with people in the home, the manager and staff and viewing of case files and some records with permission reveals there are good systems in place and information is well recorded for ensuring individual needs and choices are met. People have very individually devised care plans that meet the requirements of the standard but more importantly meet peoples needs. An example of one care plan seen is that it contains seven areas of need, that are very pertinent to the person as well as being general. There are also associated risk assessment documents in place, which reflect behavioural needs as well as personal care and health support needs. None of Care Homes for Adults (18-65 years) Page 13 of 33 Evidence: the care plan or risk assessment areas are listed in this report, as maintaining confidentiality also protects anonymity in this instance. Care plans seen did not always have a signature and date, so it is recommended that all documents are always signed and dated on compilation and on review. Evidence that care plans are reviewed is still scant as people have only been living in the home since it opened in June 2008, and some are even more recently admitted. Evidence of one review having been held is available. People have key workers and speak knowledgeably about their role and the relationships with them. People say they go places with key workers and feel they receive special support from them. People also say they make decisions on a daily basis and can choose what they want to do and when. Observation of one rising late and one going to a planned work activity late etc. evidences they do take responsibility for their decisions and actions. Staff do advise on being punctual and reliable, but ultimately consequences have to be faced if people are to learn from mistakes or poor judgement. Generally people are free to do and act as they choose providing there are no consequences that affect their health and wellbeing or the wellbeing of other people. Some people are more independent than others. Some require support to make choices and decisions, others do not. Each person is individual and their care plan reflects this. Further evidence of peoples behaviour, action taken and the levels of their independence is available in diary notes. Participation in the running of the home is also of peoples choosing and preference. Management and staff try to involve people in the running of the home and have included them in hiring of new staff in the recent past. Clearly people are not involved in running aspects of life that relate to one another, but they can become involved in such as when meal times shall be taken, what is on the menu, who has access to the laundry and when, who does the shopping, how shall people join in with community projects, do they want to invite the community into the home and for what reasons, is one staff candidate more desirable than another and why etc. People have house meetings to decide on these aspects of life and also receive relevant information following staff meetings, in which they sometimes join in. Much of what happens is for the benefit of people living in the home anyway and so management and staff tend to suggest ideas and seek peoples approval on many areas of group and individual daily living. Collaboration is well exercised. Finances are generally handled in the home by staff, but some people do receive part amounts of their allowances to spend as and when they choose. There are systems in Care Homes for Adults (18-65 years) Page 14 of 33 Evidence: place to record and monitor handling of finances and these are well maintained and audited. No checks on handling money were carried out, but people spoken to are satisfied with the arrangements in place and one person expressed a desire to purchase a large piece of electrical equipment in premature preparation to moving to independent living. Risk taking is part of daily life and being involved in helping to run certain aspects of the service. Risk assessment documents are in place for individuals though, and to enable them to take reduced risks. There are also documents in place for group and communal activities or pastimes that may affect everyone, but these were not viewed. There is a missing persons procedure and staff are made aware of the possibility of who is likely to be the subject of an unexplained absence, why and what the risks are. People have clear risk assessment documents and risk management strategies in place. The home follows the Data Protection Act 1998 when handling information as far as possible, encourages people to look at their files and documents during reviews and instructs staff in their responsibility to maintain confidentiality codes and to know when information must be passed on for safeguarding reasons. Staff demonstrate in interview their good understanding of safeguarding issues, procedures and responsibilities. Evidence of staff safeguarding adults training is available. The manager must make sure safeguarding training is updated annually. Care Homes for Adults (18-65 years) Page 15 of 33 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 lead fulfilling lifestyles of their choosing in an effort to expand their opportunities for personal development, through education, occupation, community and social links, leisure, relationships, daily routines and enjoying healthy food. Evidence: Discussion with people in the home, the manager, staff and visitors and viewing of some records and case files reveals there are good opportunities for people to lead meaningful, interesting and fulfilling lives, through work, play and personal development. People are encouraged to develop their skills in independent living, socialising and communicating. They also have opportunities to engage in education, occupation and leisure activities of their choosing. People have good community and relationship links Care Homes for Adults (18-65 years) Page 16 of 33 Evidence: and enjoy flexible routines within the home. Meal times and food provision are entirely of peoples choosing and they seem to enjoy taking part in all aspects of daily life. People say they are learning to bake, cook, shop, keep house and do their laundry. They say they take part in voluntary work and occupational activities at a local hospice and the college in either Rotherham or Doncaster. They go to the pub, restaurants, cinema and live concerts, and one person enjoys sitting on Selby Council learning disability forums. They say they enjoy such as horse riding, roller blading, watching football matches, sewing and knitting and so on. They also say staff find out what is happening in the area, or how much a concert ticket costs for example and the information is passed to them to make a decision on whether or not they wish to take up the activity. On the day of the site visit one person went to her voluntary job at the hospice, another went to college, three went out shopping, and one did some baking with the homes employed activities coordinator, while another person went out with staff to bring home an eighth person from his hospital stay. The home is a lively place, where people lead very individual lives that only sometimes cross over. The activities coordinator helps people identify, plan and carry out what they want to do and when. Plans are clear but as he says they are not always strictly followed, as sometimes people change their mind. His role involves making sure resources, transport and funding is available for planned and changed pastimes. People undertake individual activities and pastimes most of the time. All activities and outings are recorded and the coordinator also makes comments on how well people enjoy themselves. Pastimes play a large role in assisting people in their development and so it is important to offer wholesome and fulfilling experiences. People have recently made choices about taking a summer holiday and with funding supplied by the company people have decided on where and when they wish to go. They are looking forward to the warmer months as bikes are to be purchased and will be ridden on a nearby running track. People are advised on relationships with friends and partners, and all health care services are accessed and resources sought where necessary and appropriate. There is a very good social link with the Methodist church next door to the home, which is raising funds and interest within the community to renovate the old chapel so that it can be used again to its full potential. There are weekly table top sales and some people in Ivy Lodge have made friends at the church hall and help out sometimes. Ivy Lodge has also held a coffee morning in aid of the chapel fund and raised three hundred pounds. While on the site visit two people from the chapel called in to have coffee and to socialise. Care Homes for Adults (18-65 years) Page 17 of 33 Evidence: Routines of daily living are as people choose, but they are expected to keep their room tidy, to do some laundry each week and to help on a rota system to prepare the evening meal and do any other cooking or baking they wish to do. People make their own beds and polish areas of the house. Bathroom and toilet cleaning is left to the staff. Everyone has a key to their room even though they may not be confident in using it. Staff hold spares for returning items of laundry and making sure rooms are clean and tidy. Staff work very much along the lines of including people in the home in conversations and activities, to enable the smooth running of the home. Food provision is satisfactory and how people want it to be. Menus are compiled weekly according to suggestions and preferences or in house meetings according to healthy options. People help with food shopping and with preparing meals as above. Breakfast is taken on rising and runs late into the morning, lunch is light and a sandwich, or toastie etc., while evening meal is the main meal of the day and is home cooked and hot, today being sausage, mashed potatoes, Yorkshire pudding, peas and carrots. There are no concerns regarding food provision and no one made any adverse comments in surveys or during the site visit. Care Homes for Adults (18-65 years) Page 18 of 33 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 experience a good service of care and health care support and their needs are well documented and monitored. They are protected by the homes systems for handling medication and are treated respectfully and sensitively regarding issues of health, privacy and end of life requests. Evidence: Discussion with the manager, people in the home and staff and observation of interactions and viewing of some documentation with permission reveals there are good systems and practices in place to ensure people are well supported and assisted with their personal and health care. People have appropriate care and health care plans that contain records for such as monitoring accidents and injuries, GP visits, hospital appointments, weight checks, etc. Medication is recorded and monitored. There are male and female staff working in the home in balanced numbers and generally everyone is able to seek help and support from the person of their choice. Privacy and dignity are upheld through providing assistance with personal care in bedrooms and bathrooms, and routines of daily living Care Homes for Adults (18-65 years) Page 19 of 33 Evidence: are flexible. Where necessary specialist support either from health care personnel or aids and adaptations is accessed. Health care needs are well assessed, documented and monitored and advice and information is relayed to people individually and sensitively. Screening and monitoring of health issues is effective and people are accompanied to appointments etc. Annual health checks are available and carried out in private. Observations throughout the day shows staff approach to issues is good and based on best interest discussions and decisions. Medication is appropriately handled and stored. Weldrakes Chemist provide a monitored dosage system and there are protocols and procedures to follow. Medication administration record (MAR) sheets are accurately used to show receipt in and administration or return of drugs. There are satisfactory arrangements for people to take their medicines with them on a day trip or even holiday. The unit manager has completed the NCFE Safe Handling of Medicines course and instructs and assesses other staff, planned to be annually, in handling medicines, using the Ivy Homes internal training course. During 2008 and over the period of time the home has been open, twelve staff have been trained and competence assessed. Ageing and death have not been encountered or considered yet in the home as people are still very young. There are documents in files to record peoples wishes in end of life situations. People spoken to say they have all the help and support they need, say they always see a GP or other health care professional when they need one and prefer staff to control their medication. No one expressed any dissatisfaction with the health care support they receive from the service. Care Homes for Adults (18-65 years) Page 20 of 33 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 are listened to when they complain or speak up and the systems in place to resolve their complaints are good. People are also protected from harm or abuse by the systems and procedures in place to whistle blow or to deal with allegations of or suspicions of abuse. Trained and conscientious staff support people in their daily lives to ensure they can speak up or receive protection. Evidence: Discussion with people in the home, the manager and staff and viewing of documents and records reveals there are satisfactory systems in place to enable people to complain and be heard and to protect them from abuse. There is a complaint policy and procedure in place that is supplied to everyone through the service user guide and that people say they understand and would use. No one has made any formal complaints since the home opened, but people have made verbal complaints about quarrels with one another and arguments over possessions. These have been handled appropriately. The manager operates openly and includes people in determining what their lifestyles should be like. There is a complaint record, which only contains details of the quarrels and one verbal complaint, as although one person has verbally complained, and had his problems resolved without fuss, there have been no formal complaints made. Care Homes for Adults (18-65 years) Page 21 of 33 Evidence: There is a safeguarding policy, procedure and guidelines in place for staff to follow in the event of suspected or actual abuse taking place. Systems are in line with the No Secrets legislation and these too have not been properly tested yet, as no safeguarding referrals have been made. There is a whistle blowing policy within the policy file and staff say they fully understand their responsibilities when it comes to protecting people from harm. The manager has completed a Barnsley Social Services safeguarding adults course, which was done in July 2008. Some staff have done inhouse vulnerable adults and safeguarding adults training, but not all in the role they now have. It is important for all staff to undertake updated safeguarding training on an annual basis. This was relayed to the manager. People spoken to say they would tell a member of staff they trust if they thought they had been abused or harmed in any way. Some are very clear about their rights. Care Homes for Adults (18-65 years) Page 22 of 33 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 enjoy a very high standard of accommodation. The home is a pleasant, well maintained and safe environment that meets their collective and individual needs and offers very good facilities and equipment. Evidence: Discussion with people in the home, the manager and staff and viewing of some of the communal areas and some personal areas with permission, reveals the home is suitable for its intended purpose, is well maintained and meets peoples needs very well. Individual and communal space exceeds the standards with 10 single en-suite bedrooms, large lounge/dining room, a quiet room and a games room. There is a domestic kitchen used by everyone living or working in the home and two ample gardens offering storage space and recreation space. There is no passenger lift to the upper floor, but external ramps are in place for entry. As a new build in 2008 the home meets the requirements of the Disability Discrimination Act 1995, as two bedrooms and disabled bathroom facilities are on the ground floor. People say they very much like living at Ivy Lodge and enjoy its facilities. Care Homes for Adults (18-65 years) Page 23 of 33 Evidence: Individual bedrooms offer very good accommodation, clean and comfortable and all en-suite. People have made their rooms very personal and have a key to ensure security of possessions. Staff carry pass keys for use in an emergency or to make sure bedrooms are clean and safe. People have furniture and fittings of their choosing and to meet their needs. One has recently acquired a computer, a desk and computer chair and calls his room his office. Internet access is being considered. Other people have televisions, music centres etc. Requirements of standards 25 to 29 inclusive have already been fully assessed on registration in June 2008 and were therefore not assessed on this site visit. Any aids and equipment adaptations are acquired as identified for each person moving into the home and to meet their personal needs. There is a maintenance programme that caters for planned repairs and redecoration and also for emergencies. These standards continue to be met. The home is observed to be very clean, safe and comfortable, and is free from malodour. There is an infection control policy in place, but evidence that staff have completed infection control training was not seen. If staff have not done this training it will need to be completed to ensure good practice, otherwise if they have done it evidence in the form of numbers, date completed, who the course was done with and what it included needs to be supplied to the Commission. The laundry was briefly viewed and clearly meets the requirements of the Water Supply (Water Fittings) Regulations 1999. Equipment is new and has suitable sluicing cycles, and walls and floor covering are impermeable and readily cleanable. There are good hand washing facilities in the laundry and kitchen and throughout the home. Care Homes for Adults (18-65 years) Page 24 of 33 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 enjoy the care and supervision from a staff team that is well informed, qualified, is of sufficient numbers, is well recruited to ensure security, and is well trained, supervised and appraised, so people have their needs well met. Evidence: Discussion with people in the home, the manager and staff and viewing of staff files with permission reveals systems in place are well followed for making sure there are safe, qualified, trained and supervised staff working in the home in sufficient numbers and genders to meet peoples needs. There is good evidence of staff job descriptions, qualifications obtained, that enough staff are employed after going through robust recruitment in the form of applications, taking references and checking identification and staff security etc. to warrant that the home is doing a very good job of maintaining appropriate staffing. Staff files contain all information necessary to meet the requirements of the regulations related to the standards in this section and of schedule 2. There is a balanced number of staff of both gender working in the home that in interview demonstrate they understand the homes aims and objectives, are aware of Care Homes for Adults (18-65 years) Page 25 of 33 Evidence: the statement of purpose and service user guide declarations, and know they must adhere to the General Social Care Council code of conduct and practice and to the staff handbook provided by Ivy Homes (Acton) Ltd. Of the eighteen staff employed in Ivy Lodge at least eight have completed NVQ level 2 in Care. Company policy is for staff to enrol on such courses after their six month probationary period, and the home being newly registered means some staff have not yet finished this period. However, a recommendation is still made in this report to achieve at least 50 with the award. Other, mandatory training, courses include for example fire safety, safeguarding adults, non-crisis intervention, health and safety, food hygiene, first aid, medication administration etc. A full and detailed list of individual staff training is available in files and staff back up their opportunities and achievements in interview. They demonstrate good understanding of their roles and responsibilities during observation of their practice and interaction with people living in the home. Supervision and appraisal systems are also appropriately used and records in files confirm this. Care Homes for Adults (18-65 years) Page 26 of 33 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 benefit from having a qualified and trained manager to run the home in a satisfactory manner that is open, positive and inclusive. People benefit from having a tentative system of quality assuring the service, that needs developing to ensure it accurately assesses the service. All of this is backed up by sound policies and procedures, good record keeping and safe working practices that ensure people and staff health safety and welfare are promoted and protected. Evidence: Discussion with the manager and staff and viewing of some documents, records and certificates reveals there is good management of the home to ensure people are included and consulted, and that they have their health, safety and welfare well protected and promoted. The current unit manager is not the registered manager, as the service was opened with an area manager as the registered manager. Because the area manager no longer has day to day responsibility for the management of the home the current unit Care Homes for Adults (18-65 years) Page 27 of 33 Evidence: manager ought to make an application to become the registered manager. An application has been submitted already, but had to be returned because the security check was outside of the required date. It is acknowledged that a new application will be submitted in very near future. The unit manager has many years experience working with young people and people with a learning disability and is qualified to a high standard having Diploma in Higher Education in Human Behaviour, BA(Hons) Social Science, NVQ 4 in Care, Certificate in Management Studies and NVQ 4 Registered Managers Award. He has an open and inclusive management style and adheres to strict confidentiality codes. He receives formal supervision every two months and holds catch up meetings with his line manager on a weekly basis. Staff in interview say he is approachable and very supportive. The management team and staff team work well together and entirely for the best interest of people living in the home. There is a tentative quality assurance system in place that only uses some of the monitoring tools available and this needs to develop to make sure it includes a method of consulting people in the home and other stakeholders, as this is the most important tool to use. At the moment there are some audits carried out, reviews of care held, and informal discussion with visitors takes place. The quality assurance system must adopt some means of consulting people, monitoring the whole of the service provided; e.g. food provision, laundry service, staffing levels, and staff competence, skills and performance, etc. There should then be some means of quantifying the effectiveness of the whole service so that future goals can be set and aimed for. Then should the home choose to review the quality assurance system, a report must be produced under regulation 24 and a copy be sent to the Commission. It is acknowledged that the home is newly registered and therefore quality monitoring is still in its early stages. However, this is a recommendation of this report. Staff in interview say they are aware of the policies and procedures in place in the home, and that they know their responsibilities to ensure people are safe and protected from harm. They sign to say they have received a staff handbook and have read policies. They also understand the consequences of not following procedures. Record keeping is satisfactory and appears to be in line with the requirements of regulation 17 and schedules 3 and 4. The maintaining of good records should also be something that is monitored as part of the quality assurance system. As part of the assessment of the standard on health, safety and welfare of people and Care Homes for Adults (18-65 years) Page 28 of 33 Evidence: staff in the home, a sample of maintenance records and certificates was viewed. The gas and electrical certificates, or rather commissioning reports, were seen. A legionella water test certificate was seen for a test carried out on 25/07/08. The building regulation clearance report and the commissioning report of the fire safety system and extinguishers was seen, as well as the homes records for weekly fire equipment checks and regular fire safety drills. The fire plan and fire risk assessment document were viewed, but it is clear that a new risk assessment is now needed. The manager has completed training in risk assessment compilation and is capable of achieving this and assures us it will be reviewed shortly and subsequently each year. An accident record was viewed, which complies with the Data Protection Act 1998. There is no passenger lift in the building, and everyone is ambulant and so lifting equipment is not necessary at the moment. There is a business and financial plan in place, budgets are held and accounted for, and public and employers liability insurance with Allianz Insurance Company is available up to its expiry date in September 2009. The lines of accountability in the home are clear and well understood by the staff group. The home is very well managed and run. Care Homes for Adults (18-65 years) Page 29 of 33 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 30 of 33 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 6 The registered provider should make sure every document held in the home is signed and dated on compilation and on review, as one or two seen had not been signed or dated, so people know the information kept on them is up to date and reflects their current needs. The registered provider should make sure all staff complete infection control training to ensure good practice, so people are confident competent staff are caring for and supporting them, and so everyone is protected from the risk of spread of infection. If staff have already completed such training then evidence of it needs to be sent to the Commission. The registered provider should make sure there are at least 50 of staff with NVQ level 2 in Care or equivalent, so people are confident qualified and competent staff are supporting and caring for them. At the moment 8 from 18 staff have the qualification. The registered provider should make sure the quality assurance system is developed to include consultation of people and to ensure the whole service is audited, that a regular report on its findings and effectiveness is produced, and should a review of systems be held, that a copy of the review report is sent to the Commission, so people are 2 30 3 32 4 39 Care Homes for Adults (18-65 years) Page 31 of 33 confident their views and good monitoring underpin the delivery of the service and their needs are met. It is acknowledged that the home is newly registered and quality monitoring is still being developed. 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