Care Home: Laington House

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What the care home does well The pre-admission processes are very robust and significant time and effort is spent planning to make admission to the home personal and well managed. The service involves individuals in the planning of care which affects their lifestyle and quality of life. Service users are supported to take control of their own lives and are encouraged to make their own decisions and choices. Care plans are comprehensive and person centred, and always involve the individual service user. A key worker system allows staff to work on a one-to-one basis with each service user. Care plans include appropriate and relevant risk assessments which are regularly reviewed and updated when necessary. Equality and diversity issues are given a high profile within the service, and there is a strong commitment to enabling people to develop and maintain their skills. People are encouraged to maintain important personal and family relationships, and are able to access information and specialist guidance about issues such as intimate relationships. Complaints and safeguarding issues are well managed and staff undertake training in these important areas. All service users are given a copy of the complaints procedure and the service is open and transparent in dealing with complaints. The service has a well developed recruitment procedure and encourages staff to undertake external qualifications in addition to attending internal training courses. The staff team are supportive of each other and share skills and knowledge with colleagues. Staff supervision is regular and includes staff meetings, 1:1 sessions and observations of practice.Laington HouseDS0000072875.V378160.R01.S.docVersion 5.3Medication administration is of a good standard with good record keeping being maintained. What has improved since the last inspection? This was the first inspection of this newly registered service. What the care home could do better: Handwritten entries onto the MAR (medicine administration record) should be countersigned by a second person to ensure that the transcribing is correct; this will help to safeguard both the service user and the staff. Protocols for the administration of PRN (as required) medication should be developed and kept with the MAR sheet to ensure that this medication is given as required. The manager must ensure that the requirements of the Mental Capacity Act 2005 are applied where necessary. The manager should continue to seek out appropriate activities and employment opportunities for the service users. Key inspection report CARE HOME ADULTS 18-65 Laington House 1 Ethelburga Road Harold Wood Romford Essex RM3 0QR Lead Inspector Sandra Parnell-Hopkinson Key Unannounced Inspection 4th November 2009 09:00 Laington House DS0000072875.V378160.R01.S.doc Version 5.3 Page 1 This report is a review of the 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. 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 home adults 18-65 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. Laington House DS0000072875.V378160.R01.S.doc Version 5.3 Page 2 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 Laington House DS0000072875.V378160.R01.S.doc Version 5.3 Page 3 SERVICE INFORMATION Name of service Laington House Address 1 Ethelburga Road Harold Wood Romford Essex RM3 0QR 020 8885 1084 020 8885 2222 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Cascade Care Ltd Care Home 9 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (9) of places Laington House DS0000072875.V378160.R01.S.doc Version 5.3 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC to service users of the following gender: Male whose primary care needs on admission to the home are within the following category: 2. Mental disorder, excluding learning disability or dementia - Code MD The maximum number of service users who can be accommodated is: 9 This is the first key inspection for this new service Date of last inspection Brief Description of the Service: Laington House is situated in a residential area of the London Borough of Havering. The home is domestic in size and has been equipped to a good standard. The home accommodates 9 male service users who have mental health problems. All bedrooms are single with en suite facilities which include a shower. There are two bedrooms on the ground floor with the remaining bedrooms upstairs. There is a combined lounge/dining area and a small separate kitchen. A small visitors’ lounge is located on the first floor. There is a garden area to the rear of the property and limited car parking facilities are available to the front of the building. There is a small office on the ground floor which has telephone/fax and computer links. Lockable facilities are provided in each of the bedrooms. The home is situated close to Harold Wood station and there are good links to other public transport, shops and community facilities. A copy of the statement of purpose and service user’s guide is available on request. Fees are subject to an assessment following referral. Laington House DS0000072875.V378160.R01.S.doc Version 5.3 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people who use the service experience good quality outcomes. This was the first unannounced key inspection for this service since registration. The lead inspector, Mrs. Sandra Parnell-Hopkinson, was accompanied by Mr. John Lappin. We arrived at the home at 09:00 hours and were met by the deputy manager who was available throughout the inspection. We were later joined by the organisation’s operational manager. We spoke to service users and staff, viewed case files, other documentation, staff files and records and also took information from the annual quality assurance assessment (AQAA) and notifications which had been sent to the Commission. What the service does well: The pre-admission processes are very robust and significant time and effort is spent planning to make admission to the home personal and well managed. The service involves individuals in the planning of care which affects their lifestyle and quality of life. Service users are supported to take control of their own lives and are encouraged to make their own decisions and choices. Care plans are comprehensive and person centred, and always involve the individual service user. A key worker system allows staff to work on a one-to-one basis with each service user. Care plans include appropriate and relevant risk assessments which are regularly reviewed and updated when necessary. Equality and diversity issues are given a high profile within the service, and there is a strong commitment to enabling people to develop and maintain their skills. People are encouraged to maintain important personal and family relationships, and are able to access information and specialist guidance about issues such as intimate relationships. Complaints and safeguarding issues are well managed and staff undertake training in these important areas. All service users are given a copy of the complaints procedure and the service is open and transparent in dealing with complaints. The service has a well developed recruitment procedure and encourages staff to undertake external qualifications in addition to attending internal training courses. The staff team are supportive of each other and share skills and knowledge with colleagues. Staff supervision is regular and includes staff meetings, 1:1 sessions and observations of practice. Laington House DS0000072875.V378160.R01.S.doc Version 5.3 Page 6 Medication administration is of a good standard with good record keeping being maintained. What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking 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. Laington House DS0000072875.V378160.R01.S.doc Version 5.3 Page 7 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Laington House DS0000072875.V378160.R01.S.doc Version 5.3 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4 and 5 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective service users and their representatives have the information required to help them choose a home that will meet their needs. EVIDENCE: We spoke to service users and staff and looked at various documents and are satisfied that significant time and effort is spent planning to make admission to the home personal and well managed. All new service users receive a comprehensive needs assessment before admission. This is carried out by staff with skill and sensitivity, and the service ensures that it receives comprehensive information from assessments that have been undertaken through care management arrangements. The assessment focuses on achieving positive outcomes for the service users and this includes ensuring that the facilities, staffing and specialist services provided by the service meet the ethnic and diversity needs of the individual. Laington House DS0000072875.V378160.R01.S.doc Version 5.3 Page 9 Admissions are generally on a phased basis, with prospective service users being invited to visit the home for a day/s, then an overnight stay or a weekend stay so that the prospective service user can meet with, and get to know the other service users and staff. Through these visits the service is able to identify, with the service user, any needs and concerns that may not have been identified during the initial assessment. In this way the service endeavours to ensure that the care plan outcomes are those that will meet the needs of the individual. All service users have a copy of the service user’s guide and a copy of the statement of purpose is available within the home. New service users are provided with a statement of terms and conditions or a contract, and this sets out in detail what is included in the fee, the role and responsibility of the provider and the rights and obligations of the individual. The management actively promotes opportunity for discussion and clarification and terms and conditions are reviewed on a regular basis. Laington House DS0000072875.V378160.R01.S.doc Version 5.3 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9 and 10 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals are involved in decisions about their lives and are encouraged to plan an active role in planning the care and support they need and receive. EVIDENCE: We looked at the files of 2 service users, and spoke to several service users and staff and also looked at information contained in other documents including the annual quality assurance assessment which had been returned by the service. A key principle of the service is that people are in control of their lives and that they should direct the service. Staff are fully committed in supporting individuals to lead purposeful and fulfilling lives as independently as possible. Laington House DS0000072875.V378160.R01.S.doc Version 5.3 Page 11 Service users are supported to make their own informed decisions and have the right to take risks in their daily lives. All service users have a comprehensive care plan that is developed with the individual. It is based on a full and up to date holistic assessment and clearly addresses any needs identified around gender, age, sexual orientation, race, religion or belief and disability. The plans viewed were person centred and focused on the individual’s strengths and personal preferences. Plans were different and individualised and included evidence that the service values improving outcomes for service users. Each service user has a key worker who actively provides one to one support, keeps the care plan up to date and makes sure that other staff are made aware of the current needs and wishes of the service user. We saw evidence that care plans are used as a working tool, and are reviewed on a monthly basis, or more frequently if the need is identified. Reviews always include the service user, who can invite others to attend the review such as a family member or a social worker. Reviews focus on finding out what has worked, where progress has been made, achievements, concerns and plans for the future. Care plans include comprehensive risk assessments which are regularly reviewed. Any limitations on freedom, choice or facilities are always in the person’s best interests and discussed with them. This is particularly important as the service is for male adults with a mental health illness and who have a forensic history. The management of risk is positive in addressing safety issues while aiming for improved outcomes for individuals. Service users are actively involved in the running of the home, and regular meetings are held to ascertain their views on activities, menu planning and rotas for the cooking of group meals and cleaning communal areas. The service has procedures to ensure that service users are informed of their rights to confidentiality, but understand when staff may have to share personal information. All service users can have access to advocacy services for support, and information on this is available within the home. Laington House DS0000072875.V378160.R01.S.doc Version 5.3 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): This is what people staying in this care home experience: 12, 13, 14, 15, 16 and 17 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users are able to make choices about their life style and are supported to develop their life skills. EVIDENCE: The service has a strong commitment to enabling people to develop or maintain their skills, including social, emotional, communication and independent living skills. Individuals are supported to identify their goals and are encouraged to work to achieve them. This can result in two steps forward and one step back due to the sometimes lack of self-motivation from service users. In discussions with the staff it was apparent that they recognised the importance of continually working with service users around motivation, Laington House DS0000072875.V378160.R01.S.doc Version 5.3 Page 13 especially as the aim of the service users’ is to eventually move to more independent living. Service users are encouraged to take responsibility for keeping their own bedrooms clean, doing their own laundry, cooking meals and cleaning the communal areas of the home. Each service user has a key to his own bedroom and also to the main door of the home. Service users have the right to allow or refuse entry to their own bedroom. However, when the staff need access for maintenance or health and safety checks advance written notice of this is given. Each individual gets his own breakfast and lunch at a time suited to their own needs, but the evening meal is generally taken with all of the service users, who each take turns in cooking this. Service users have access to drinks and snacks throughout the day and night. However, one service user told us that more substantial snacks were not always available. We did discuss this with the management who have assured us that more substantial snacks such as beans on toast, egg on toast, soups and sandwiches would be available for people. We do appreciate that an important part of the development of life skills is around financial management, and the service works hard to ensure that service users are enabled to budget for daily living expenses, especially as the aim is for people to move onto more independent living arrangements. The majority of the service users are white British but staff are from various ethnic minorities, and staff are trying to encourage service users to develop a more varied menu that includes new and sometimes unfamiliar food. Staff are also working with service users to encourage them to eat a balanced and nutritious diet. Where appropriate, education and occupational opportunities are encouraged, supported and promoted. Some service users are currently attending college courses. On the day of the inspection a service user told us that “I am going to learn to do gardening, and to-day is my first day.” Later that morning he left with a member of staff to travel to the gardening facility. We saw him on his return and he told us “I really enjoyed it and am looking forward to going again.” The service is also exploring local day facilities at a MIND club, as a service user has expressed a wish to attend. Service users are encouraged to access and enjoy the opportunities available in the local community and are encouraged to use public transport, the local pub and the local leisure facilities. Some service users are members of the local gym, and are enjoying the exercises that are also helping them to maintain a more healthy weight. Another service user has expressed an interest in horse riding and this is being pursued by the service. Because of the nature of the service, being for people with mental health problems, there have been some difficulties with the local community. However, the service has worked hard with the service users and the police to foster good relationships with the neighbours and the wider community, and the situation is now more positive. All service users are encouraged to maintain good relationships with family and friends, and visitors are welcome Laington House DS0000072875.V378160.R01.S.doc Version 5.3 Page 14 to visit the home at any time. Some family members do visit and enjoy meals with the service users. Laington House DS0000072875.V378160.R01.S.doc Version 5.3 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 People using the 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 health and personal care that people receive is based on their individual needs, with the principles of respect, dignity and privacy being put into practice. EVIDENCE: Through the care planning procedure and process the service is able to identify the support required for each individual with regards to personal care support. Currently all of the service users are fully independent with regards to personal care and hygiene. All of the service users are registered with a GP, and have access to a dentist, chiropodist and optician where necessary. Since moving into Laington House, Laington House DS0000072875.V378160.R01.S.doc Version 5.3 Page 16 several service users now wear spectacles as it was identified that they needed these. Service users are encouraged to attend the appointments on their own so that they develop these skills for moving on to more independent living. However, where staff support is required this is given. Obviously, because of the varied and complex health care needs of the service users, especially with regard to their mental health, it is important that they attend the regular meetings and reviews required under the CPA (care programme approach) or if under a section of the Mental Health Act, and staff ensure that such appointments are kept. The service recognises the importance of supporting service users in developing and maintaining relationships, and guidance and support in this area is given and discussed during key worker sessions with the agreement of the individual. Because of the nature of the service to people with mental health problems, staff are very alert to changes in mood, behaviour and general wellbeing and know how they should respond and take action. Where necessary, the service arranges training on health care topics that relate to the health care needs of the service users. The service has developed efficient medication policy, procedure and practice guidance, and this was evidenced during an inspection of the medication administration records (MAR). Where staff are involved in the administration of medication they have undertaken the necessary training. Quality assurance systems are in place to ensure that the home’s policy is put into practice, and this is also confirmed in independent audits undertaken by the home’s pharmacist. We looked at the MAR’s and found these to be in order. However, we would recommend that where handwritten entries are made, that two signatures are obtained to verify that the transcribed information is correct. This will act as a safeguard to both service users and staff. Where PRN (as required) medication is prescribed it is important that there is a written protocol in place. Again this will ensure that this medication is being given according to the need. Controlled drugs were being stored appropriately. The aim of the service is for service users to become self-medicating. However, this is done in consultation with other professionals involved with the individual, the staff in the home and the service user. Self-medicating regimes are put into place over a period of time and in a manner suited to the individual needs. Service users who are self-medicating are monitored and their medication is discussed during key work sessions so that any concerns can be dealt with promptly, and reviews can be arranged as necessary. Where appropriate, service users are also encouraged to become involved in ordering their repeat prescriptions, again as part of the self-medicating regime which may be in place. Laington House DS0000072875.V378160.R01.S.doc Version 5.3 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users are able to express their concerns, and have access to a robust, effective complaints procedure and are protected from abuse and have their rights protected. EVIDENCE: In discussions with several service users it was evident that they knew how to complain. The home has an open culture that allows people to express their views and concerns in a safe and understanding environment. Generally, we were told by service users that they were happy with the service provided, felt safe and well supported. However, one service user told us that he was not very happy at the present time. We did discuss this with the management who were very aware of the situation, and were working with the service user and his health care professionals to resolve his current issues. The complaints procedure is given to everyone living at the home and is displayed in a number of areas within the service. The service keeps a record of any complaints and this includes details of any investigations and actions taken. The service views complaints in a positive manner and uses outcomes to improve the service to people living at the home. Laington House DS0000072875.V378160.R01.S.doc Version 5.3 Page 18 We spoke to some staff about the policies and procedures for safeguarding, and they were able to demonstrate a clear understanding of these procedures and knew when incidents needed to be referred under safeguarding of vulnerable adults, and to whom the referral was to be sent. The service has a whistle-blowing policy and, again, staff demonstrated an awareness of this and told us that they felt that they would be supported by the service if they ever had to report concerns about colleagues and/or managers. Training sessions for staff in safeguarding are regularly arranged by the home, as is other training around dealing with physical and verbal aggression. Staff spoken to understood what restraint is, and told us that alternatives to its use in any form are always looked for. Due to the nature of the service people may be subject to restrictions. However, they are involved in the decision making process about any limitations to their choice in this area. Individual assessments are always completed with the involvement of the person, where possible, their representative and any other professional such as the care manager, GP, or other health professionals. Laington House DS0000072875.V378160.R01.S.doc Version 5.3 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25 and 30. People using the 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 physical design and layout of the home enables people to live in a safe, well-maintained and comfortable environment which encourages independence. EVIDENCE: We undertook a tour of the premises and found that all communal areas were clean and well maintained. The kitchen area was clean and food was being stored appropriately. The laundry area was also clean, and service users are responsible for doing their own laundry. All of the bedrooms are single with en suite facilities which include a shower. Two service users invited us to view their bedrooms, and it was apparent that Laington House DS0000072875.V378160.R01.S.doc Version 5.3 Page 20 people are able to personalise their own bedrooms according to their wishes. Service users are responsible for ensuring that their bedrooms are kept in a reasonable state of cleanliness, and this task is part of their programme for an eventual move to more independent living. The home does allow smoking and appropriate smoke detectors are in place and the home complies with fire regulations. Smoking is only allowed in the bedrooms or in the back garden area of the home. If staff need to go into the bedroom of a service user, and this by prior arrangement, then the service user is asked not to smoke for the previous 30 minutes to reduce any risk of smoke inhalation by the member of staff. The rear garden is reasonably maintained and does provide a seating area for service users. The service does have plans to demolish the existing shed and replace this with a larger construction which could accommodate a pool table, which would be welcomed by the service users. The home does have internet facilities and some of the service users have their own laptops. However, the home does have plans to provide a computer for the use of all of the service users. A Wii has also been purchased for the use of the service users. Laington House DS0000072875.V378160.R01.S.doc Version 5.3 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 and 36. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff in the home are trained, skilled and in sufficient numbers to support the people who use the service and to support the smooth running of the service. EVIDENCE: We were able to speak to several of the service users who generally told us that the staff were supportive and approachable. Obviously, there are times when there may be tensions between staff and service users due to the nature of the service, but staff understand this and are trained to deal with difficult situations. Staff are also supported out of hours by an experienced on call manager who also has access to a second tier on call person. We observed that generally staff had good interactions with the service users, and in discussions demonstrated that they were very knowledgeable as to the needs of the service users. Laington House DS0000072875.V378160.R01.S.doc Version 5.3 Page 22 Because this is a newly registered service, the organisation is still recruiting staff for this home, but intermediate support is being given by qualified staff from other homes in the organisation. The content of the induction and probationary periods are very robust and service specific. Staff members are encouraged to undertake external qualifications and there are many internal courses available for staff. Training is focussed on delivering improved outcomes for people. Recent training has included mental health, first aid, verbal and physical aggression, safeguarding of vulnerable adults, restraint, fire safety, infection control and food hygiene. We looked at the files of 2 recently recruited members of staff and found that the process was robust. The organisation initially uses the services of an external consultancy, and then those applicants who have been successful in being selected for an interview are invited to attend a comprehensive interview process. The organisation recognises the importance of having an effective recruitment procedure in the delivery of good quality services. Applicants are invited to visit the home and generally have an opportunity to meet some of the service users. However, the organisation is looking at formally including service users in the interview process for new staff. The organisation also has a robust system for ensuring that students and staff on work permits are working in accordance with their conditions as advised by the Home Office. Through talking to staff and viewing documentation, it was evident that regular staff meetings are held together with regular 1:1 supervision and observations of practice. Laington House DS0000072875.V378160.R01.S.doc Version 5.3 Page 23 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39, 41 and 42. People using the 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 management and administration of the home is based on openness and respect and the service has effective quality assurance systems in place. EVIDENCE: This was the first inspection for this newly registered and on arrival we were welcomed by the deputy manager, who told us that the registered manager had recently been promoted within the organisation and that a new manager had been recruited but was currently absent due to personal reasons. During the day the previous manager, now the operational manager for the organisation, arrived to talk to us. Laington House DS0000072875.V378160.R01.S.doc Version 5.3 Page 24 In discussions with the deputy manager it was apparent that he was very knowledgeable as to the service users, their needs and progress since living at Laington House. He was very aware of the need for confidentiality and also of fire safety within the home. Both the deputy manager and the previous manager demonstrated a clear understanding of the key principles and focus of the service, based on the organisational values and priorities. All work to continuously improve services to provide an increased quality of life for the service users with a strong focus on equality and diversity issues and promoting human rights. The service has a strong focus on person centred thinking, with service users shaping the service wherever possible. The management has a strong ethos of being open and transparent in all areas of the running of the home. Service users at Laington House are placed under various sections of the Mental Health Act. However, there may be times when the requirements of the Mental Capacity Act 2005 would need to be used, and this was discussed with the operational manager who undertook to ensure that the necessary procedures were put into place. The annual quality assurance assessment (AQAA), which is a document required by the Commission, had been comprehensively completed and returned as requested. This contained relevant information that was supported by a wide range of evidence gathered during the inspection process. Policies and procedures are sound and are regularly reviewed and updated in line with changing legislation. The service works to a clear health and safety policy and staff were aware of the policy and have been trained to put theory into practice. Records are of a good standard and are routinely completed. Risk assessments involve service users in their development, and these are fully completed, reviewed and influence the planning of care and routines within the service. Wherever possible, service users are supported to manage their own money plus budgeting skills as this is important in their eventual move to more independent living. The organisation has effective quality assurance systems for monitoring the performance and practice of the home, and the organisation provides appropriate support in the running of the service. The home has the necessary insurance cover to enable it to fulfil any loss or legal liabilities. We did not look at maintenance records as these were all viewed as part of the recent registration process for the service. The organisation is currently looking at developing a quality group of service users from each of its homes, to be involved in practice and policies and procedures. Laington House DS0000072875.V378160.R01.S.doc Version 5.3 Page 25 Regulation 37 notifications as required under the Care Homes Regulations 2001 are sent to the Commission as necessary, and visits as required under Regulation 26 of the Care Homes Regulations 2001 are undertaken. Currently there have not been any referrals under the Mental Capacity Act 2005 Deprivation of Liberty Safeguards (DOLS). Laington House DS0000072875.V378160.R01.S.doc Version 5.3 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 3 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 3 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 3 3 X 2 3 X Version 5.3 Page 27 Laington House DS0000072875.V378160.R01.S.doc Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA20 Regulation 13(2) Timescale for action The registered person shall make 30/11/09 arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. Two signatures to be recorded with handwritten entries onto the MARs. This will help to safeguard both service users and staff when transcribing information. The registered person shall 30/11/09 ensure that the care home is conducted so as to promote and make proper provision for the health and welfare of service users. That the requirements of the Mental Capacity Act 2005 are known and implemented by staff where necessary and appropriate. Requirement 2 YA41 12(1)(a) Laington House DS0000072875.V378160.R01.S.doc Version 5.3 Page 28 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA12 Good Practice Recommendations That the registered persons continue to seek out appropriate activities and employment opportunities for the benefit of service users. Laington House DS0000072875.V378160.R01.S.doc Version 5.3 Page 29 Care Quality Commission Care Quality Commission Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: 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). 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