Care Home: Leonard Cheshire Of Gloucestershire

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What the care home does well Purpose built accommodation is provided for people with a physical disability that includes access to a hydrotherapy pool and physiotherapist. Excellent systems for maintaining a safe environment are in place. The Expert by Experience said that "spontaneously all the residents confirmed that they liked living at the home and they all agreed the new manager was very approachable." People are involved in the quality assurance process and have regular house meetings and representation on the catering and health and safety committees. What has improved since the last inspection? A consistent approach to care planning is in place which includes regular review of care plans. Systems for the administration of medication were satisfactory. A robust system for collating recruitment and selection records is now in place, making sure that all records required my us are obtained before new staff start work. What the care home could do better: The manager is consulting with people living in the home about the catering provision. It is important that people have a nutritional and wholesome diet which promotes their health and wellbeing. It has been identified that current training systems are not keeping staff up to date with the knowledge and skills they need to meet people`s needs. The cleanliness of wheelchairs needs to be monitored. Staffing levels may sometimes impact on access to activities particularly in the evenings and at weekends. One person commented, "I think an extra pair of hands could be needed at weekends." Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Leonard Cheshire Of Gloucestershire Charlton Lane Leckhampton Cheltenham Glos GL53 9HD     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Lynne Bennett     Date: 1 3 0 8 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 31 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 31 Information about the care home Name of care home: Address: Leonard Cheshire Of Gloucestershire Charlton Lane Leckhampton Cheltenham Glos GL53 9HD 01242512569 Telephone number: Fax number: Email address: Provider web address: glos@cent.leonard-cheshire.org.uk www.lcdisability.org Name of registered provider(s): Type of registration: Number of places registered: Leonard Cheshire Disability care home 36 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability old age, not falling within any other category physical disability Additional conditions: To accommodate one named service user (under a Learning Disability Category) until they leave the home. Date of last inspection Brief description of the care home Leonard Cheshire of Gloucestershire provides residential and nursing care for people with a physical disability. The home is owned and managed by Leonard Cheshire Disability. The home is located in Leckhampton, not far from Cheltenham town centre, and close to local facilities and amenities. The home was purpose built, providing a main building divided into five lodges for six people, communal spaces, offices and a Care Homes for Adults (18-65 years) Page 4 of 31 Over 65 0 2 0 1 0 36 Brief description of the care home hydrotherapy pool, a sensory room and a physiotherapy room. There are six bungalows that enable people to have greater independence but also retain some support from staff. The home has four mini buses and a car; people also use public transport, local taxis and the community transport system. The Statement of Purpose and Service User Guide are available from the main office and information about the home is available in the foyer. Fee levels range from 700 to 2000 pounds plus per week. Care Homes for Adults (18-65 years) Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This inspection took place in August 2009 by one inspector including two visits to the home on the 12th and 13th of August. We were accompanied on the second visit by an Expert by Experience who is a person, because of their shared experience of using services, and/or ways of communicating, accompanied us (the Care Quality Commission) to help get a picture of what it is like to live in the home. The registered manager completed an AQAA (Annual Quality Assurance Assessment) as part of the inspection, providing considerable information about the service and plans for further improvement. It also provided numerical information about the service (DataSet). We talked to 6 people using the service, and asked staff about those peoples needs. We also looked at the care plans, medical records and daily notes for these people. Care Homes for Adults (18-65 years) Page 6 of 31 This is called case tracking. We also talked to other people living in the home and the Expert by Experience was involved in a group discussion with 20 people. Their responses and feedback from the Expert are included in this report. We also looked at a selection of other records including health and safety systems, quality assurance audits and staff files. We completed a walk around the environment with the manager. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 31 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have access to the information they need enabling them to make a decision about whether they wish to live at the home. A comprehensive assessment of the persons wishes and needs are taken into consideration before offering them a place. Evidence: The Statement of Purpose and Service User Guide had been reviewed and rewritten in February 2009 to reflect changes to the service. The Service User Guide was accessible to people in the front hall of the home. There had been a number of new admissions to the home. We casetracked the care of three people and spoke to another person who had just moved in. All said how happy they were living in the home and that they had settled in really well. The registered manager said that she and the homes Physiotherapist completed an assessment with the person prior to them visiting the home. A copy of one of these was seen. They would then supply initial care plans to staff in the lodges ready for visits, overnight stays and trial weeks. One person said they had so enjoyed their trial week that they decided to move into the home straight away. During our visit their furniture had Care Homes for Adults (18-65 years) Page 10 of 31 Evidence: arrived from their previous home and staff were supporting them to settle in. A tracking form was being used for the most recent admissions providing evidence of transition meetings, initial referral and assessments. The registered manager had introduced new enquiry files since joining the home to provide a robust admissions process. There was evidence that she had requested an assessment of need and care plan from a placing authority at the start of the admissions process and that this had been provided before the person moved into the home. People said they had visited the home or that staff had visited them in their previous placement. For one person with extremely complex needs nurses spent two weeks working with them and their carers at their former placement. When they moved into the home they had additional support from nurses from their former placement for 48 hours to work alongside their care team in the home. New people had copies of a statement of terms and conditions in place on their files and there were copies of contracts between them, the home and placing authorities. Care Homes for Adults (18-65 years) Page 11 of 31 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans reflect peoples assessed needs and there is some evidence that people are being supported to make choices about their lifestyles. Ways of improving communication with people are explored to enable them to be involved in decision making process. Risks are being managed to enable people to live safely. Evidence: We case tracked 5 people including three people who had recently moved into the home and sampled other files. Leonard Cheshire presently uses an Individual Service Plan (ISP) format but was planning to change to a Person Centred Planning system of care planning. Some people had chosen to keep their ISP in their room and one person talked through their care plans and risk assessments with us. There was evidence that some people had signed their care plans. A holistic assessment of each persons physical, intellectual, social and emotional needs was in place with corresponding care plans and risk assessments to guide staff about how their needs were to be met. There was evidence that these were being regularly monitored, reviewed and amended to reflect any changing needs. Care Homes for Adults (18-65 years) Page 12 of 31 Evidence: People were having annual reviews and inviting a representative from their placing authority. Copies of placing authority assessments and care plans were in place for some. The registered manager said she had introduced a system for involving people in the preparation of the reviews providing feedback for the agenda. Copies of agendas for two people indicated that people had discussed their lives and lifestyles with their keyworkers. Feedback had been received from other people involved in their care such as relatives or health professionals. Daily records were being kept which provided brief details of how peoples care was being met. These were supplemented by a range of monitoring forms such as food/fluid charts and an activities record. Staff were observed supporting people in line with their care plans for instance supporting them with activities, with eating and drinking or moving and handling. The AQAA stated that people would have access to Leonard Cheshires Communication Support Team to access improved communication opportunities for service users with profound communication difficulties. People spoken with used a range of communication aids including lite writers and Bliss symbols. The registered manager said that they had been able to alter the voice of the lite writer to personalise this to the person using the aid. Staff were observed promoting positive communication for all during the visits. A range of risk assessments were in place which were being regularly reviewed. Hazards around the home and for tasks completed by staff were identified and minimised. The assessments enabled people to take risks in as safely a way as possible rather than preventing them from participating in activities. People said they had been involved in training in health and safety and risk assessment along with staff. People had been supported by staff to highlight concerns over access to the public highway increasing risks to them when out and about locally. This had been featured in the local newspaper. Care Homes for Adults (18-65 years) Page 13 of 31 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Opportunities to participate in social, educational, cultural and recreational activities may be affected by staffing levels. People are supported to maintain contacts with families and friends. People are being involved in a review of catering in the home to make sure that this provision meets with their nutritional and dietary needs. Evidence: We had mixed feedback from people living in the home and staff about opportunities for people to access a range of activities, particularly those outside of the home. People had schedules of activities in their files indicating attendance at colleges, day centres, evening classes, hydrotherapy and physiotherapy. An activity co-ordinator was employed to provide a selection of activities in the home during the week which also included day trips. She maintained an activity file providing photographic evidence of art and craft sessions, cookery including Barbeques and bring and share celebrations, quiz and indoor games. A volunteer was providing an archery evening Care Homes for Adults (18-65 years) Page 14 of 31 Evidence: class each week which people were observed attending. Feedback to the Expert by Experience included, they acknowledged that activities were well organised and supported. Similarly so with trips outside of the home. A record was being kept of activities completed by each person. For those people who were able to use public transport or access the community without support there was evidence that they were leading fully inclusive lifestyles. For other people needing staff support there were fewer opportunities which people said lessened at weekends and in the evening. However staff said with planning of both staff support and drivers they had been able to support people at concerts, music festivals, football matches and going to Italy and Spain for a holiday. The manager said she had revised the staff rota which would provide greater flexibility for staff to support people with activities. This was due to start in September and staff would be aware of their responsibility to discuss with people their wishes and to plan activities. Surveys also indicated that staff shortages had impacted on access to activities. Staff spoken with said that shifts were covered mostly when there were shortfalls due to sickness and that agency staff were used. There continued to be great dependence on volunteers to help with driving of the homes vehicles. The Expert by Experience said that the group discussion had also raised concerns about access to drivers and escorts. The manager had already identified this as an issue and had requested a smaller vehicle which could be used by one person using a wheelchair and up to 4 other people. Leonard Cheshire had informed her that if this could not be provided through the homes budget it would be funded through fund raising, which she hoped would be soon. A volunteer co-ordinator had recently taken up post and was concentrating on identifying specific areas where people wanted additional support such as help with writing a memoir, and then providing a volunteer to support them to achieve this. A number of people were involved in voluntary work or work placements. They discussed work opportunities with the Expert by Experience but felt there was little or no encouragement to become economically active in this way. Parents and relatives were observed visiting people during our inspection and people were visiting their family for longer stays. People said they were able to entertain friends in their rooms or communal areas of the home. Each lodge had been provided with a computer with internet access and there were computers in the activity room which people were observed using. Some people have a telephone in their rooms. Two people discussed plans for their wedding in spring next year at their local church. They were being supported by staff to plan this and would be moving within the home to a larger room. Care Homes for Adults (18-65 years) Page 15 of 31 Evidence: People were observed doing their washing and making snacks and drinks. Some take responsibility for cleaning their rooms and have helped to redecorate their rooms. The home had researched appropriate technology to enable people to have keys to their rooms or the bungalows including keys with sensors and swipe cards. The home has two cats which live in one of the lodges but have the run of the home. People who smoke can do so in their rooms if they wish. Each room has French windows and a patio area. There was also an area adopted by people at the front of the building with tables, chairs and parasols which had become a meeting place for smokers and non smokers. The manager had instigated a catering review in response to feedback from people living in the home and our previous concerns. Feedback from people living in the home for this years quality assurance audit indicated that 32 per cent of people were satisfied with the quality of food and 36 per cent were dissatisfied. She had held regular catering meetings with people and they had been asked to complete a questionnaire. The catering staff, people living in the home and care staff had visited another Leonard Cheshire home to view their catering facilities. All this information was being collated to produce an action plan reflecting peoples wishes about catering at the home. People were observed having a lunch of either breaded chicken and salad or mince, potatoes and vegetables followed by fresh fruit or chocolate sponge and custard. The Expert by Experience had joined people for lunch and commented, It was unappetising to look at and to eat. It is suggested that attention is paid to this area. The evening before lodges had been provided with ingredients to make hot dogs or sandwiches. Lodges have cooking facilities and some people choose to make snacks. Where lunch time meals were being reheated the temperature was being tested and recorded. Those examined were being reheated to the appropriate temperatures. Each lodge was provided with a basket of fresh fruit on the second day of our visit. Previous inspections have highlighted our concerns about the nutritional content of the diet provided for people and at the last inspection, training had been provided for catering staff and people indicated there had been improvements. Although the manager was taking steps to address this, we have made a requirement to make sure this is addressed. Some people require special diets and there was evidence that dietitians had been involved where needed. Several people who had PEG (percutaneous endoscopic gastronomy tube) feeds could also have small amounts of soft food. It had been reported by staff that the individual ingredients were being liquidized together. The manager had requested that each item was liquidized individually and presented in an appetising way. Equipment needed for PEG feeds was being stored appropriately. For people taking Ensure this was being given in line with their care plans and monitoring Care Homes for Adults (18-65 years) Page 16 of 31 Evidence: records kept. Care Homes for Adults (18-65 years) Page 17 of 31 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Personal care support is offered in a way that responds to peoples needs and preferences, promoting peoples dignity. Peoples health and personal care needs are being met helping them to stay well. Their health and wellbeing are promoted by satisfactory arrangements for the handling of medication and training of staff in specialised techniques. Evidence: Each person had a detailed ISP describing how they wished to be supported with their personal care needs. They had a record indicating that they had been consulted about the gender of staff providing their personal care. They also had a privacy and dignity statement which indicated how they would like staff to support them. Staff were observed postively interacting with people treating them with dignity and sensitivity and being discreet when support was needed with their personal care. The Expert by Experience stated that people had said they could choose what time to wake up and to go bed. He commented on the state of peoples wheelchairs. Some of the wheelchairs were very dirty. It was confirmed that wheelchair maintenance took place weekly so it would appear this is not a task on the maintenance list. He also noted that the standard of some of the wheelchairs was poor, being very basic, in some cases slow. Care Homes for Adults (18-65 years) Page 18 of 31 Evidence: He suggested raising awareness and or advocacy around the selection of wheelchairs. Assessments were completed for moving and handling which stated how many staff were to be involved in each task and the equipment which should be used with them. Tissue viability assessments had also been completed and indicating what action needed to be taken to support people at risk of developing pressure sores and what equipment needed to be in place. A record was being kept for all health care appointments with a note of the outcome of each visit. People were being supported to see their dentist at appropriate intervals. They also had support to visit their General Practitioner and were referred promptly for outpatient appointments. Each lodge had a medication cabinet which was located in a medication cupboard. The temperature of these cabinets needs to be monitored. Staff confirmed they had completed training in the safe handling of medication and nurses were responsible for auditing their competency. Medication was dispensed in a monitored dosage system. Medication administration records were satisfactory although all staff should make sure that any handwritten entries are countersigned by two staff. Protocols were in place for the use of homely remedies and as necessary medication. Stock control for all medication was monitored via the medication administration record. Creams and liquids were labelled with the date of opening. Protocols were in place for the administration of medication via a PEG (percutaneous endoscopic gastronomy tube). Care Homes for Adults (18-65 years) Page 19 of 31 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service has an accessible complaints procedure which enables concerns to be raised by people living in the home or on their behalf. Systems are in place which should safeguard people from possible abuse. Evidence: The AQAA indicated that the home had received one complaint in the last twelve months. It also stated that people moving into the home were given a copy of the organisations Have Your Say leaflet. Records of complaints were being kept with evidence of the outcome. People said they would speak to their key workers or the manager about any concerns they may have. They said they would be listened to and were confident that action would be taken as a result. One person said that the managers door was always open and another said they felt they could approach her about any concerns at any time. Minutes confirmed that residents meetings were being held providing another forum for people to discuss concerns. People had expressed dissatisfaction with the catering provision and this had prompted a review of catering services. A copy of Leonard Cheshire Disability complaints procedure was displayed in the entrance hall and people had a summary of this in their service user guide. Staff had access to training in the safeguarding of adults including refresher courses. A recent health and safety audit indicated that some mandatory training including refreshers in the safeguarding of adults were overdue. See Standard 35. People living Care Homes for Adults (18-65 years) Page 20 of 31 Evidence: in the home had also had access to this training. There was information in the managers office about the Mental Capacity Act and Deprivation of Liberty Safeguards. She discussed the impact of this legislation on the service and had involved advocates where necessary to discuss peoples capacity to consent. The AQAA indicated that Leonard Cheshire Disability would be providing training to staff and that in the meantime the manager was cascading this information to them. Consideration was being given as to how best to record restrictions such as the use of bed-sides and the rationale for their use. The use of lapbelts for people using wheelchairs was recorded in some risk assessments where people refused to use them. The use of these should also be recorded. Lockable facilities were provided in rooms for peoples valuables and cash. People living in the home were able to access training in money management. Some people had inventories on their files listing any fixtures and fittings they owned. Care Homes for Adults (18-65 years) Page 21 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a home that is safe, clean and well maintained which recognises their diverse needs creating an environment that matches their personal requirements. Specialist equipment is provided to those people who need it. Evidence: The home was purpose built and has excellent access and adaptations for people with a physical disability. The entrance porch has been redesigned providing easy but secure access and a place for people to meet and greet. Some people have chosen to smoke in the front grounds and tables and chairs were provided for this purpose. This has become an area where people congregate. It is important that non smokers are aware that people who wish to smoke use this area for this purpose. The communal areas around the home are well maintained. People have said that they feel the lounge is under used and so are being involved in discussions about how best to make use of this area. They also commented on the decor of the lounge and dining room which had been redecorated by volunteers. People had commented that these rooms were rather dark and so were planning to redecorate. Artwork created by people living in the home had been used to good effect in hallways and communal areas. Lodges reflected the lifestyles and personalities of people living there. Each person had decorated their rooms to suit their personal requirements. Overhead tracking was Care Homes for Adults (18-65 years) Page 22 of 31 Evidence: in situ in bedrooms and bathrooms. Specialist adaptations were in place and people had access to assisted baths. The manager had plans to redecorate bathrooms. Some carpets in communal hallways were due to be replaced. The gardens around the home had a make over with areas providing decking and patios. A large wheelchair swing had also been given to the home and was being installed in the garden. The Expert by Experience commented on problems with parking at the home, particularly no dedicated parking for disabled visitors. This had been affected by building work at nearby properties. There had been changes to the parking area increasing access for the homes buses, providing a dedicated parking area for people using the hydrotherapy pool and providing a drop off point. Three of the bungalows had their own parking bay which were temporarily being used by staff and visitors to the home. The laundry was clean and tidy during our visit. Infection control measures were in place should there be an outbreak of swine flu in the home. Personal protective equipment was provided and good infection control measures were in place in the lodges. Care Homes for Adults (18-65 years) Page 23 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples needs are met by a competent staff team, who need to have access to a robust training programme and refresher training to maintain their skills and knowledge. People are involved in recruitment and selection and the procedures that are in place should safeguard them from possible harm. Evidence: The DataSet indicated that 32 per cent of staff had a NVQ in Health and Social Care. The manager confirmed that the NVQ programme was now back on track to enable staff to complete their awards. All staff had completed an induction with Leonard Cheshire Disability which was equivalent to the Skills for Care Induction programme. The manager had also introduced an induction for the first days in the home which included prompts about dignity and privacy and providing guidance on tissue viability. An agenda was seen for a new member of staff introducing them to people living in the home, staff and records. New staff said they had been supported during their induction and felt they had been provided with sufficient information and training. People living in the home discussed their concerns with the Expert by Experience about high staff turnover, their rates of pay and staffing levels. Surveys also indicated that staff were unhappy with their levels of pay and had concerns over staffing levels. As indicated previously in the report the new manager had identified this as a concern and had changed the rota to increase staffing levels during the afternoon and at Care Homes for Adults (18-65 years) Page 24 of 31 Evidence: weekends. This, she hoped would provide greater flexibility enabling staff to support people with activities both inside and outside of the home. The AQAA stated, Staff are committed to the Service Users, and work hard to give people the best standards of care possible. People living in the home said that staff are very nice, very talkative and they feel very positive about the new staff. Recruitment and selection procedures involved people living in the home either during informal visits or as part of the interviewing process. Robust systems were in place to ensure that all records required by us were in place before people were appointed. We looked at files for 4 new staff appointed in 2008 and 2009. Each person had provided a full employment history on their application form. Where there were gaps these had been explored with the applicant and evidence provided and recorded with their application. Where people had previously worked with adults or children and had not provided these employers as referees, there was evidence that the manager had approached these employers to ascertain the reason for leaving. Proof of identity and a current photograph were in place. Copies of birth certificates were removed from files during our visits in line with recommendations from the Data Protection Act not to keep these. Confirmation that a satisfactory Criminal Records Bureau check had been obtained were in place. At the last inspection this standard was rated as excellent. As previously mentioned a recent audit had identified that some mandatory training and refresher courses had lapsed and there was an urgent need to address this. The manager had discussed with senior managers at Leonard Cheshire Disability the need to reinstate a training officer at the home to improve the delivery of training within the home. Staff confirmed that training had been scheduled for the autumn and that information was provided in the staff room. A training matrix indicated when staff had completed their training and what needed to be completed. Training in Equality and Disability and Disability and the Law was provided. Staff also confirmed they had access to training in specialist techniques. Nurses confirmed that they maintain their professional development and have supervision from the care supervisor. The manager had identified that staff were not having regular supervision or annual appraisals. She said that supervision sessions for all staff had been scheduled and they were having regular staff meetings. Copies of meetings were seen on staff files. Staff spoken with said they felt supported and that the manager was accessible. Staff meetings and senior management meetings were taking place. Care Homes for Adults (18-65 years) Page 25 of 31 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home are benefiting from a manager who has a dynamic and creative approach, and who is providing clear direction and leadership. Effective quality assurance systems are in place involving people. Robust systems for the monitoring of health and safety should protect people from possible harm. Evidence: The manager is a qualified nurse and has a management qualification. She has considerable experience working in care and supporting people with a physical disability. She had just successfully completed the Fit Person process with us to become the registered manager of the home and was waiting for our official confirmation. She had comprehensively completed an AQAA and forwarded this to us before the deadline. She had developed an action plan for improvements at the home and was involving people living there in this process. People living in the home and staff said that she was enthusiastic and approachable. A survey response said she respects and encourages staff to be the best we can be and promotes us to have initiative and enjoy our work. The Expert by Experience observed that her door was open unless she had a meeting or discussion which required privacy. Care Homes for Adults (18-65 years) Page 26 of 31 Evidence: Management had received training in the Mental Capacity Act and Deprivation of Liberty Safeguards. As mentioned there was evidence that IMCAs and/or advocates were being involved with people where appropriate and the necessary assessments and records were being completed by the home. No one in the home was subject to a Deprivation of Liberty Safeguard at the time of the inspection. Leonard Cheshire Disability has a quality assurance system in place which involves people living in the home. They participate in both the unannounced Regulation 26 visits required by us and the annual quality assurance audit of the home. Copies of Regulation 26 reports were examined confirming this and that any actions carried forward were being monitored. Feedback from people living in the home for this years quality assurance audit was made available. Overall, 59 per cent of people said they thought they received an excellent service, with 36 per cent stating it was good and 5 per cent adequate. One person living in the home had just been elected to represent the Region at a Leonard Cheshire Disability Service User Network Alliance (SUNA) and was due to attend a meeting. Other people living in the home confirmed they were representatives on the Health and Safety Committee. Residents meetings were also taking place regularly to which the manager was invited. A health and safety co-ordinator oversees all issues on a day to day basis and maintains robust records. Environmental risk assessments and individual risk assessment were in place with evidence of regular review. A fire risk assessment had been completed by an external organisation and fire evacuation procedures reflected current legislation. Fire records and drills were taking place. Records were being maintained for water temperatures, fridges and freezers and cooked food temperatures. Certificates sampled in the home confirmed information provided in the DataSet that servicing of equipment and utilities was in place. Care Homes for Adults (18-65 years) Page 27 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 28 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 17 12 The registered person must make sure that people have a nutritional and wholesome diet. This is to promote the health and well being of people living at the home. 30/09/2009 2 35 18 The registered person must make sure that staff have the skills, knowledge and understanding to support people living in the home. 30/09/2009 This will make sure that staff are able to meet the needs of the people they support. 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 14 Monitor access to activities for people at weekends and evenings. Care Homes for Adults (18-65 years) Page 29 of 31 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 2 18 Consider raising awareness and/or advocacy around the choice of wheelchairs. Regularly check the condition and cleanliness of wheelchairs. The temperature of medication cabinets should be monitored and recorded. Any handwritten entries on medication administration records should be countersigned by staff to confirm they are correct. Each person should have a copy of an inventory in place. Staff should have access to refresher training in the safeguarding of adults. Non smokers should be aware that the area in the front of the building is also an area which will be used by smokers. 3 4 20 20 5 6 7 23 23 24 Care Homes for Adults (18-65 years) Page 30 of 31 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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