Care Home: Kacee Lodge

What the care home does well Kacee Lodge provides a friendly and homely environment for residents. Staff work well as a team and demonstrated a caring and sensitive attitude. There is good access to health care and good liaison with health and social care professionals. Three relatives spoken with were pleased with the care and service provided at the home. One had no concerns and two relatives stated that communication had improved and action had been taken to respond to any concerns they had. What has improved since the last inspection? The home has being going through a transition with the former manager having left and a number of staff also leaving. However there is good senior management support with the Support Manager covering the vacant manager post. Recruitment had been unsuccessful for a manager, although a deputy manager had been appointed and a second recruitment drive for a manager was in process. Progress had been made to address maintenance issues. The lounge/dining room and several bedrooms had been redecorated and refurbished in part. The activities room had been tidied and the jacuzzi removed to provide an activities room for residents and a staff training/meeting room. The sensory room had been redecorated and fitted with specialist lighting providing a relaxed and calming environment for people using the room. Medication policies and procedures were now available for staff guidance. Medication was available as prescribed and records were generally well recorded. There were few omissions and these had the reason recorded. Room temperature monitoring had been implemented and recorded until 1/04/09. The premises were well maintained and clean. The shower room was clean and had been refurbished. Infection control facilities and practices had improved. Handwashing facilities (liquid soap, paper towels and bins) had been provided throughout and staff practices were observed to be safe. Infection control policies and procedures were available for staff guidance. Staffing levels had increased and additional staff were on duty three days per week to support residents` activities and outings. Staff training had been provided in fire safety and manual handling. Fire safety practices/checks were undertaken as required including records of staff attending drills being made, ensuring all staff attended within a period. Risks assessments had improved and demonstrated that risks were minimised. Residents` bedrooms had been provided with new bedding, curtains, light shades and bedrooms were more personalised. Records of residents personal monies were available for inspection. Care planning had improved with a `pen portrait` developed to aid staff quick access to residents` needs. Person centred care planning was being developed and included a health action plan. The needs of residents with a sensory impairment had been reviewed and action taken to provide foot baths, hand massage and nail manicures.More staff are trained to drive the vehicle used to take residents on outings. the manager was therefore now investigating opportunities for additional activities, for example music therapy, swimming etc. The complaints procedure had been reviewed for residents in a pictorial format. What the care home could do better: A more user friendly service user guide should be developed in pictorial format and with larger photographs included. A suitable manager should be appointed as soon as practicably able. Stronger links should be developed with advocacy services to ensure all residents are assisted to make independent decisions about their lives. Person centred care plans should be further developed. Staff training should be provided for all staff on how to meet the needs of people with a sensory impairment. More activities and entertainment should be arranged with an annual holiday provided that residents are able to choose and help to plan. A programme of ongoing maintenance should continue to ensure that equipment remains in working order and damage to paintwork is repaired. The standards for medicines administration and recording were generally good. However the development of medication profiles for individual residents would ensure staff are aware of the reason for the medication being prescribed and its potential side effects. The record of staff initials and signatures should be updated to ensure that any adverse incidents can be appropriately followed up. There should be systems in place for monitoring training to ensure that all staff attend manual handling training annually. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Kacee Lodge Ivy Lodge Road Great Horkesley Colchester Essex CO6 4EN     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: Diana Green     Date: 0 7 0 5 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 31 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 31 Information about the care home Name of care home: Address: Kacee Lodge Ivy Lodge Road Great Horkesley Colchester Essex CO6 4EN 01206272108 01206273867 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) : Clearwater Care (Hackney) Ltd care home 8 Number of places (if applicable): Under 65 Over 65 0 0 learning disability physical disability Additional conditions: 8 8 The maximum number of service users who can be accommodated is 8 The registered person may provide the following categories 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: Learning Disability - Code LD Physical Disability - Code PD Date of last inspection Brief description of the care home Kacee Lodge is a care home for adults with physical and learning disabilities. The property is situated in the Essex village of Great Horkesley, approximately 2 miles from Colchester Town Centre. The home is a detached bungalow with parking to the front. There is a bus route close by. All service users access local community amenities and activities, with the home providing transport and escorts. Bedrooms comprise of six single rooms and one shared double room. There is one assisted bath, one walk in shower room and two toilets. Communal accommodation is comprised of a lounge/ dining room, a sensory room and an activity room. The kitchen Care Homes for Adults (18-65 years) Page 4 of 31 Brief description of the care home and laundry are comparable with those found in a normal household. The fees range from £1042.51 to £1459.43 weekly. Additional costs apply for chiropody, toiletries, hairdressing and newspapers. This information was provided to the CQC in May 2009. Care Homes for Adults (18-65 years) Page 5 of 31 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 last inspection on this service was 15th April 2008. This unannounced inspection took place on 7th May 2009. All of the Key National Minimum Standards (NMS) for Younger Adults, and the intended outcomes, were assessed in relation to this service during the inspection. This report has been written using accumulated evidence gathered prior to and during the site visit, including the homes Annual Quality Assurance Assessment (AQAA). The Annual Quality Assurance Assessment (AQAA), a self assessment that focuses on how well outcomes are being met for people using the service, was completed by the home and returned to us prior to the visit to the home. Information received in the AQAA provided us with some detail to assist us in understanding how the registered Care Homes for Adults (18-65 years) Page 6 of 31 persons understand the services strengths and weaknesses and how they will address them. The inspection process included reviewing documents required under the Care Home Regulations. A number of records were looked at in relation to residents, staff recruitment and training, staff rotas and policies and procedures.Time was spent talking to staff and the manager. Surveys were sent out service users and their representatives, health and social care professionals and staff. However only one survey was returned and telephone contact was therefore made with some residents relatives/representatives. The Support Manager and staff were welcoming and helpful throughout the inspection. What the care home does well: What has improved since the last inspection? The home has being going through a transition with the former manager having left and a number of staff also leaving. However there is good senior management support with the Support Manager covering the vacant manager post. Recruitment had been unsuccessful for a manager, although a deputy manager had been appointed and a second recruitment drive for a manager was in process. Progress had been made to address maintenance issues. The lounge/dining room and several bedrooms had been redecorated and refurbished in part. The activities room had been tidied and the jacuzzi removed to provide an activities room for residents and a staff training/meeting room. The sensory room had been redecorated and fitted with specialist lighting providing a relaxed and calming environment for people using the room. Medication policies and procedures were now available for staff guidance. Medication was available as prescribed and records were generally well recorded. There were few omissions and these had the reason recorded. Room temperature monitoring had been implemented and recorded until 1/04/09. The premises were well maintained and clean. The shower room was clean and had been refurbished. Infection control facilities and practices had improved. Handwashing facilities (liquid soap, paper towels and bins) had been provided throughout and staff practices were observed to be safe. Infection control policies and procedures were available for staff guidance. Staffing levels had increased and additional staff were on duty three days per week to support residents activities and outings. Staff training had been provided in fire safety and manual handling. Fire safety practices/checks were undertaken as required including records of staff attending drills being made, ensuring all staff attended within a period. Risks assessments had improved and demonstrated that risks were minimised. Residents bedrooms had been provided with new bedding, curtains, light shades and bedrooms were more personalised. Records of residents personal monies were available for inspection. Care planning had improved with a pen portrait developed to aid staff quick access to residents needs. Person centred care planning was being developed and included a health action plan. The needs of residents with a sensory impairment had been reviewed and action taken to provide foot baths, hand massage and nail manicures. Care Homes for Adults (18-65 years) Page 8 of 31 More staff are trained to drive the vehicle used to take residents on outings. the manager was therefore now investigating opportunities for additional activities, for example music therapy, swimming etc. The complaints procedure had been reviewed for residents in a pictorial format. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details 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 31 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 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People planning to live at Kacee Lodge can expect to have the information they need and to have an assessment prior to admission to determine if their needs can be met. Evidence: The home had a statement of purpose and service user guide that had been reviewed since the previous key inspection. Copies were provided at inspection and were seen to meet regulatory requirements. The acting manager (assessment and referrals manager)said she planned to fully review both documents. The admission procedures were discussed with the acting manager during the site visit. There had been two respite admissions only since the previous inspection. It was therefore not possible to fully inspect the assessment process. However the manager explained that referrals are received from social workers and assessments are undertaken in hospital, home or care home as relevant. An assessment tool is used to ensure all needs are identified and to determine if they can be met at the home. Potential residents and their representatives are invited to view the home and meet Care Homes for Adults (18-65 years) Page 11 of 31 Evidence: with staff and residents and have a meal with them. Care Homes for Adults (18-65 years) Page 12 of 31 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Kacee Lodge can expect to have their care needs met but cannot be assured they will be supported to make independent decisions about their lives. Evidence: The acting manager said she was in the process of reviewing all care plans to develop a more person centred approach. This was confirmed from the three care plans that were viewed during the site visit. Each record contained good detail of the persons care needs to enable staff to understand and support individual needs. A pen portrait had been developed for each person that provided guidance to staff on their care needs and a copy was held in their individual rooms. All of the three care plans had been regularly reviewed and updated to reflect changing needs. Risk assessments were recorded for individual risks (manual handling, risk of falls, risk of seizures etc.). These were detailed and had been recently reviewed. One care plan had been developed to provide a more person centred approach and included a life profile in pictures/photographs. Each resident had a key worker and the manager said that the Care Homes for Adults (18-65 years) Page 13 of 31 Evidence: system had recently been reviewed as several staff had left employment and new staff had been appointed. Whilst this must have caused disruption for residents the overall atmosphere in the home was calm. Due to the degree of disability it was not possible for residents to easily communicate any concerns or issues they may have. We were informed that all residents had a family member that was involved in their care and assisted in making decisions. However some were less involved than others. The manager said that accessing advocacy services was difficult, although one resident did have an advocate. However contact was made with the advocate following the site visit and they stated that they had not been able to see the resident when they visited the home and no further contact had been made with them. Risk assessments (i.e. risks to self and others for different types of behaviours/seizures) was seen with procedures in place for monitoring and to provide guidance to staff on how they should be managed and risks minimised. One resident had been admitted to accident and emergency following a seizure but the Commission had not been notified as required by regulations. This appeared to have been an oversight and policies and procedures in place did however demonstrate the homes commitment to minimising risks and hazards and promoting the health and safety of residents. Care Homes for Adults (18-65 years) Page 14 of 31 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Kacee Lodge can expect to have a planned programme of social activities and to receive a well balanced and nutritional diet in a family type environment. However insufficient integration into the local community and a lack of holidays do not enhance their lives. Evidence: Due to the complex needs of people living at Kacee Lodge none were able to take up employment or educational opportunities. No residents attended day centres. However we were informed that a resident had attended a local unit for a short period but experienced difficulties as different staff took them each time. The manager said that the service would recommence in two weeks as a staff member had been designated to take them who was also able to drive the vehicle. Care Homes for Adults (18-65 years) Page 15 of 31 Evidence: A limited range of activities outside the home were provided, for example bouncability, shopping trips. One resident had hydrotherapy and had been referred for music therapy. The manager said they were also investigating swimming for which a risk assessment was planned to be undertaken. In-house activities provided (some seen on photographs in the home) included cake making, pizza making, puzzles, hand massage, foot massage, manicures, reading and use of the sensory room. Trips were also organised to the pub, to Maldon and Clacton. A birthday party was arranged on the day of the site visit and the manager said that weather permitting, barbecues are arranged and ball playing in the garden. No residents had been enabled to have a holiday since the previous key inspection. A relative when asked How do you think the care home can improve? stated provide more activities and more stimulation. Due to the staff turnover there had been no annual holiday arranged since the previous key inpection, although there was evidence that these had been provided prior to that. The homes statement of purpose stated that Kacee Lodge is committed to encouraging residents to maintain their circle of friends and family and also made reference to the visiting arrangements. From discussion with the manager it was evident that there was close contact with each of the residents relative/representative and efforts were made to communicate regularly with them. One relative spoken with said that recently there had been improvements made in enabling their loved one to keep in touch and said that a staff member brought them home to stay with them. The homes daily routines were noticeably more relaxed than at the previous key inspection. Staff appeared to have more time to support residents. Some residents are now involved in household tasks, for example cleaning bedrooms, where previously there had been none. However this was not detailed in the service user guide. The records detailed residents preferred name which staff were observed to use when speaking with them. It was evident from observation and the records viewed that staff aimed to uphold residents privacy and dignity when providing personal care and in conversation. However one shared room had no locked facility available for storage of personal /valuable items. The kitchen was secure with a digital door entry lock The room was domestic in size, clean and well fitted with fridge, freezer, hob/oven, microwave etc. Personal protective clothing (disposable aprons, gloves) and hand gel were provided for staff. It was good to see also that food hygiene rules were on display for staff guidance who were responsible for cooking meals. Temperature monitoring for the fridge and freezer was recorded ensuring that food was stored within safe recommended levels. Food cupboards and the fridge were well stocked with healthy foods (fruit, vegetables,cereals etc.). The care records viewed confirmed that nutritional needs are assessed and weights monitored and supplements provided as needed. Care Homes for Adults (18-65 years) Page 16 of 31 Care Homes for Adults (18-65 years) Page 17 of 31 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Kacee Lodge can expect to have their healthcare needs met and to be safeguarded by the homes medication policy and procedures. Evidence: From discussion with the manager and inspection of records it was evident that residents had good access to health care services. Arrangements were in place for residents to visit their own GP who also attended as requested. Health care professionals were also involved for example district nurses, occupational therapist and speech and language therapists. Some residents attended outpatients appointments. A visiting dentist attended the home six monthly to treat residents, also confirmed from the records. Care plans now also included a health action plan. This was seen for one resident and included details of access to GP, Consultant, district nurse, continence assessment, cancer specialist, wheelchair clinic and Clinical Nurse Specialists and a Mental Capacity Act assessment that had recently been undertaken. However a visiting health professional raised concerns that care staff did not follow advice given by them intended to improve an individuals mobility/independence. A relative raised concerns regarding their loved ones mobility. However the records Care Homes for Adults (18-65 years) Page 18 of 31 Evidence: confirmed that action had been taken to provide hydrotherapy for them. The medication systems were discussed with the manager and a care worker. Medication policies and procedures (last reviewed April 2007) were available for staff guidance. A list of staff signatures and initials was available to enable follow up and appropriate action to be taken in the event of an adverse incident. However this included staff names who no longer worked at the home and therefore required updating. We were informed that a Director was in the process of reviewing all policies and procedures. Medication was supplied by in a monitored dosage system and individual containers from the local pharmacist. Medication was stored in a locked cupboard that was secured to the wall in the dining room and in a fridge located in the managers office. Monitoring of room and fridge temperatures was recorded to ensure medication was stored within safe recommended levels (maximum 25 degrees Centigrade). However this was last recorded on 1/04/09. The medication supplies and records were inspected for three residents. All supplies were present as prescribed and the majority of administration records were well recorded. However one resident was prescribed a cream once daily and a five day break had been instructed by the GP. This was not clearly recorded on the MAR sheet and there were therefore gaps in the records with no reason recorded for the apparent omissions. The MAR sheets were also left out rather than being locked away as required under Data Protection. Medication was administered by senior staff with appropriate training and confirmed from the staff records. Care Homes for Adults (18-65 years) Page 19 of 31 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 Kacee Lodge can expect to have their concerns and complaints listened to and acted upon and to be protected by the homes safeguarding procedures. Evidence: The home had a complaint policy and procedure that included timescales for a response. The procedure was included in the statement of purpose and in the service user guide. A copy was also displayed in the home. A pictorial version had also been developed to promote residents understanding. From discussion with the manager and the complaints record viewed it was evident that complaints were investigated in line with the homes procedures an appropriate action taken to resolve issues. The home had safeguarding policy and procedures together with a whistle blowing policy in place for staff guidance. Essex adults safeguarding procedures were also available in the home. We were informed that the manager is a trainer for safeguarding and therefore able to provide in-house training for staff. The records confirmed that all care staff had confirmed they had read the homes procedures during their induction. The training records confirmed that recently appointed staff had received safeguarding adults training on 3/4th March 2009. There had been one allegation of abuse made since the previous key inspection that had been investigated in line with Essex procedures and appropriate action taken. Care Homes for Adults (18-65 years) Page 20 of 31 Evidence: The home had a policy and procedures for dealing with residents monies. Most residents had a family member who managed their finances on their behalf. Personal monies were held for some residents and held in a separate cash box that was stored securely. Transactions were recorded and receipts held. We were informed that a senior manager was appointee for one resident and was in correspondence with the Department of Works and Pensions to ensure they were receiving their appropriate allowances. From discussion with the manager it was evident that where there were concerns in residents receiving their personal allowances and action was being taken to refer to the local authority. Care Homes for Adults (18-65 years) Page 21 of 31 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 Kacee Lodge can expect to live in a clean, comfortable and homely environment that is well maintained but one which would benefit from more attractive gardens. Evidence: A tour of the premises was undertaken during the site visit. The premises were clean and several areas had been redecorated including the lounge/dining room, activities room, snoozelum room, shower room, bathroom and several bedrooms. It was good to see that the activities room had been rearranged, the jacuzzi removed and redecorated. The room now served as a staff meeting/training room and also for residents activities. The premises were accessible for residents and wheelchairs with some restrictions in place for safety (for example the kitchen). Fire safety equipment was in place (fire extinguishers, smoke alarms etc) and records viewed confirmed that fire safety practices were in place to meet the requirements of the local fire service. A maintenance person was employed to ensure ongoing repair and maintenance of the home. However the garden which was laid mainly to lawn was rather bare and in need of tidying and planting to make it more attractive for residents. Residents rooms viewed were personalised with photographs, toys, collages and Care Homes for Adults (18-65 years) Page 22 of 31 Evidence: pictures, radio/CD players. Some had been redecorated since the previous key inspection and were clean and bright. Action had been taken to provide curtains and lampshades for the rooms identified at the previous key inspection to ensure their privacy and dignity. A new mattress had also been provided to replace the torn mattress. The premises were clean and free from odour throughout. Staff handwashing facilities (liquid soap, paper towels and pedal bins) were provided in residents rooms, bathrooms and the kitchen to minimise the risk of infection. Antibacterial hand gel was also provided for staff and visitors use. The home had policy and procedures for infection control and action to be taken in the event of a flu pandemic (seen in the files viewed). Staff practices were observed to be safe. The laundry room was domestic in size and was fitted with a drier and a washing machine with sluice facility (able to wash at minimum 65 degrees centigrade for not less than 10 minutes). Both were in working order and regularly maintained. Linen viewed was clean and well laundered. Care Homes for Adults (18-65 years) Page 23 of 31 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 living at Kacee Lodge can expect to be cared for by robustly recruited and well trained staff who are well supported and well supervised. Evidence: There had been a high staff turnover since the previous key inspection resulting in experienced and qualified staff having left employment. However recently appointed staff were receiving appropriate training. There were eighteen care staff employed and the records confirmed that two care staff had an NVQ level 3 qualification and five care staff had an NVQ level 2 qualification. This is marginally less than the 50 needed to meet the recommended standard. However we were informed that one care staff was undertaking NVQ level 2, one was undertaking NVQ level 3 and two care staff were undertaking level 4. If successful this would then exceed the standard. In addition to the manager who attended during the morning, there was one senior care staff and two care staff on duty. Two staff were on duty during the night. We were informed that additional care staff were employed several days per week to support residents activities and two staff had taken two residents out that morning shopping. Residents appeared well cared for and were well supervised during the site visit. The atmosphere in the home was more sociable and relaxed and staff did not Care Homes for Adults (18-65 years) Page 24 of 31 Evidence: appear rushed. Training records for the same care staff were viewed. These confirmed that they had received induction to Skills for Care Standards and an introduction to safeguarding adults. Three further individual staff records were viewed. These confirmed that since the previous key inspection training had been provided in , basic food hygiene, infection control, fire safety, basic first aid, safeguarding adults and risk assessments. The records detailed manual handling training as having been undertaken on 19/01/07. The manager stated that two of the staff had attended on 21/07/08 and one had not attended. Feedback from a healthcare professional indicated that further training in moving and handling was needed to ensure the specific needs of resents could be appropriately met and that this had been offered but not taken up. Supervision arrangements were discussed with the manager who explained that staff handover was provided between shifts to discuss residents changing needs. Ongoing observation and monitoring of practice was also evident as the manager was regularly on site. Regular recorded supervision sessions were undertaken where practice and training needs were discussed and confirmed from the records viewed during the site visit.This ensured that care staff were appropriately supported and able to develop their practice to enable them to meet residents needs more effectively. Care Homes for Adults (18-65 years) Page 25 of 31 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 living at Kacee Lodge can expect to live in a well managed home with good standards of health and safety that protects them and staff. Evidence: The manager post was currently vacant and was being covered full-time by the Support Manager who had a management qualification and considerable experience in care of people with learning disabilities. A deputy manager had recently been appointed and recruitment was again underway for a manager, having been unsuccessful in the previous recruitment drive. The homes quality assurance programme was discussed with the support manager. Surveys were sent to service users and their representatives and to health and social care professional to seek their views and an action plan was developed from any issues brought up during the surveys. Reports required under regulation 26 were completed by one of the Directors of the organisation and action taken to address issues raised. An audit strategy had also been launched in April 2009 which comprised Care Homes for Adults (18-65 years) Page 26 of 31 Evidence: a range of audits that were undertaken monthly, for example medication, health and safety etc. we were informed that the manager was planning to undertaken a review using the Key Lines of Regulatory Assessment (KLORA). This provided some evidence on how the service aimed to identify areas for improvement. The AQAA however lacked sufficient detail to fully describe the current service provided and did not clearly state how areas for improvement had been identified and how they were to be addressed. Records held on behalf of residents were kept up to date and stored safely in secure facilities in a locked office in accordance with the Data Protection Act 1998. Records viewed at this inspection included: statement of purpose, service user guide, care plans, medication records, staff recruitment, staff training, residents finances, maintenance records and fire safety records. The home had a health and safety policy and procedures for staff guidance. The records viewed confirmed that new staff received health and safety training and updated training was also provided. Evidence of a sample of records viewed showed that there were systems in place to ensure the servicing of equipment and utilities (e.g. gas, electrical safety, annual PAT testing etc.) and there was evidence of appropriate weekly and monthly internal checks being carried out (e.g. checks on fire equipment, fire alarms, emergency lighting, hot water temperatures). Care Homes for Adults (18-65 years) Page 27 of 31 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 31 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 1 20 13 The administration records 30/06/2009 must be recorded accurately and in full with the reason for any omissions recorded. This will ensure that medication is given as prescribed. 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 7 To ensure residents are fully supported to make independent decisions about their lives and are enabled a choice, action should be taken to refer individual residents to advocacy services as needed. To ensure staff providing activities are skilled and competent, training in provision of activities for people with learning disabilities should be provided. To ensure residents are part of the local community and have an active social life more activities should be provided. To ensure residents have fulfilling lives the option of an annual holiday which they help to choose and plan should be offered. Page 29 of 31 2 13 3 13 4 14 Care Homes for Adults (18-65 years) 5 20 To ensure adverse incidents can be appropriately followed up the list of staff signature and initials who are designated to administer medication should only include staff currently working at the home. The gardens should be tidied and planted with flowers and shrubs to provide an attractive outlook for residents. Staff should receive additional moving and handling training to ensure residents specific needs are appropriately met. Systems should be in place to ensure all staff attend manual handling training annually. 6 7 24 35 8 35 Care Homes for Adults (18-65 years) Page 30 of 31 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) 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. 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