Care Home: Landau Lodge

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What the care home does well People are assessed before they move into the home, this helps to ensure that the staff in the home are aware of their needs and how these are to be met. Care plans are developed from the assessment information, with whenever possible the involvement of the individual or their representative. The care plans include the choices of the individual and how they communicate these choices. They are regularly reviewed and kept up to date, to help ensure that staff are aware of the latest needs of the individual and how these are to be supported. People are supported to have their health needs met. People are supported to undertake activities of their choices, with a variety of activities both inside the home and in their local community. They are also supported to maintain relationships with their families. Overall people live in a home that is comfortable and where they can personalise their own rooms to make them more homely. The new manager is competent in her role, and staff feel that she offers them support. What has improved since the last inspection? There is evidence that peoples` needs are met within the home. Behaviour management plans are in place and are now followed that support people with their needs. We found that the system for reporting any allegations of harm have improved and that issues are overall, now reported to the Local Authority as per policy. There is some evidence that people receive their 1:1 support in the home for undertaking activities of daily living and leisure. Staff have received some training in order to support people in the meeting of their needs, and the manager has begun assessing peoples competence following training . The doors in the home that lead to the garden area are now alarmed so that should someone leave the home the staff would become aware of this. There is now some consistency with the management of the home , there is a manager in post and she is registered with the CQC. What the care home could do better: The service is for people with learning disabilities and complex needs. Although staff receive training their practice continues to be inconsistent when supporting the people who live in the home. This requires addressing so that people receive a consistent service in the meeting of all their needs. The policy for supporting someone in hospital, should be made available to all parties, including the persons relatives. This should include the level of support that is to be offered and by whom. How people and their behaviours are described should be reviewed to ensure that this is not detrimental to the individual and reflects negatively on them. People should receive emergency medical attention in a timely manner, in order for their health needs to be met as fully as possible. The notifying of allegations of harm must be consistent and practices in this area continue to require improvement. Clear records should be kept to identify how people have received their 1:1 hours of support and who has provided this support. This will help to provide a clear audit trail for assessment for the meeting of needs. All areas of the home must be free from offensive odours, this should be addressed as a matter of urgency. Key inspection report Care homes for adults (18-65 years) Name: Address: Landau Lodge Triton Road Kingston upon Hull East Yorkshire HU9 4HU     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Sarah Rodmell     Date: 2 0 0 4 2 0 1 0 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. 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: Landau Lodge Triton Road Kingston upon Hull East Yorkshire HU9 4HU 01482781042 01482781062 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): www.voyagecare.com Milbury Care Services Ltd Name of registered manager (if applicable) Miss Melanie Jane Ward Type of registration: Number of places registered: care home 10 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 10 The registered person may provide the following category of service only: Care home only - Code PC. to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Learning disability - Code LD. Date of last inspection Brief description of the care home Landau Lodge is owned by Milbury Care and is registered to provide care and accommodation for up to 10 adults between the ages of 18-65 who have a learning disability. The home is purpose built and is located to the east of Hull city centre. The property is built over one floor and has six bedrooms; all bedrooms are single with en-suite facilities. Two of these have additional cooking facilities and can be used more as bed sits to promote a persons independence. There is an office, large hallway, kitchen/dining room, laundry, quiet room and lounge, Care Homes for Adults (18-65 years) Page 4 of 34 Over 65 0 10 3 0 0 6 2 0 0 9 Brief description of the care home and a sleep-in room for staff. The property has wheelchair access throughout. The home has a garden to the side and rear and there is a car park to the side of the property with additional on-street parking. In the grounds there are four self-contained bungalows that provide individual accommodation for an additional four people who can live more independently but still with one to one support when needed. Information on the service is made available to current users of the service via the statement of purpose, the service users guide and the current inspection report. Care Homes for Adults (18-65 years) Page 5 of 34 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means that the people who use this service experience adequate quality outcomes. This inspection report is based on information received by the Care Quality Commission (CQC) since the last Key Inspection of the home on the 30th June 2009, including information gathered during a site visit to the home. The unannounced site visit was undertaken by one inspector over 1 day. Throughout the visit the manager was available and assisted the inspector. Inspection of the premises and close examination of a range of documentation, including three care plans, were also undertaken. The registered person submitted Care Homes for Adults (18-65 years) Page 6 of 34 information about the service prior to the site visit by completing and returning an Annual Quality Assurance Assessment (AQAA) form. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. We received surveys both from the people who live in the home and the staff team. These are referred to in the main text of the report. The registered manager told us that the current fee for residential care is £1500-£1900 per week. At the end of this site visit, feedback was given to the registered manager, including some of the requirements and recommendations that would be made in the key inspection report. We have reviewed our practice when making requirements to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations - but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. 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 service is for people with learning disabilities and complex needs. Although staff receive training their practice continues to be inconsistent when supporting the people who live in the home. This requires addressing so that people receive a consistent service in the meeting of all their needs. The policy for supporting someone in hospital, should be made available to all parties, including the persons relatives. This should include the level of support that is to be offered and by whom. Care Homes for Adults (18-65 years) Page 8 of 34 How people and their behaviours are described should be reviewed to ensure that this is not detrimental to the individual and reflects negatively on them. People should receive emergency medical attention in a timely manner, in order for their health needs to be met as fully as possible. The notifying of allegations of harm must be consistent and practices in this area continue to require improvement. Clear records should be kept to identify how people have received their 1:1 hours of support and who has provided this support. This will help to provide a clear audit trail for assessment for the meeting of needs. All areas of the home must be free from offensive odours, this should be addressed as a matter of urgency. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 34 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 34 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. We looked at standards 2 & 3. People are assessed prior to moving into the home to ensure that the home are aware of and can meet their needs. However a lack of consistency in staff skills means that the standard of support cannot be guaranteed. Evidence: We looked at the care plans for the people who live in the home. Six of these people have been living in the home for some time, one person has recently moved into the home. Prior to them moving into the home the manager visited them and completed a pre-assessment of their needs. The assessment included consultation with the persons advocacy service, details of their current situation, their history, mobility, personal care, behaviour, physical health, mental health, medication needs, allergies and diet. The manager also received a copy of the Local Authority assessment and care plan. The manager has used the assessment information to complete care plans for each person. These included any input from other professional services and were detailed Care Homes for Adults (18-65 years) Page 11 of 34 Evidence: on the support people may need to make choices in their lives and to to be able to manage their behaviours. One professional that we spoke to told us that they did not feel that the staff team always had the skills to offer a specialist service to the people who live in the home. They felt that although staff attended training, some lost the skills they achieved at the training and so the level of service offered was not consistent. Another professional fedback that they felt that peoples needs were met, but that the staff skill mix was variable and that not all staff offered the same level of support, with staff requiring further training. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. We looked at standards 6,7,&9. People are supported through a comprehensive care planning process to have their needs met, however a lack of consistent staff skills and ability may compromise this. Evidence: We looked in detail at three of the care plans for people who live in the home. The care plans included details of the persons assessments and we saw that these had been reviewed and updated. Details included, for example, the individuals physical needs, general health, personal care, communication, and independent living skills. With a support plan area for each of the persons area of need, describing how someones needs are to be met.It also included the details of any specialist support the person received and is as far as possible developed with the individual or their representative. One person had recently moved into the home and a health professional told us that the recording and reporting to the health team for this person were good. Care Homes for Adults (18-65 years) Page 13 of 34 Evidence: Information in staff surveys included that staff felt that they received up to date information regarding the needs of the service users. We spoke to a professional who told us that staff follow their instructions regarding the indivduals care plan and they follow all instructions given. We saw that the plans of care clearly described the persons choices and how they would communicate these to the staff team. Staff were given clear details, for example, how to support someone to eat meals of their choice, where to sit to eat these and how to support the person to spend their free time as they wished. However, there has been an incident in the home whereby a care plan was not followed and a service user sustained an injury. One person also has access to an independent advocate. People are supported with the meeting of their daily needs through a system of key working which offers continuity of care and assists in the persons needs being met. Peoples care plans include a variety of risk assessments to support them in living their lives. The risk assessments include, for example, moving and handling, behaviour risk assessments including details of their management plans and triggers for peoples behaviours. Feedback from a health professional reflected that a large amount of specialist input is required to support the service users and they felt that this exceeded the level of support that this type of service should require. Another health professional told us that their support is accessed a lot by the service.However the overall feedback was that it was felt that peoples needs were met in the home. Care Homes for Adults (18-65 years) Page 14 of 34 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. We looked at standards 12,13,15,16 &17. There is a system in place to offer people specialised 1:1 support, however , the information available is not clear in how all of this support is offered and this could be improved upon to enhance peoples lives. Evidence: When we looked at the plans of care for people we saw that these included the details of peoples preferences on how they spend their leisure time. This included activities in the home, for example, baking and activities in the local community, for example, going out for a walk. There is a weekly plan of activities for each person in the home. Additionally each person has a record of the activities that they have undertaken, and activities are also recorded in peoples daily diary notes. Information from service user surveys included that people felt they were able to make decisions and do what they Care Homes for Adults (18-65 years) Page 15 of 34 Evidence: want. The feedback we received in surveys was largely positive, although one person did feel that the amount of activities in the home could be increased. At the last inspection of the service it was recommended that people undertook activities with people outside of the home environment. People do undertake activities outside of the home, but interactions with others could be increased; this remains as a recommendation. We also asked about two of the people who live in the home as one person prefers quiet and another enjoys noise. The staff member told us that this is managed as the person prefers it to be noisy in their own area and that the other person will go to their own room if they feel the home is too noisy. There were records of people spending time with their family and this included both their family visiting them in their own home and them visiting their family. People in the home are all funded for 1:1 support from the staff team. The amount of hours support varies for each person. The manager showed us how she allocates staff to ensure that people receive this support. With this including how the time for each person can be divided between more than one staff to ensure that each staff member continues to support people when the individuals needs are particularly high. However not all of the hours were clearly allocated and in discussion the manager told us that she and the deputy manager both work with service users and provide the additional hours. These hours should be clearly identified on the duty rota to assist with care planning and to offer a clear audit trail. We saw both on the day of the visit and in peoples notes that people are able to access different areas of their home as they choose to. People were able to stay in their own room or spend time in the communal areas as and when they chose to. These choices were clearly described in the persons plan of care, informing staff of the choices that people make and how they would communicate these choices to the staff team. We saw that care staff use the word naughty, in peoples files. We discussed this with the manager who told us that this is used within the service through a formal communication method. However as this service is for adults the use of this word to describe someone or their behaviour could be disrespectful and reflect negatively towards the person. Weekly food diaries are kept for each person so that clear records are available of what a person has ate and what they have refused. There are menus available in the home and records are kept of the meals cooked. Staff told us that they are able to Care Homes for Adults (18-65 years) Page 16 of 34 Evidence: shop locally and use this to be able to offer people more choices. Care Homes for Adults (18-65 years) Page 17 of 34 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. We looked at standards 18,19 & 20. People are on the whole supported to have their health needs met, although inconsistencies within the staff team could jeopardise this. Evidence: Peoples care plans were detailed in the level of support that people require in order for staff to assist them in the meeting of their needs. We looked at the details held on how people would be supported with their personal care. These were clear and detailed. They explained what peoples preferences were and how staff were to ensure that peoples support was offered in the best possible ways.This included what time people liked to get up or go to bed. Detailed information was also included on how to meet peoples health needs. This included clear instructions on how to support someone with attending a medical appointment and this included how the staff were to explain the appointment to the individual. This included that sometimes staff would show the individual, ( through demonstration) what was going to happen and for staff to be aware to re-arrange the Care Homes for Adults (18-65 years) Page 18 of 34 Evidence: appointment if the individual could not manage it at the time they attended. This system helps to alleviate anxieties and worries about appointments and helps people to try again at appointments and makes it more possible that their health needs may be met. One professional told us that they have to work hard with the staff team to ensure that peoples health needs are met and that they often have to remind the staff about health appointments.Although another professional felt that the staff team refer to the GP as necessary. One accident had occurred in the home, whereby a service user required medical attention. This was not responded to in a timely manner by the staff team and this persons health needs were not fully met at this point. Feedback included that people were unclear on the details of how people would be supported to attend health appointments. This included what level of support would be offered and by whom. The manager should ensure that all relatives and professionals are informed of the level of support offered by the service should this situation arise for a service user. Records were seen of the monitoring of peoples weight, these records included the details of what clothes the person was wearing at the time of being weighed. This helps when trying to identify any reason for fluctuations in a persons weight and can eliminate that it may be their clothing. Peoples care plans included referral letters and responses from other health professionals who are or have been supporting the person in the home. We looked at the medication systems in the home. Medication is stored securely with clear records kept of all medication received, administered and disposed of in the home. The records included that two people check the medication when it arrives in the home and that people have individual medication management plans. There is a fridge for the storage of medication that requires to be kept cool, with the temperatures for this being monitored and recording so that if a problem occurs it is soon known and peoples medication is not compromised. There was a list of the staff signatures to allow for a clear audit trail of who had administered what medication and when. Care Homes for Adults (18-65 years) Page 19 of 34 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are systems in place to support people to raise complaints and to be protected from harm, however practices need to improve to ensure that people are fully protected from harm. Evidence: We looked at the complaints processes and records held in the home There had been one complaint raised to the organisation and this was by the manager on behalf of the people who live in the home. The manager told us how this had been handled by the organisation and had produced a positive result for the people who live in the home.The information recorded in the staff surveys included that staff felt they knew what actions to take should someone have concerns about the home, however the information recorded in the service user surveys reflected that not everyone who lives in the home is aware of how to make a complaint. There are systems in place for the reporting of incidents in the home that may be regarded as an allegation of harm. This procedure is clearly on display in the main office of the home and the CQC have been notified of the majority of these incidents. This includes incidents between services users, any accidents in the home or if an allegation is made about staff conduct. Both the staff training matrix and staff files included information that staff had received training on the Safeguarding of Vulnerable Adults. Care Homes for Adults (18-65 years) Page 20 of 34 Evidence: However on the day of the visit 2 separate incidents were recorded in a persons care plan that had not been reported through this system or to the CQC. This included that a service user had assaulted another service user. The manager responded promptly to this forwarding these details on the day of the inspection to both the safeguarding team and CQC. Also informing other parties , for example, the persons care coordinator. Additionally she planned to interview the staff who had been on duty on the day of the incidents to ascertain why these had not initially been reported. The manager must ensure that all incidents are reported in a timely manner. An incident occurred in the home whereby a service user scalded themselves whilst having a hot drink and required emergency medical attention. Staff did not respond quickly enough so there was a delay in seeking medical treatment. This incident was reported as a safeguarding incident and the Local Authority requested that the organisation undertake an internal investigation. Initial findings from the investigation have highlighted that staff members did not follow the instructions in the care plan to make the person a luke warm drink and gave then a drink made from boiling water resulting in the injury. The organisation have undertaken the re-training of some staff. Managers must ensure that staff follow instructions and details in the care plan which will mean that peoples needs are met and that they are protected from the risk of harm and injury. Care Homes for Adults (18-65 years) Page 21 of 34 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. We looked at standards 24 & 30. People live in a home that they can individualise but where ongoing maintenance issues could detract from the homeliness. Evidence: We were assisted by a member of staff to complete a tour of the premises. We looked at two of the bungalows that are separate to the main building. Both of these offered good space to people to be able to relax in their own lounge/ diner. Both people have been able to personalise their homes and these reflected the two different personalities. We looked in the main building of the home, this was clean throughout. Here people have shared communal space but have their own individual bedrooms. These are ensuite and the staff told us that there are plans to develop these further. At the last visit to the home it was noted that two of the en-suites had offensive odours and this was again noted at this visit. However, the staff member told us that actions have been taken to rectify these problems. Both of the en-suites are to be re-furbished and we were told that the plans have been developed for this and it is simply that once Care Homes for Adults (18-65 years) Page 22 of 34 Evidence: permission is gained from head office this maintenance can commence. When asked the staff told us that maintenance and repairs are completed in a timely manner. One complaint that was raised by the manager on behalf of the people who live in the home was regarding the hot water systems not working. The manager told us that once received this matter was dealt with promptly by the organisation. We saw that two kitchen drawers required fastening back onto the main units, one being in the main building and the member of staff said that these had been reported to the maintenance people. There is a separate laundry area and staff records recorded that staff had received training in infection control. We saw some of the maintenance records for the fire safety systems in the home. There is a fire risk assessment and an individual risk assessment for each service user. There was evidence that the fire extinguishers,fire alarm and emergency lighting systems had all received maintenance checks to ensure that they were in working order. Care Homes for Adults (18-65 years) Page 23 of 34 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. We looked at standards 32, 33, 34, 35 & 36. People are supported by adequate numbers of staff who receive training. However this does not ensure that people receive all of their funded hours and the correct level of support that peole require from this type of service. Evidence: The manager told us about the 1:1 hours that people are funded for each day. This varied from one person being funded for 11 hours 1:1 to another person being funded for 14 hours 1:1 per day to two people being funded for 5 hours 1:1 per day. We saw that there is a notice board in the main office of the home that clearly identifies which member of staff is working with which service user on each shift. This also includes that due to the high level of need of the service users, two staff swap between who they are supporting half way through the shift. One member of staff was allocated to support 2 services users whilst on shift and the manager told us that although not clearly identified both she and the deputy manager offer additional support for these people to ensure that they receive their 1:1 hours. It is advised that clear records are kept of which member of staff is supporting which service user with their 1:1 time each day, to provide a clear audit trail of the hours provided in the home. One professional fedback to us that they felt there appeared to be enough staff on duty as Care Homes for Adults (18-65 years) Page 24 of 34 Evidence: staff never appeared rushed in their roles. At the last inspection staff raised concerns over the level of staff sickness in the home, no concerns were raised regarding this at this visit. When we spoke to another health professional they told us that they felt that there are often a lot of staff changes in the home with staff moving within the organisation, although another persons feedback was that they saw the same staff members at each visit. We looked at the information provided in the AQAA and this recorded that there had been 4 staff who ceased working in the home in the last year. There are 23 staff employed in the home, this equals a staff turnaround of 17 per cent. We looked at the staff recruitment records, however these are now stored at the head office of the organisation. We saw some records for one person employed in the home, this included that their identity had been verified and that a Criminal records Bureau check had been undertaken, however this had been verified by the head office so it was unclear if a Protection of Vulnerable adults (POVA) check had also been completed. These checks help to ensure that people do not hold a criminal conviction that may prevent them from working with vulnerable people and that they are suitable for this role. Due to the lack of available evidence it was not possible to fully assess the recruitment practices in the home and these will be assessed in more detail at the next visit to the service. We looked at the staff training matrix. This showed that staff had undertaken training in Food Hygiene, Fire, First Aid, Moving and Handling, Medication, Infection Control, the Protection of Vulnerable Adults, Equality and Diversity and Makaton. The manager told us that she checked if people were competent in a subject after training in their supervision notes. Although this was listed in supervision there was not enough detail to show how the person was assessed as competent and the manager was advised to add further details to these records. We looked at individual records of training and these confirmed that staff had undertaken the courses listed on the training matrix. When we spoke to one member of staff they told us that they have completed their National Vocational Qualification (NVQ) level 2 in care , and that they have completed training in Epilepsy, Autism, First Aid, Medication and the Learning Disability Award Framework (LDAF). We spoke to one health professional, they told us that they felt the staff did not always have the skills to fully support the people who live in the home.That it was clear when staff had recently attended training but that they appear to quickly lose the skills that they have been taught. Another professional told us that although they Care Homes for Adults (18-65 years) Page 25 of 34 Evidence: felt that service users needs were met, the level of support offered was not consistent across the staff team. They felt that the staff skill mix varied and that staff required additional training to ensure that people received the same level of support from all staff. Further feedback was that staff did have the necessary skills and always ask for assistance. However staff felt that they had been given training relevant to their role, although not all staff felt that their initial induction to the service had covered everything that they needed to know when they commenced their role. There appears to be a lack of consistency in the level of and maintenance of the understanding of training and how this is put into practice. Although overall service user needs are met this issue requires addressing to ensure that peoples specialist needs are met and that people receive a consistent service. Care Homes for Adults (18-65 years) Page 26 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. We looked at standards 37,39 & 42. People are supported by a competent manager who has developed the systems in the home to include the service users in its development and to protect people from the risk of harm. Evidence: The manager has worked in the home for some time and has previous management experience. She told us about the recent training that she has undertaken and this included a leadership management course. She told us that some of her contracted hours are spent directly supporting the people who live in the home. However the records for this were unclear and should be improved upon. As this service supports people who have a high level of need it is advisable that the management of the home is a full time role. The feedback that we received from two professionals included that they felt the manager had taken on board their advice regarding the support for a service user and Care Homes for Adults (18-65 years) Page 27 of 34 Evidence: had actioned this.With one person also commenting that they were kept informed by the manager and that she ensured that the staff also kept them informed when she was not available Information recorded in staff surveys reflected that staff felt that they were given enough support from their manager. We looked at the records for regulation 26 visits and saw that these take place regularly in the home.One health professional was concerned that it was difficult to contact management out of hours,it is recommended that this is addressed and that the system and information on contact details of made available to all concerned with the service. One incident that required to be notified to the Commission had not been notified. The manager must ensure that all notifications are forwarded in a timely manner. We looked at the quality assurance system in the home and that that this includes questionnaires for people involved with the home.There were records kept of the staff and service users meeting that also take place regularly in the home and offer people the opportunity to participate in the development of the home and in the decisions made. We looked at the systems for handling the finances of the people who live in the home. Records are kept of all monies , with receipts and we saw with the manager that these balances appeared correct. We saw that health and safety monthly checks are undertaken in the home and that all accidents are recorded. Information in the AQAA recorded that Gas and Electrical systems had received maintenance checks. These were not examined at this inspection of the service and will be looked at at the next visit. Care Homes for Adults (18-65 years) Page 28 of 34 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 29 of 34 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 3 18 The registered person must be able to demonstrate the homes capacity to consistently meet the assessed needs of people admitted to the home and must not admit or retain people whose needs it cannot meet. Staff employed must consistently have the skills required to meet the needs of the people living in the home to ensure that individual support plans are consistently met. 11/06/2010 2 6 13 Staff must follow the 11/06/2010 instructions in peoples care plans that describe how their assessed needs are to be met. This helps to ensure that peoples needs are fully met and that accidents do not occur. Care Homes for Adults (18-65 years) Page 30 of 34 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 3 13 17 Records must be kept that clearly show how they receive their 1:1 support and who this is provided by. This will help to ensure that people receive the correct amount of support from the most suitable members of staff. 10/06/2010 4 19 18 People must receive consistent support from all of the staff team with the meeting of their health needs. This will help to ensure that support levels do not fluctuate and needs are always met. 10/06/2010 5 23 13 People must be protected from harm and injury; there should not be any delays in the seeking of emergency medical attention. This will help to ensure that people do not suffer unnecessarily from accidents and that their health needs are met. 11/06/2010 6 23 13 Safeguarding alerts must be consistently reported to the Local Authority as per the agreed protocols. 10/06/2010 Care Homes for Adults (18-65 years) Page 31 of 34 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action This will help to ensure that people are supported and protected from harm. 7 30 13 All areas of the home must be free from offensive odours. This allows people to live in a more homely and comfortable home. 8 32 18 There should be at all times 09/07/2010 suitably qualified and competent people to support the service users. This helps to ensure that people receive the same level of consistent support. 9 35 18 All staff should receive 09/07/2010 regular refresher courses and be re-assessed by the manager to ensure they have understood the course and are competent with this. This will help to ensure that peoples needs are all met to a consistent and good standard. 10 35 18 Staff should be trained in 09/07/2010 specialist areas to support people with their individual needs. This training should be undertaken refreshed and assessed as to the level of understanding. 10/06/2010 Care Homes for Adults (18-65 years) Page 32 of 34 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action This will help to ensure that peoples specialist needs are met. 11 37 37 Incidents in the service must 11/06/2010 be reported to the Commission without delay. This will help to ensure a clear audit trail and that appropriate actions are taken. 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 2 14 14 People could undertake activities with people who do not live in the home. The activities provided in the home should be kept under review to ensure that people are receiving the correct amount of activity to meet their needs and prevent them from being bored. The management of the home should ensure that the language used to describe people is not demeaning or disrespectful. The management of the home should ensure that all service users and their representatives, including health professionals are aware of the policies and procedures of supporting someone when they attend hospital, particularly in an emergency. The management of the service should be undertaken on a full time basis to ensure that needs are met. 3 15 4 19 5 37 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. 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