Care Home: Ladignac Residential Care Home

Similar services:

• 2 Perhaver Park
• The Vicarage
• St George`s
• 5 Seafield Road
• Radfords
• Honeybourne House
• 32 Beaumont Way

What the care home does well One of the main strengths of the service is that people who use the service are treated as individuals. There is a clear acknowledgement from the home`s owner that people should be able to make choices about what they do. People who use the service confirmed that they were given choices about how they spend their time at the home. Potential risks to individuals who use the service are taken into account when care is planned and their independence is promoted with due regard for their welfare. People who use the service are able to engage in a range of activities that are meaningful to them including holidays and community events. We found that Mrs Deaville has reviewed staffing levels in the home to enable people to access more activities on an individual basis. People`s rights to an ordinary life are respected and they are supported in maintaining relationships with friends and family. People who use the service are supported with their personal care and have appropriate intervention from health care professionals to meet their needs. The home environment is pleasant, clean and homely with the owner taking appropriate steps to make adaptations to the property to meet one person`s needs more effectively. The service appears to be run in the best interests of people who live there. What has improved since the last inspection? Care plans for people who use the service have been reviewed so that they are better organised and contain more detail. The record-keeping system in place in relation to people`s money is more comprehensive and better protects people who use the service. Safety checks on portable electrical appliances have been carried out to ensure that equipment is safe to use. Staffing levels in the home have been reviewed so that a more person-centred approach to activities can be put in place. What the care home could do better: The main weakness found at this inspection was in relation to medication practices. We have made four requirements in relation to this. We found that one medication and one cream being administered to a person was not being recorded. This must be addressed so there is a clear record of all medicines and creams that have been given to people. Information about creams to be used must also be included in the care plan so it is clear to the reader what cream needs to be applied, where, how, why and when. We also found that where there have been conversations with health care professionals about changes in people`s medication these have not always been recorded. This is important as it forms part of the audit trail by which we can be sure medication is being given as prescribed. Staff training also needs to be sought in medication administration so that they have the knowledge and skills to be able to give and record medication in a safe way following best practice at all times. We have also made a requirement and a recommendation in relation to the home`s Statement of Purpose. Although the provider has produced a document that contains some information about the service there are some gaps in the information about services and accommodation provided by the home which need greater clarification. As a result of this inspection we have also made recommendations in relation to care planning, health care documentation, medication, staff training, the home`s complaints procedure and some aspects of health and safety in the home. Recommendations are based on good practice and should be given serious consideration by the provider in improving outcomes for people and making procedures and record-keeping more robust. Key inspection report Care homes for adults (18-65 years) Name: Address: Ladignac Residential Care Home 38 Crookhays Shaftesbury Dorset SP7 8DX     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Heidi Banks     Date: 2 3 1 1 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 34 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 34 Information about the care home Name of care home: Address: Ladignac Residential Care Home 38 Crookhays Shaftesbury Dorset SP7 8DX 01747854978 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Work:01252615035 Ms Janet Deaville Name of registered manager (if applicable) Type of registration: Number of places registered: care home 3 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who may be accommodated is 3. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender 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 Ladignac is a home providing accommodation and care for three people with a learning disability. Accommodation is provided on two floors. The home is situated in a residential area of Shaftesbury. The owner of the home, Mrs Janet Deaville, also manages the service on a day-to-day basis. There is one full-time and one part-time member of staff employed to work in the home. Care Homes for Adults (18-65 years) Page 4 of 34 Over 65 0 3 2 4 1 1 2 0 0 8 Brief description of the care home The range of fees charged by the service are currently £1347 - £1396 per fortnight. Further general information about fees and fair terms of contracts can be found on the website of the Office of Fair Trading at www.oft.gov.uk. Care Homes for Adults (18-65 years) Page 5 of 34 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: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This was an announced key inspection of Ladignac. We announced the inspection with four days notice as we are aware that Ladignac is a small home which may not be staffed during the day. We also wanted to make sure that the owner of the home, who is also in day-to-day charge of the service, could be present. The inspection was carried out by one inspector from the Care Quality Commission. However, we have used the term we throughout the report to show that the report is the view of the Care Quality Commission. Our inspection of the service took place over one day. As part of our inspection we were able to meet the owner of the home, Mrs Janet Deaville, and talk to one member of care staff. We looked at a sample of records held at the home including information about people who use the service, recruitment and training records, medication and health care records and health and safety documentation. Care Homes for Adults (18-65 years) Page 6 of 34 Before the inspection we sent surveys to the home to be distributed to people who use the service, their care workers and those who have contact with them. We received a total of seven completed surveys; three from people who use the service, two from care workers employed to work in the home and two from care professionals who have contact with the service. Peoples comments have been reflected in this report. Care Homes for Adults (18-65 years) Page 7 of 34 What the care home does well: What has improved since the last inspection? What they could do better: The main weakness found at this inspection was in relation to medication practices. We have made four requirements in relation to this. We found that one medication and one cream being administered to a person was not being recorded. This must be addressed so there is a clear record of all medicines and creams that have been given to people. Information about creams to be used must also be included in the care plan so it is clear to the reader what cream needs to be applied, where, how, why and when. We also found that where there have been conversations with health care professionals about changes in peoples medication these have not always been recorded. This is important as it forms part of the audit trail by which we can be sure medication is being given as prescribed. Staff training also needs to be sought in medication administration so that they have the knowledge and skills to be able to give and record medication in a safe way following best practice at all times. We have also made a requirement and a recommendation in relation to the homes Care Homes for Adults (18-65 years) Page 8 of 34 Statement of Purpose. Although the provider has produced a document that contains some information about the service there are some gaps in the information about services and accommodation provided by the home which need greater clarification. As a result of this inspection we have also made recommendations in relation to care planning, health care documentation, medication, staff training, the homes complaints procedure and some aspects of health and safety in the home. Recommendations are based on good practice and should be given serious consideration by the provider in improving outcomes for people and making procedures and record-keeping more robust. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 34 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 34 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There have been no new admissions to Ladignac since the last inspection so we are unable to determine whether peoples needs are assessed appropriately before they come to live in the home. The home has a Statement of Purpose which contains some of the information required by the regulations but needs to be expanded in some areas so there is greater clarity for the reader about accommodation offered and services provided. Evidence: At the time of this inspection there were three people living at Ladignac. All three had been living at the home for several years. Therefore, for the purposes of this inspection we are unable to determine how the home ensures peoples needs are assessed before they are admitted to the service. We asked Mrs Deaville for a copy of the homes Statement of Purpose. Mrs Deaville forwarded this to us after the inspection. The document was reviewed in November 2009. The Statement of Purpose gave us basic information about the values of the home, a description of the service, staff employed at the home, fire precautions and Care Homes for Adults (18-65 years) Page 11 of 34 Evidence: emergency procedures and admissions procedures. In some areas, information should be expanded upon. For example, specific information about the sizes of rooms must be detailed, especially as the recent installation of a shower facility in one bedroom will have impacted on the available space. The contact details of the registered provider must also be included in the document. Information also needs to be included on arrangements in place to support service users with attending religious services if they request this. The Statement of Purpose should also offer clarity around the use of the lounge adjacent to the service users kitchen so that it is detailed whether this is the lounge of the provider, who lives at the home, or whether it is for the use of service users as well. We have sent some guidance to Mrs Deaville on information that should be included in the Statement of Purpose. Care Homes for Adults (18-65 years) Page 12 of 34 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are supported to make choices in their everyday lives and take appropriate risks so that their independence is promoted as far as practicable. Evidence: We looked at the care plan for one person who lives in the home. This contained some good information on the persons communication style and likes and dislikes. There was also information on things the person can do for themselves such as various household tasks and areas where support is needed. We discussed with the provider that individuals support plans should be produced in a format that is accessible to them so that they can understand its content and participate as far as practicable in its design. Indeed, one person who uses the service is able to read and write so it would be possible for them to create a plan for themselves with some support. Both care workers responding to our survey told us they were given up-to-date information about the needs of the people they support. Records showed evidence of reviews taking place with people who use the service and members of the multi-disciplinary team to ensure that their needs are being met. Care Homes for Adults (18-65 years) Page 13 of 34 Evidence: We talked to Mrs Deaville about how the home promotes the rights of people to choose what they do. Mrs Deaville gave us an example of how holidays and activities have been arranged based on individual needs and preferences. This was also reflected in a sample of records we looked at. Since the last inspection the home has employed a further care worker with a view to ensuring individuals are able to have the one-to-one attention they need to pursue specific activities or interests with support. Staff we spoke with indicated that this has worked well and had direct benefits for people who use the service. All three people who use the service told us in surveys that they can do what they want to do in the evenings and at weekends. A relative told us that the home tries to implement any fresh ideas such as getting an exercise bicycle for service users to use. We looked at one persons file to see if there was sufficient information about risks and how these were to be managed. We found that risks in relation to road safety, vulnerability, use of electrical equipment and managing finances had all been given consideration with information on how care workers should support the service user with these issues. Daily records we looked at showed that people who use the service have access to a range of activities in their community which enable them to live an ordinary life. Care Homes for Adults (18-65 years) Page 14 of 34 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 who use the service access a range of activities and opportunities based around their individual needs and goals. Their rights to live an ordinary life are acknowledged and contact with family and friends is promoted. Evidence: All three people who live at Ladignac attend local day services during the week. Mrs Deaville told us that a range of activities is available to people in the evenings and at weekends. This was confirmed by the records we looked at which showed evidence of individuals visiting local towns and attending local events. We saw that one person who enjoys reading is a member of a local library and plans are in place to support individuals with accessing places of interest that are further afield. As indicated in the last section of the report, all three people who live in the home told us in surveys that they can do what they want to do in their free time. We found that holidays and short breaks have been given consideration in peoples plans. Care Homes for Adults (18-65 years) Page 15 of 34 Evidence: Individual records showed evidence of peoples contact with their friends and families. This included relatives visiting people at Ladignac and people being enabled to visit their family at home. The homes Statement of Purpose indicates that there are no restrictions on visiting times in the home as long as it does not adversely impact on other people who use the service. A relative responding to a survey also indicated that communication between themselves and the service was good. Mrs Deaville told us that she has contact with families of people who use the service on a weekly basis which helps promote communication. Discussion with Mrs Deaville indicated that each person who lives in the home is recognised as an individual. There was a clear acknowledgement about how their needs differ and how the service has to respond to this. For example, one person who is able to access their local community independently is given opportunities to do so. Staffing levels have also been reviewed since the last inspection to ensure that each individual has opportunities for one-to-one support with activities. Discussion with Mrs Deaville and a member of staff indicated that this ensures individuals social needs are met by the service and they can pursue interests as individuals rather than as a group. The records we looked at for one service user also indicated that they are given opportunities to participate in household tasks and take responsibility for this as part of living an ordinary life. Information held about individual service users indicated their likes and dislikes in relation to food. Discussion with Mrs Deaville showed that she is aware of the specific needs of one person who uses the service in relation to their food intake and has liaised with the multi-disciplinary team with regards to this. Records also showed that people are offered opportunities to visit cafes in the local area for lunch and coffee. Care Homes for Adults (18-65 years) Page 16 of 34 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples personal and health care needs are met with involvement of relevant social and health care professionals. Medication systems in the home are not robust enough to fully protect people and ensure good practice is followed at all times. Evidence: We looked at information on one persons file in relation to their personal care needs. We found that the care plan contained some basic information on their needs but this was expanded upon later in the record with more detail. In particular there was some good detail about how staff should support them with their oral health. The records indicated that staff would take responsibility for nail care. Mrs Deaville reported that none of the people using the service are seen by a chiropodist. We suggested that this is something the home should explore as a foot check-up, even on an ad hoc basis, might help identify any foot-related problems at an early stage. We discussed that this may be particularly important for people who do not communicate verbally and therefore may not be able to state that they are experiencing discomfort. Mrs Deaville agreed that this is something that could be looked into as part of each individuals care plan. The survey we sent to people who use the service asked the question; Do the care staff and managers treat you well. Two people answered this question, one Care Homes for Adults (18-65 years) Page 17 of 34 Evidence: person indicating this was always the case and the other indicating this usually happened. We looked at the records for two people who use the service, both of which showed evidence of intervention by health care professionals in relation to their health needs. This included appointments at the hospital, local surgery, optician and involvement from the community team. We noted that health appointments had been recorded within the context of daily notes rather than in a separate record specifically for appointments. We recommended that this is reviewed so that it is easier for people to see how health issues are being followed up and information does not get lost within daily recording. We looked at arrangements in place in the home in relation to peoples medication needs. Medication is supplied by a local pharmacy in original containers. The home uses their own medication administration records but instructions on the chart have not been double-signed to confirm their accuracy. We have made a recommendation that this system is put in place. A care worker told us that one person who uses the service has a cream applied. We could not find any information on the medication administration record or in the care plan relating to which cream was needed, where it should be applied, why or how it was being used. We have sent Mrs Deaville some good practice guidance on the application and recording of creams for the home to use in reviewing their practices. Mrs Deaville informed us that the doctor was currently reducing the dose of one persons medication. Some information about this reduction had been written up on the persons file but an instruction for the home to continue on the present dose had not been documented although Mrs Deaville was able to give a verbal account of the instructions she had been given over the telephone. We were told that one person who lives in the home had recently been prescribed lactulose and we were shown the bottle that is being used. The label on the bottle indicated that 5-10 mls should be given. Mrs Deaville told us that 10 mls was being given daily. However, there was no record of the lactulose being prescribed. Mrs Deaville told us that the lactulose had been prescribed over the telephone by the persons doctor. There was also no record on the persons medication administration record chart of the lactulose being administered. We are making requirements that the home ensures that instructions to change medication taken over the telephone are clearly documented on the persons records and that there is a clear system in place to evidence the administration of all medicines in the home. Where a variable dosage is prescribed, for example, 5-10 mls, records need to show how much was Care Homes for Adults (18-65 years) Page 18 of 34 Evidence: administered on each occasion. We asked a member of staff whether they had received training in medication since working in the home. They told us that they had been shown what to do by the previous provider. Mrs Deaville told us that she was in the process of investigating suitable training in medication. We are making a requirement for this to take place before 26th February 2009 so that people who use the service can be confident that staff have the training they need to be able to implement safe systems of working. Care Homes for Adults (18-65 years) Page 19 of 34 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Although some policies and procedures are in place to promote the protection of people who use the service there are ways in which this could be made more robust including the provision of regular update training for staff. Evidence: Mrs Deaville showed us a copy of the homes complaints procedure. We did not see that this was on display at the home at the time of the inspection. The procedure indicated that people wishing to raise concerns or complaints should contact Mrs Deaville. Due to the size of the home and nature of its management there is no-one else within the service who could potentially be contacted about concerns that arise. In light of this, we suggested that, as all three people who use the service are funded by Dorset County Council, contact details for the local authority are given on the document so that if people wish to escalate their complaint they know they can do so via the local authoritys complaints procedure. Information about the Care Quality Commission should also be updated on the document so it reflects the organisations current name and contact details. Mrs Deaville told us that the home has not received any complaints about the service they provide. She told us about an issue that had been raised by a relative and how this had been responded to. We suggest that the home ensures that day-to-day concerns are also documented with the action taken by the provider or staff to respond to them so that there is a clear audit trail of how the home responds to issues that arise. A service user told us in a survey that they know who to speak to if they are not happy and they know how to make a complaint. Out of Care Homes for Adults (18-65 years) Page 20 of 34 Evidence: two care professionals responding to our survey, one indicated that the service usually responds appropriately to concerns that are raised by themselves or service users, one indicating that this was only sometimes the case. The Commission has not received any concerns or complaints about the service in the last twelve months. Both care workers who completed a survey told us that they knew what to do if someone raised concerns about the home. We asked Mrs Deaville if she had a copy of the pan-Dorset safeguarding policy at the home. A copy was not readily available so we forwarded a copy to the home following the inspection. A recommendation was made at the last inspection that an update in safeguarding training is undertaken by staff working in the home. We spoke to a care worker who told us they had done training in the protection of vulnerable adults a few years ago. Mrs Deaville told us that update training was still to be provided. We suggest that Mrs Deaville liaises with the local authority who provide adult protection training for care workers. We spoke to the member of staff concerned who knew what action to take if she was concerned that there was malpractice in the home. We looked at the records for a new member of staff. Although there was evidence of Mrs Deaville going through an induction checklist with the care worker it was not evident that this included instruction on recognising and responding to abuse. Mrs Deaville told us that the care worker had read the homes policies in relation to this. We recommend that policies and procedures read by care workers are clearly documented, their understanding checked and that, in any case, formal training in recognising and responding to abuse is provided to the care worker. We are not aware of any safeguarding investigations that have taken place in the home since the last inspection. Mrs Deaville told us that, following a recommendation made at the last inspection, she has reviewed procedures in place in relation to handling peoples money. We checked a sample of receipts against transactions that had been logged which indicated that receipts had been maintained for various purchases. Mrs Deaville told us that she regularly audits individuals financial records to ensure that they are accurate and evidence of this was seen on file. Care Homes for Adults (18-65 years) Page 21 of 34 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. The home environment is of a suitable standard to ensure that peoples needs are met and they have a pleasant, clean and comfortable place to live in. Evidence: Ladignac is a semi-detached property situated in a residential area of Shaftesbury. There is an area for parking at the front of the home. Accommodation within the home comprises an entrance hall, a residents lounge, a spacious conservatory, kitchen, utility room and three single bedrooms. One bedroom is on the ground floor next to a toilet / shower room with a wash hand basin facility. There are two further bedrooms on the first floor of the home, one of which has a wet room shower facility for the sole use of the resident who occupies the room. There is a communal toilet and bath facility also on the first floor of the property. A garden which includes a summer house and patio is situated at the rear of the property for use by residents. The home is furnished in a homely, domestic style which is appropriate to the service it aims to provide. At the time of the inspection the home presented as wellmaintained. We noted that in one of the lounges in the home there was some paintwork that needed to be repaired around the window to the utility room. Mrs Deaville told us that this was her lounge. We have made a recommendation under Standard 1 that the Statement of Purpose is clear about which areas in the home are Care Homes for Adults (18-65 years) Page 22 of 34 Evidence: for use by residents and which are the private accommodation of the provider. In any case, the lounge is the main route through to the communal kitchen and therefore is accessed by all residents. A care professional who has contact with the home commented favourably on the wet room facility that has been installed in one service users bedroom. This adaptation to the home was made as a result of identifying that the individual would benefit from a level access shower due to their changing health needs. The person told us that the adaptations that have been made, including new doors and windows, are a vast improvement. At the time of the inspection the home presented as clean and tidy. There were no unpleasant odours in the home. Two people who use the service who responded to our survey told us that the home is always fresh and clean, one indicated this was usually the case. Liquid soap was available for use at wash hand basins and a separate utility area for laundry was in place. Mrs Deaville told us that she has obtained training packs in infection control for staff to work through although this has not been implemented as yet. We have recommended that this is carried out as soon as possible. Care Homes for Adults (18-65 years) Page 23 of 34 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service benefit from a small staff team who know them well and there are satisfactory recruitment procedures in place to ensure staff are safe to work with them. The provider is looking at ways in which peoples training needs can be met but this needs to be expanded further so that staff benefit from specialist, as well as mandatory, training. Evidence: Ladignac has a small staff team which comprises Mrs Deaville who, as well as being the owner of the home is also in day-to-day charge of the service, a care worker who has worked there for four years and a new care worker who was employed in September 2009 and currently works alongside existing staff. This means that there is consistency and continuity of care for people who live at the home. We found that appropriate checks had been carried out on the new care worker before they started in post to determine their suitability to work with vulnerable adults. We saw evidence of an induction checklist on file although this was seen to cover employment issues rather than the Common Induction Standards. Mrs Deaville told us that the Common Induction Standards would be roughly covered as part of the induction programme. We reminded Mrs Deaville that it is expected this will be done within twelve weeks of the new worker starting in post. We were informed that the Care Homes for Adults (18-65 years) Page 24 of 34 Evidence: care worker had read the policies and procedures for the home although this had not been documented and there was no evidence that their understanding of the procedures had been checked with them. The care worker concerned indicated in a survey that their induction was ongoing. Mrs Deaville also confirmed that the care worker was not working alone in the home at the present time and was not attending to individuals personal care needs, their role being to promote activities for people who use the service. The care worker who has worked at the home for four years told us they had recently been given training packs on food hygiene, health and safety and infection control which they were working through. Mrs Deaville told us that training in total communication approaches was also being scheduled. A recommendation was made at the last inspection for training in mental health and learning disability to be implemented for care workers and this recommendation is repeated as there was no evidence of this training having been undertaken. We asked care professionals who have contact with the home whether they felt the services managers and staff have the right skills and experience to support peoples social and health care needs. One told us that this was usually the case, the other indicated sometimes. Both care workers who are employed at the home told us that they were being offered regular support by the owner of the service. One confirmed that this included formal supervision sessions as well as informal day-to-day support. Care Homes for Adults (18-65 years) Page 25 of 34 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 who live at Ladignac benefit from an owner who is implementing some positive changes to improve their quality of life. Procedures are in place to keep people safe but there are some areas that would benefit from a more robust approach to ensure that risks are minimised as far as practicable. Evidence: Mrs Deaville has been the owner of Ladignac since May 2008. She has also been in day-to-day charge of the home since October 2008 when the previous registered manager left the service. Mrs Deaville also lives at the home approximately three weeks out of every four. Discussion with one of the care workers employed to work in the home indicated that people who use the service were settled, having coped with the changes of ownership and management during 2008. She told us that communication with the owner of the home was good and that some positive changes had been made including the appointment of a second care worker in the home. Communication was an area that was also highlighted by a relative of a person who uses the service as being something the home does well. Indeed, Mrs Deaville told us that she aims to have regular contact with relatives so they are kept updated about Care Homes for Adults (18-65 years) Page 26 of 34 Evidence: their family members needs. A care professional who has contact with the home told us; I believe Janet (proprietor) genuinely cares about the welfare of the people she provides services to and works towards maintaining good standards of practice and improving the quality of their lives. At the last inspection of the service it was identified that a quality assurance process had been implemented by the home. This was confirmed by Mrs Deaville at this inspection who informed us that she had sent out surveys to people who have contact with the home on one occasion since she took over the homes ownership. It is suggested to Mrs Deaville that she makes this an annual process to ensure that the views of people who use, and have contact with, the service are obtained on a regular basis and the home bases its development on this. We looked at a sample of health and safety records. These showed that gas and electrical installation safety checks had been carried out and, following a recommendation made at the last inspection, portable appliances had also had a safety check. The fire risk assessment in place at the home is basic and was dated 03/01/2008. This had been done by the previous provider of the service. Although there has been no changes in residents since this time we are recommending that Mrs Deaville takes advice about what should be in a fire risk assessment and reviews its content on a regular basis. Mrs Deaville told us that she has been through fire safety procedures with the new care worker employed to work in the home although this has not been documented. Again, we recommend that the home maintains clear records to evidence that care workers have been instructed in fire safety. Satisfactory records were in place in relation to the testing of smoke alarms in the property and practice evacuations. We were told that the home is trying to identify suitable first aid training for care workers in the local area. Mrs Deaville told us that window restrictors are not fitted to rooms on the first floor of the home. She told us that the risk of individuals falling out of windows is low. We looked at the risk assessment for one person which indicated low risk. The control measure in place to minimise risk was a cabinet being placed in front of the window preventing any chance of an accident. We advised Mrs Deaville that a cabinet would not necessarily prevent a person from falling as they could potentially climb onto, or move, the cabinet. Mrs Deaville told us that the service user concerned dislikes having their windows open and will close them unless they are told not to do so. While acknowledging this, we recommend that the installation of window restrictors on the first floor of the home is given serious consideration to ensure the safety of people Care Homes for Adults (18-65 years) Page 27 of 34 Evidence: who use the service. Care Homes for Adults (18-65 years) Page 28 of 34 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 29 of 34 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 1 4 You must ensure that the Statement of Purpose gives specific information about the size of each bedroom and whether it meets the national minimum standard for available space. You must ensure that the contact details of the provider are clearly detailed in the homes Statement of Purpose. You must do this to ensure that service users and their representatives have full and accurate information available to them. 31/01/2010 2 20 13 You must ensure that where 31/12/2009 people who use the service require creams to be applied there is comprehensive information about this in their care plan and a system is in place to record administration. Page 30 of 34 Care Homes for Adults (18-65 years) 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 You must do this to ensure that people get the creams they need and that this is recorded. 3 20 13 You must ensure that care 26/02/2010 workers who are responsible for administering medication to people who use the service receive training in safe systems of working. You must do this to evidence that people who use the service are supported by care workers with the knowledge and skills to implement safe systems of working. 4 20 13 You must ensure that where 31/12/2009 medication has been prescribed, or amended, over the telephone there is a clear record of this conversation and the instructions given. You must do this to evidence that you are giving medication as prescribed. 5 20 13 You must ensure that there 31/12/2009 is a record in place for the administration of all medicines to people who use the service. Care Homes for Adults (18-65 years) Page 31 of 34 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 You must do this to demonstrate that medication is being 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 1 You should ensure that the Statement of Purpose offers greater clarity on specific aspects of the accommodation and facilities and services provided by the home. You should look at ways to make care plans accessible to people who use the service so they can fully participate in their design and compilation and understand their content. You should review record-keeping systems around peoples health care appointments so that information can be found quickly and easily and there is a clear audit trail of professional advice that has been given. Where you are producing your own medication administration record charts you should ensure that instructions about medication are double-signed to confirm their accuracy. You should ensure that the homes complaints procedure reflects the details of the local authority and accurate contact information for the Care Quality Commission so that people know where they can seek advice. A copy of the homes complaints procedure should be on display in the home so that people who use the service and those that visit them know how to raise concerns should they need to. 2 6 3 19 4 20 5 22 6 23 You should ensure that care workers employed to work in the home have regular and robust training in the protection of vulnerable adults. You should ensure that care workers employed to work in 7 30 Care Homes for Adults (18-65 years) Page 32 of 34 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 the home receive formal training in infection control procedures as soon as possible. 8 32 You should ensure that people employed to work in the home benefit from specialist training that reflects the needs of people who use the service. You should ensure that the induction training you provide to care workers covers all areas of the Common Induction Standards and there is a process in place by which their understanding of policies and procedures is checked with them. You should take advice from the appropriate authority about the content of your fire risk assessment and ensure the homes risk assessment is reviewed whenever there are changes, or at least on an annual basis. You should ensure that instruction given to care workers on fire safety procedures is clearly documented. You should give serious consideration to the fitting of window restrictors on the first floor of the home to ensure that risks are minimised. 9 35 10 42 Care Homes for Adults (18-65 years) Page 33 of 34 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 34 of 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!