Care Home: Lakeside House

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What the care home does well The people who live in the home we spoke with or who wrote to us said they are treated well by staff, who listen to them and act on what they say. They know who to speak to if they are unhappy and know how to complain should they wish to. The parents we spoke with said they are happy with the service their relative receives. Their views are always listened to and acted upon wherever possible. The staff members we spoke with or who who wrote to us said they are provided with up to date information about the care needs of the people who live in the home. They are provided with appropriate training and are generally well supported in their roles. The home is run in an open and inclusive way. The views of people who live in the home, and those close to them, are considered when planning improvements for the future. There are regular staff and house meetings where people can express their views and keep up to date. Personalised care plans are developed; each individual, and those close to them, are involved in the care planning and review processes. What has improved since the last inspection? People who live in the home are regularly weighed and these records are now clearly maintained to ensure that significant losses or gains are easily noticed and appropriate action can be taken. The garden is now well maintained and people who live in the home are involved in its up keep. There are now clear instructions for staff to follow for prescribed creams and lotions which people in the home use. This ensures people are supported with their medicines in a safe way. What the care home could do better: The Registered Person must ensure that any person who lives in the home who requires staff to physically intervene to support their difficult behaviours has a risk assessment in place to support this practice. This would help to ensure each individual is responded to in a safe and consistent way. The Registered Person should ensure the plans to redesign and refurbish the home are carried out. This would provide people with private bathing facilities and more choice of communal space which may better meet their needs. The Registered Person should ensure that the frequency of staff supervision is improved. This would ensure all members of staff are supported to provide a good service to people who live in the home. Key inspection report Care homes for adults (18-65 years) Name: Address: Lakeside House Somerset Court Harp Road Brent Knoll Highbridge Somerset TA9 4HQ     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: David Smith     Date: 1 7 0 7 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: Lakeside House Somerset Court Harp Road Brent Knoll Highbridge Somerset TA9 4HQ 01278761909 01278760747 julian.morse@nas.org.uk Vanessahalfacre@nas.org.uk National Autistic Society care home 7 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability physical disability Additional conditions: Date of last inspection Brief description of the care home Lakeside House is a large detached bungalow situated in the extensive grounds of Somerset Court. The home is operated by the National Autistic Society, a UK charity for people with Autism or Aspergers syndrome, and their families; the registered manager is Mr Julian Morse. The home provides accommodation for up to seven people; each must have a diagnosis of an autistic spectrum disorder and been subject to a full assessment of their needs. Lakeside House has a large lounge diner, kitchen, seven single bedrooms with wash hand basins, two bathrooms with overhead showers and a separate wet room (containing a shower); there are adequate toilet facilities. The home has a washing machine in the kitchen, but the majority of the laundry is sent to the main onsite facility. One room is used by staff as office space. The home has its own garden Care Homes for Adults (18-65 years) Page 4 of 34 7 7 Over 65 0 0 Brief description of the care home area Fees at the home are dependant on individual need and staffing requirements. 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: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The last Key Inspection of this service was completed on 18/07/07. This was an unannounced visit to the home to enable us to complete a Key Inspection of this service. We spent approximately seven hours in the home on the day of our visit. The inspection was carried out by one inspector, but the term we is used in this report. This is because the report, and the judgements within it, are on behalf of the Care Quality Commission (CQC). The pre-inspection planning involved reviewing the report of the last Key Inspection completed in July 2007 and the Annual Service Review carried out in August 2008. We also looked at the service history, which details all other contact with, or about, the home. Care Homes for Adults (18-65 years) Page 6 of 34 We provided a number of surveys for staff members and health professionals to enable us to carry out the last Annual Service Review. We sent new surveys to the individuals who live here, health professionals and staff members as part of this Key Inspection; ten were completed and returned. The views of each person who wrote to us have been included in this report. We spoke informally with some of the people who live in the home and some time was spent in communal areas observing interaction and communication between staff members and some of the people who live in the home. We spoke with the Manager and six members of staff. Two parents and one health professional were attending a review meeting on the day we visited; we therefore took the opportunity to speak with them after their meeting. We gathered additional information for this report by looking at a number of records within the home such as individuals care records, risk assessments, accident and incident reports, medication administration, staffing rotas and other staff records and some health and safety procedures. We viewed all communal areas of the home and some of the bedrooms used by the people who live here. We were also provided with a tour of the Somerset Court site, including the IT suite, art and woodwork facilities. 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 Registered Person must ensure that any person who lives in the home who requires staff to physically intervene to support their difficult behaviours has a risk assessment in place to support this practice. This would help to ensure each individual is responded to in a safe and consistent way. The Registered Person should ensure the plans to redesign and refurbish the home are carried out. This would provide people with private bathing facilities and more choice of communal space which may better meet their needs. The Registered Person should ensure that the frequency of staff supervision is improved. This would ensure all members of staff are supported to provide a good Care Homes for Adults (18-65 years) Page 8 of 34 service to people who live in the home. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals are given the information they need about the home to enable them to make an informed choice about where to live. People are confident the home can support them as generally their needs are thoroughly assessed before they are given the opportunity to move in. Evidence: The home has both a Statement of Purpose and Service Users Guide, which are regularly updated. These provide clear information regarding the range of services and support the home is able to offer. Each person who lives in the home who wrote to us said they were asked if they wished to move to the home and that they did receive enough information to decide if this was the right home for them to live in. We looked at the records for one person who has recently moved into the home. These contain lots of information about them, such as care plans or assessments from Care Homes for Adults (18-65 years) Page 11 of 34 Evidence: their Funding Authority, together with a number of other reports which describe their history and their support needs. A representative from the National Autistic Society also carried out an assessment to help decide if Lakeside House would be a suitable place for them to live and to ensure the home could meet their needs. It has recently become clear that some important areas of support this individual requires or ways of supporting them developed in their previous home were not included in this assessment; it is not clear why, as previous assessments have been carried out well. The home are currently finding it extremely difficult to meet all of this persons needs: this is described in more detail in the body of this report. However, the organisation have now changed who carries out assessments; in future the Manager will help carry out assessments for any person considering moving into Lakeside House and they have already been trained to do this. Each person who lives in the home is provided with a contract which describe the homes aims, objectives, level of fees and who is responsible for payment, complaints procedure and each persons rights and responsibilities whilst living in the home. 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. Individuals needs and goals are met and each person has a plan that they, and people close to them, have been involved in making. Each person is supported to make decisions about their lives and to take risks to enable them to live as independently as possible. Evidence: We looked at the care records for two of the people who live in the home. Each person has a detailed plan which describes the care and support they require and how staff should provide it; information is also included about their likes and dislikes, any particular conditions they may have, who the important people in their life are, how they communicate and what daily routines they may have. The home has a good system in place to ensure each care plan is regularly reviewed and updated. Staff write a monthly report which describes each persons progress towards any agreed goals and other areas such as the activities they have participated Care Homes for Adults (18-65 years) Page 13 of 34 Evidence: in. Each individual has regular review meetings, which they, staff from the home, a representative from their Funding Authority and family members usually attend. One person attended their review meeting on the day we visited. This individual told us I am happy living at Lakeside and their parents and social worker said they are happy with the service they receive. Both parents said they have always been involved in care planning and the reviews for their relative and if they have felt any changes have been necessary, their views have always been listened to. The staff members we spoke with or who wrote to us said they are provided with up to date information about the care needs of the people who live in the home. Comments from staff include we support people as individuals, staff have a good understanding of peoples needs, we offer a high standard of care and support to the people who live here and we work well promoting choice and try to make sure individuals wishes are met. Some of the people who live here have communication difficulties; staff work extremely hard to ensure that people are offered choices in a way that they are able to understand; pictures and picture symbols are used throughout the home. The Manager also gave us a recent example of providing pictures of various chickens so that people could choose the ones they liked; these are now kept in the orchard area at the rear of the home. The are monthly meetings with the people who live at Lakeside House. Although these are house meetings, people are consulted individually as they seem happier with this approach. Records are kept of each meeting and the ones we looked at show that various topics have been discussed such as which meals people would like, which vegetables they would like to grow in their garden and which shows at the theatre they would like to see. Interaction between staff and some of the people who live in the home was observed informally during our visit. These show that staff have a good knowledge of each persons support needs and how to communicate with them effectively. Both the people who live here and staff appear relaxed in each others company and at no time did staff appear rushed or unable to give people their attention. People were given choices; staff support them, and sometimes help by explaining options, but let them choose. Those who wrote to us said they make decisions about what they wish to do during the daytime, evenings and at weekends and staff listen to them and act on what they say. One person told us staff help me when Im not sure. Care Homes for Adults (18-65 years) Page 14 of 34 Evidence: Care and support is provided within a risk assessment framework. Each of the person centred risk assessments examined are detailed and have been regularly reviewed; some of the assessments we viewed were for swimming, horse riding, travelling in vehicles and shopping trips. One member of staff who writes risk assessments said the staff team do feed into the process. They explained that each persons assessments take some time to write as they are very detailed; they do take into account the particular risks each individual may face. Care Homes for Adults (18-65 years) Page 15 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. Each person is treated as a individual and has opportunities and appropriate support to access leisure and educational facilities. Each persons rights are respected. Individuals are able to keep in touch with families and friends. People have healthy, well presented meals which they are involved in choosing. Evidence: The home encourages and supports people to pursue their hobbies or leisure interests as well as offering support with daily living tasks. People who live in the home are able to access on site day care facilities, which offer a wide range of activities, such as art, horticulture, IT skills and woodwork. Care Homes for Adults (18-65 years) Page 16 of 34 Evidence: There are other resources on the Somerset Court site including a gym, cafe and extensive grounds for walking and cycling, which people are free to use. Some individuals choose to access college courses off site; this gives them further opportunity to access the wider community and to meet new people. The records we looked at show that people use the facilities on site as well as accessing the community for drives, walks, shopping trips, meals out and theatre trips. People are also supported to organise and go on holidays of their choice. One the day we visited two people returned from a holiday in Kent, where they were supported by staff from the home. People have a weekly in house day where they are supported by staff to undertake household chores and learn and develop life skills. Should an individual follow a particular religion, or have religious beliefs, the home offers appropriate support. The last AQAA says that individuals are supported to access the church of their choice on a regular basis, this gives individuals the opportunity to fulfill their spiritual needs and gain wider community integration. There are no public transport links, so people continue to rely on taxis and the homes transport to access community facilities. This is generally not an issue, however one individual is currently going out each day, supported by staff, in an effort to manage their increasingly difficult behaviours. Whilst this benefits this one person, staff told us it can have an adverse effect on some of the other people in the home who may not be able to access other transport if the homes own vehicle is being used and they are not able to borrow a vehicle. Each person is supported to maintain links with their family and friends; visitors to the home are welcome. People visit their families and some go on holidays with family members. The parents we spoke with said they are always informed of important issues and feel that communication between the home and themselves is good. One said I have nothing but praise for Lakeside House, this is the best home [my relative] has lived in. The health professionals who wrote to us said the home supports people to live the life they choose, generally responds well to their different needs and respects each persons privacy and dignity. The staff we spoke with feel that each person is seen and treated as an individual. Comments from staff include we support service users as individuals, staff have a good understanding of service users needs, we treat all as individuals and we work Care Homes for Adults (18-65 years) Page 17 of 34 Evidence: well promoting choice and trying to make sure individuals wishes are met. Peoples rights and responsibilities are also confirmed in their contract; this includes house rules relating to keeping rooms tidy, not breaking the law, not upsetting others and expecting people to follow health and safety procedures such as fire drills. People also know what they can expect the home to do such as employing enough staff, repairing the home, decorate communal areas and have adequate insurance. The home continues to provide a variety of meals and snacks, which are healthy and nutritious. The house meetings, described earlier in this report, are often used to help people decide which meals they would like to be cooked in the home. People eat their meals in the dining area, which is well furnished and overlooks the garden. One person eats their meals in a quiet space near their bedroom; this arrangement better suits their needs. Care Homes for Adults (18-65 years) Page 18 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People receive personal support in they way they prefer and their healthcare needs are well met. The home supports each person with their medicines in a safe way. Evidence: Care plans provide clear guidance for staff on how they should support those living at the home with their personal and healthcare. One persons records we looked at contain a very detailed plan in relation to their particular medical condition and a comprehensive health action plan. This plan has details of how this individual communicates, the medicines they take and which professionals are involved in supporting their health care. This document is designed to be portable, so can be easily taken if this person goes on holiday or was admitted to hospital for example. Each person is registered with a local G.P., dentist and optician. Other specialist services are accessed when an identified need arises. Clear records are kept of each appointment with health professionals; these note the reason for the appointment and the outcome. The records we looked at show that people are accessing doctors, Care Homes for Adults (18-65 years) Page 19 of 34 Evidence: dentists, chiropodists, opticians and more specialised services such as psychiatry and psychology. We asked following our last visit that people are weighed regularly to ensure that any significant losses or gains are easily noticed; the records we looked at show that people are weighed each month and this is recorded in their care records. Individuals have a wash hand basin in their bedroom. There are two communal bathrooms and a wet room (containing a shower) where staff may help with personal care. Both male and female staff are employed; any preference about the gender of the person who assists with intimate care is recorded. The staff we spoke with understand and discussed issues around privacy and dignity and encourage and support people who live in the home in this area. One staff member said they feel the environment does not always meet peoples needs; their opinion is some peoples hygiene is really poor so they shouldnt have to share bathrooms. Another staff member said the home could do with an update so that bedrooms have an en-suite facility. The healthcare professionals who wrote to us said the home does generally meet each persons health care needs, seeks their advice and acts upon this to manage and improve individuals health care. When asked what the home does well one professional said they are person centred and provide lots of activities. In relation to what they could do better they said react in a more timely way once care arrangements change. The home uses a monitored dosage system of medication administration, which is well managed. Each person has their own medicine profile as part of their care records; these give staff clear instructions to follow, such as how and when people prefer to take their medicines and also explain what the medicines are for. There is appropriate storage, including storage for medication that requires refrigeration. The records we looked at contained a list of staff who are trained to dispense medication, a specimen of their signature and the initials they use on medicine records. There is a photo of each of the people who live in the home in their medication records and they have given written consent to medication being administered by staff. Each time medicines are dispensed by staff, another member of staff acts as a witness. They both sign their own record; this means there are two sets of medication Care Homes for Adults (18-65 years) Page 20 of 34 Evidence: records in use in the home. We asked the home to ensure there are clear directions for the application of prescribed creams and lotions following our last visit; these are now in place. Care Homes for Adults (18-65 years) Page 21 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. If individuals who live in the home, or people close to them, have concerns about their care they know how to complain; their views would be listened to and acted on. People are generally safeguarded from abuse, neglect and self harm and the home would take action to follow up any allegations. Evidence: The home has a formal Complaints Policy, a Safeguarding and a Whistle Blowing Policy, which staff can use in confidence to raise any issue or concern they have regarding poor practice. There have been no complaints since our last visit and we have not had any complaints or concerns direct regarding the services provided by the home. The people who live in the home who wrote to us said they know they are able to complain if they are unhappy about any aspect of the home. One person said they would speak with staff supporting me. Health professionals who wrote to us said they do know who to speak to if they have any concerns regarding the care and support provided at the home; they feel their views would be listened to and taken seriously. Care Homes for Adults (18-65 years) Page 22 of 34 Evidence: The staff we spoke with and those who wrote to us are clear about the important role they have to ensure people are happy with their service and remain safe; they know what to do if an individual, family member or a friend is concerned about any aspect of the care and support they provide. The home has guidelines and risk assessments in place for supporting individuals who are distressed or presenting behaviours which may be seen as challenging the service provided, such as being verbally or physically aggressive towards staff or other people who live in the home, or self-harming. The one person who requires physical intervention does not have a risk assessment to support this practice; this must be put in place as soon as possible. Staff use both Spell and Studio 3 approaches to help support people who present these types of behaviours. Spell is a specialised plan for people within the Autistic Spectrum and Studio 3 promotes the management of difficult behaviours using low arousal techniques and gentle physical skills. The Manager told us the each person who lives in the does present the service with various challenges; generally the low arousal approaches work well and incidents can be diffused without the need for staff to physically intervene. Staff are finding the behaviours displayed by one person are currently very difficult to manage. One incident report we looked at showed that this person physically assaulted five staff members during the same incident; other reports show they have physically assaulted three staff, pushing one to the floor and on another occasion they hit a member of staff who now requires medical treatment. They have also made verbal threats to other people who live in the home and have entered their rooms and stolen items from them. One member of staff said they feel other individuals are scared of this person; they gave examples of one person becoming very anxious and their self harming behaviour escalating and another when one person was threatened by them they cowered. Staff told us that they have had to use untrained and unauthorised methods of restraint on two occasions to keep themselves and other people who live in the home safe; this includes two or three staff restraining this person whilst they were on the floor. Staff have had debriefing sessions following incidents. We did note that staff have raised concerns about the methods they have had to use; one staff member said they did not wish to do off the cuff physical restraint which is classed as taboo and Care Homes for Adults (18-65 years) Page 23 of 34 Evidence: another person said I dont think it is safe them living here. We had to take them to the floor, we are not meant to do it but we had no other option to keep people safe. The home have kept us closely advised of this situation. They have taken many steps to support this individual, increasing the level of staffing, having regular contact with psychiatry, the Funding Authority and the local Social Work Team; the Police are also aware of the situation. We discussed this issue with the Manager during our visit and suggested that a referral under safeguarding procedures be made immediately. Both the home and ourselves have now made this referral. Staff are provided with training in relation to Safeguarding Vulnerable Adults and are subject to enhanced Criminal Record Bureau disclosures (known as CRBs), before they start work in the home. The home maintains thorough records of each accident, incident or other significant event which occurs in the home. We are always notified of significant events together with any other concerns regarding individuals who live in the home. Care Homes for Adults (18-65 years) Page 24 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. Lakeside House generally provides a homely and comfortable environment for people to live in. Evidence: Lakeside House is a single story building set in the grounds of Somerset Court but with its own private garden area; it is not on a public transport route and there are no community facilities within easy walking distance. There are seven single bedrooms. Each has a wash hand basin and there are communal bathing and showering facilities. Both bathrooms have a toilet in and there is a toilet with wash basin for staff and visitors. There is a large lounge diner that people who live in the home can use when they wish; there is also a domestic style kitchen. There are no other communal areas which people can use or spend time with visitors. There is no laundry at the home; there is a washing machine in the kitchen which is not sufficient to meet peoples needs. Some people do use the homes washing machine during their in house days but the majority of laundry continues to be taken to a large laundry within the main Somerset Court site. Care Homes for Adults (18-65 years) Page 25 of 34 Evidence: We did view all of the communal areas of the home; these are generally well kept and suitably furnished. The kitchen units are in need of replacement and the Manager told us they already have quotes to replace these; when this work is being completed, the layout of the kitchen will be changed slightly and an island unit added. There is a regular maintenance programme and maintenance staff are available on the site. The home is decorated regularly and the people who live here are involved in choosing decorations and colour schemes as much as possible. New flooring has been laid in some areas. We also viewed some of the bedrooms used by people who live here. These are decorated to reflect peoples own tastes and contain many personal items which help make them personal. Should people not wish to have much furniture or other items in their room, this is respected and the home ensure that each person involved, such as family members and their Funding Authority, are aware of this. The home has its own garden area. A large vegetable garden has been developed; the vegetables grown have been chosen by the people who live here. They have now fenced off part of the orchard area at the rear of the home; chickens are kept there. Again, the people who live here chose which particular chickens they would like to keep. All areas of the home we saw were clean and tidy; individuals are encouraged to help with cleaning tasks as much as possible. The people who live in the home who wrote to us said they liked the environment and it is always kept fresh and clean. One person said I help to keep my house clean. The Manager explained the environment has not always suited people who have lived at Lakeside House and may have contributed to them presenting difficult behaviours. There is now a longer term plan to develop, thoroughly refurbish and redesign the home. Should this work be completed, less people would live in the home, each would have en-suite facilities in their own rooms, separate communal areas would be created to give people a choice of where to sit and provide more private areas should people have visitors. This work is linked to new properties being built within the Somerset Court site, so this remains a longer term plan. Care Homes for Adults (18-65 years) Page 26 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Each persons needs are met and they are generally provided with safe and appropriate support by a competent and well trained staff team. Thorough checks are carried out on new staff to ensure they are suitable to work in the home. Evidence: Staff are provided with job descriptions which clearly identify their roles and responsibilities. Staff we spoke with and those who wrote to us said they are clear about their own and others responsibilities. The home has one Senior Practitioner, three Practitioners and 16 Support Workers. Seven staff have achieved a National Vocational Qualification (known as an NVQ); six staff are currently working towards their awards. The staff we spoke with said and those who wrote to us said they are happy working in the home and told us they are always given up to date information about the people they support. They feel there is generally a relaxed atmosphere in the home, they feel listened to and that their views are taken seriously and acted upon wherever possible. Care Homes for Adults (18-65 years) Page 27 of 34 Evidence: Comments from staff include: I really enjoy working at Lakeside, I love working here, its really busy but you get lots of support and we have a brilliant staff team. The health professional spoken with and those who wrote to us said the staff team usually have the right skills and experience to support peoples social and health care needs. The home has a robust recruitment process. The personnel records of staff who have recently joined the team contain copies of their application form, documents proving their identity and eligibility to work in the UK, two satisfactory references and Enhanced CRBs. New staff complete a thorough induction training programme; all staff are provided with mandatory courses such as first aid, food hygiene, fire safety, how to move and handle people safely, health and safety and infection control. Staff are also given training in specific areas such as medication administration, awareness of people who have learning disabilities or epilepsy, how to manage difficult or aggressive behaviour and abuse (currently known as safeguarding vulnerable adults). The staff we spoke with and those who wrote to us are happy with the level of training they receive. They are provided with training they feel helps them understand and meet peoples needs, keeps them up to date on new ways of working and gives them enough knowledge about healthcare and medication. One member of staff said this is the best place I have worked for training. Staff are usually provided with regular supervision; this is a 1:1 meeting with their line manager. This has become irregular in the last few months due to the team having to respond to one person whose behaviours have caused concern. Each supervision meeting that is held is recorded and kept in the staff members own file. In addition to this, staff are provided with an annual appraisal. Care Homes for Adults (18-65 years) Page 28 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. The home is well run and each individual benefits from how it is managed. The views of the people who live in the home, or those close them, are sought to help the home review their practice. Each person is generally safeguarded as the home keeps clear records, staff understand the ways things should be done and health and safety practices are carried out. Evidence: The registered manager of the home is Julian Morse. He has considerable experience in this field and has attained NVQ Level 4 in Care, the Registered Managers Award (NVQ level 4) and is a qualified NVQ Assessor. The people who live in the home who wrote to us and discussions with relatives, staff members and the Manager show that there is an open and inclusive management Care Homes for Adults (18-65 years) Page 29 of 34 Evidence: style. People said they are happy to discuss any issues with the manager and they feel they are always listened to; people said communication and management support is good. The views of the people who live in the home are sought. Regular house meetings are arranged, as described earlier in this report. More informal discussions take place on a day to day basis. The views of family members are taken into account; they are involved in the care planning process and at reviews. Somerset Court was holding a partnership day on the day following our visit, which gives friends and family a further opportunity to visit their relatives and meet with staff informally. The management systems and structures are efficient; the record keeping is of a good standard. Files and documentation remain well organised, easy to access and stored securely. The home has a number of policies and procedures, which are designed to ensure that both the people who live in the home and the staff team are safe, the service complies with the law and remains aware of best practice or new ways of working. The home is audited each month by an independent member of staff from the organisation. During these visits both people who live in the home and staff members are spoken with to gain their views on the quality of care and support provided; written records are also looked at. A clear record of each audit is kept in the home. There are recording systems in place to support health and safety in the home which are used consistently. The is an up to date Fire Risk Assessment in place and the home has adequate insurance cover. Care Homes for Adults (18-65 years) Page 30 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 31 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 23 13 The Registered Person must ensure that any person who lives in the home who requires staff to physically intervene to support their difficult behaviours has a risk assessment in place to support this practice. This would help to ensure each individual is responded to in a safe and consistent way. 17/08/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 24 The Registered Person should ensure the plans to redesign and refurbish the home are carried out. This would provide people with private bathing facilities and more choice of communal space which may better meet their needs. The Registered Person should ensure that the frequency of staff supervision is improved. This would ensure all members of staff are supported to provide a good service Page 32 of 34 2 36 Care Homes for Adults (18-65 years) 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 to the people who live in the home. 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. 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