Care Home: Lifestyles

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What the care home does well People are assessed before they move in, and they too have the chance to see what living at Lifestyles would be like, before they have to make a firm decision to move there.LifestylesDS0000062824.V376859.R01.S.docVersion 5.2Staff know people who live at Lifestyles well. This helps them to be able to anticipate where they may be having problems, and need extra support to keep well and independent. People can make decisions about what they do, and when, in relation to activities, further education, and jobs. They can enjoy the privacy of their own room when they want to, and are confident that they will not be disturbed by staff entering their room when they have not invited them to. People know they can complain to the management if things go wrong, and that action will be taken to put things right. The home is run by a registered provider and manager who are keen to improve the service people get. What has improved since the last inspection? Staff now review care plans with the person they belong to. Staff look at them more often, and people sign them and their risk assessments to show that they agree with what has been written. This helps staff to be sure that they are supporting people in the agreed way. The kitchen fridges and freezers have all been replaced with new ones, and some work has been done in the kitchen to make it easier to keep clean and hygienic. Some of the fire doors have been replaced, and the remainder will be replaced soon. This will give people better protection should a fire break out. Staff have received lots of training so they know how to work safely, and so that they understand better the conditions that people living at Lifestyles may have. They have also had training which tells them what to do should they believe, or be told, that someone living at Lifestyles was not being treated properly. The registered provider now keeps a monthly report about visits to the home, which show what has been discussed, and who with. This will assure people that she is being kept informed about the running of the home, and people`s satisfaction there. What the care home could do better: Continued risks to people, and information from their care managers, could always be included in people`s care plan, so they are up to date, and provide a true and complete picture of the current needs of the individual. More thorough checks of prospective employees could be carried out, so people can be assured that every step has been taken to protect them from unsuitable workers.LifestylesDS0000062824.V376859.R01.S.doc Version 5.2 The temperature of hot water that people have access to could be monitored better, to make sure that they are not at risk from scalds. Some improvements could be made to the way medication is managed and monitored so that the service people get is safe, and any risk to them identified at an early point. Written information about how to complain could be made more accessible to people, and policies at the home could support the local authority as lead investigators into cases of abuse, so staff tell the right people at the right time if they have concerns about the way people are treated. Some improvements could be made to the environment to make the bathrooms more pleasant and hygienic for those who live there. The manager could apply to the commission to become registered, so people know that she has been assessed as being a fit person to run Lifestyles. More people could be surveyed to gather their views about how the home is run, and this information used collectively when deciding what changes should be made to ensure it is running in the best interests of those who live there. Key inspection report CARE HOME ADULTS 18-65 Lifestyles 55-59 Wentworth Road Scarcroft Hill York YO24 1DG Lead Inspector Anne Prankitt Key Unannounced Inspection 27th July 2009 09:30 Lifestyles DS0000062824.V376859.R01.S.doc Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care home adults 18-65 can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Lifestyles DS0000062824.V376859.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Lifestyles DS0000062824.V376859.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Lifestyles Address 55-59 Wentworth Road Scarcroft Hill York YO24 1DG 01904 645650 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Dove Care Ltd. Care Home 19 Category(ies) of Learning disability (19), Mental disorder, registration, with number excluding learning disability or dementia (19) of places Lifestyles DS0000062824.V376859.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 29th July 2008 Brief Description of the Service: Lifestyles is owned by Dove Care Limited and is registered to provide personal care, support and accommodation for up to nineteen people with learning disabilities and/or a mental disorder. Only men were living there at the time of this inspection. The home comprises of three large terraced houses linked together, with a variety of communal rooms, single and double bedrooms and a patio garden at the back of the house. The home is within walking distance of York city centre, its amenities and leisure facilities. The current weekly fee at the time of the site visit on 27th July 2009 is £440.89 per week. There are no additional charges. Current information about services provided at Lifestyles is available in the form of a statement of purpose and service user guide that explains the care and facilities on offer at the home. The most recent inspection report is on display in the home. There is currently no registered manager, although an acting manager is in post. Lifestyles DS0000062824.V376859.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. The key inspection included a review of the following information to provide evidence for this report: • • Information that has been received about the home since the last key inspection. A self assessment, called an Annual Quality Assurance Assessment (AQAA). This assessment told us how the manager and registered provider thinks outcomes are being met for people using the service. It also gave us some numerical information about the service. Comment cards sent to ten people who live at the service. All of these were returned completed, along with five completed by staff who work at Lifestyles. A site visit to the home which took place on 27 July 2009, and which lasted for approximately eight hours. • • During the site visit, several people who live there, two staff, the manager and the registered provider were spoken with. Brief discussion was also had with one relative. Three people’s care plans were looked at in detail, as were two staff recruitment files, some policies and procedures, and some records about health and safety in the home. Time was also spent watching the general activity of the home, to get an idea about what it is like to live there. The manager and registered provider were available throughout the day, and feedback was given to the manager at the end. Since the site visit, the registered provider has contacted us to tell us about some of the things she has organised straight away after this feedback was given. 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 where it is considered that people who use services are not being out at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. What the service does well: People are assessed before they move in, and they too have the chance to see what living at Lifestyles would be like, before they have to make a firm decision to move there. Lifestyles DS0000062824.V376859.R01.S.doc Version 5.2 Page 6 Staff know people who live at Lifestyles well. This helps them to be able to anticipate where they may be having problems, and need extra support to keep well and independent. People can make decisions about what they do, and when, in relation to activities, further education, and jobs. They can enjoy the privacy of their own room when they want to, and are confident that they will not be disturbed by staff entering their room when they have not invited them to. People know they can complain to the management if things go wrong, and that action will be taken to put things right. The home is run by a registered provider and manager who are keen to improve the service people get. What has improved since the last inspection? What they could do better: Continued risks to people, and information from their care managers, could always be included in people’s care plan, so they are up to date, and provide a true and complete picture of the current needs of the individual. More thorough checks of prospective employees could be carried out, so people can be assured that every step has been taken to protect them from unsuitable workers. Lifestyles DS0000062824.V376859.R01.S.doc Version 5.2 Page 7 The temperature of hot water that people have access to could be monitored better, to make sure that they are not at risk from scalds. Some improvements could be made to the way medication is managed and monitored so that the service people get is safe, and any risk to them identified at an early point. Written information about how to complain could be made more accessible to people, and policies at the home could support the local authority as lead investigators into cases of abuse, so staff tell the right people at the right time if they have concerns about the way people are treated. Some improvements could be made to the environment to make the bathrooms more pleasant and hygienic for those who live there. The manager could apply to the commission to become registered, so people know that she has been assessed as being a fit person to run Lifestyles. More people could be surveyed to gather their views about how the home is run, and this information used collectively when deciding what changes should be made to ensure it is running in the best interests of those who live there. 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. Lifestyles DS0000062824.V376859.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Lifestyles DS0000062824.V376859.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 2 People using the service experience good quality outcomes in this area. People are appropriately assessed before they are admitted. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Nobody has been admitted since the last key inspection took place at Lifestyles, when it was assessed that there were appropriate levels of assessment in place prior to people moving there. The manager told us in the Annual Quality Assurance Assessment that it would still be the case that people would be assessed before being offered a place, to make sure that their needs could be met by the home. The person would be invited to visit the home with their care manager, and would be slowly introduced to life there. This gives everyone the opportunity to see how the placement would work. We were also told that people are given written information, including any house rules that have been introduced to help the home run smoothly. This information is in the form of a brochure, and also the service user’s guide. The guide did not contain a copy of the complaints procedure. The manager has agreed to include this information so people admitted in the future have a written copy of the procedure. Lifestyles DS0000062824.V376859.R01.S.doc Version 5.2 Page 10 Staff were satisfied that they get enough information about people before they are admitted, so they know what support they will need when they arrive. Most people have lived at Lifestyles for a long time. However, eight out of ten people who returned their surveys said that they were asked if they wanted to move to Lifestyles, and seven said they got enough information to help them decide whether they wanted to move in. One person said that the home provided ‘very nice board and lodgings’. Another commented that Lifestyles was ‘one of the best places going’. Lifestyles DS0000062824.V376859.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 and 9 People using the service experience adequate quality outcomes in this area. People get good support. But this care, and how risk is managed, is not always reflected in the written information kept about them. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: People have a full initial assessment which covers their personal and health, emotional and social care needs. The assessments seen were good, because the information written about people was individual. However, these assessments were not dated or signed, and some of the information was no longer relevant. This made it confusing, because the assessment did not always match with what was written in the care plans, and we could not see how long ago the assessment had been done. People then have care plans and risk assessments completed for areas where it has been identified that they need support, or where they may be at risk. These are normally updated as things change, or reviewed every two months by the person’s key worker, and signed where possible by the person to whom Lifestyles DS0000062824.V376859.R01.S.doc Version 5.2 Page 12 the plan belongs. Some people don’t want to be involved in the review. This is their choice. One person said they do not always want to talk about their support needs, but had confidence that staff understand them. In support of this, some of the information in people’s care plans was very person centred, showing that staff understand people who live at Lifestyles well. One person commented ‘They (the staff) sit and listen to every detail that I explain and then they would advise me what to do’. People’s care is also reviewed periodically by their care manager, when they have one, after which the care manager produces their own updated care plan. Although a copy of this was included in people’s file, the care plan completed by the home was not always updated to reflect the outcome of the care manager’s review. This meant in one case that continued concerns about risk to the person, and how the home could manage this risk effectively, were not included in the plan completed by the home. Some risk assessments identified risk, but did not always explain how this could be minimised for people, or translated into a care plan to tell staff how they could work consistently to support the person. Staff at Lifestyles are responsible for supporting people on a daily basis, so they need to have written guidance about how to do so consistently. However, other evidence showed that despite this shortfall, equipment and advice had been sought to help keep risk to them minimised. Staff said they have better access to the plans now. They read them periodically, and have good verbal reports each day, so they know about any changes in people’s support needs. The care plans are kept separately to people’s daily records. Keeping these notes together would encourage staff to refer to the care plan when writing daily records, and would help to further ensure that the support people get is consistent. However, all five staff who returned their survey said that they always get up to date information about people’s needs, and four of these said the way they share information amongst each other ‘always’ works well. This fifth said this was ‘usually’ the case. Although there are some basic house rules, people were satisfied that they could make choices and decisions in their daily lives. However, staff have over the past year demonstrated that they respond quickly to unexplained absences. Some people are very independent, and one manages their own finances completely. Others rely on staff to assist them, and the manager and administrator are appointees for some of these people. A record is kept of money received and spent on people’s behalf. Wherever possible, people sign to indicate when they have received their weekly personal allowance. One person was pleased that the arrangements allowed them to budget throughout the week, and said that they ‘always have enough money’. Lifestyles DS0000062824.V376859.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): This is what people staying in this care home experience: 12,13 15,16 and 17 People using the service experience good quality outcomes in this area. People can make choices about their lifestyle, and are supported to develop their skills. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: People attend a range of activities to suit their needs and wishes. This includes paid employment, voluntary work and college courses. Some people attend church each week. People are also involved in a local football team. Some said they enjoy a weekly visit to the local pub with their friends. One said ‘I’m very happy – there’s plenty to do’. Those who are unable to leave the home alone because of sight problems, get the chance to go out for a walk with staff on a daily basis if they wish. Sensory activities are also available, such as dominoes and games, which these people enjoyed on the day we visited. Most people have tasks to complete each day. They are responsible for the cleaning of their own room, doing the laundry, and for keeping the communal Lifestyles DS0000062824.V376859.R01.S.doc Version 5.2 Page 14 areas of the home clean and tidy. They do this on a rota. People said they did not mind doing these activities, nor the fact that there are certain house rules, which they are told about before they arrive. These include set times at which people are expected go to their room at night, at what time their television must be switched off, and where people are allowed to smoke. People were asked if they were happy with these rules. They said they were, and they understood that by sticking to these rules, they were respecting others in the home. Staff said however that there is flexibility in the routine. People who returned their surveys said that they ‘always’ or ‘usually’ made decisions about what they do each day. When we visited the home, people told us that they have a key to their room, and that they can come and go as they wish. We received comments like ‘It’s nice. We have freedom’, ‘The home looks after me very well and leaves me to do what I want during the day..’. A person spoken with said that staff respect their privacy, and do not disturb them if they want to be alone. Another said that staff only ever enter their room if they have asked permission. This shows that people’s right to privacy is respected. People can welcome their family and friends into the home whenever they wish. They are not discouraged from developing personal relationships with people of their choice. The manager said that appropriate support and guidance would be provided to them if needed. One person said that the manager takes them to visit their family when they need support to get there. There is a three weekly menu, which has been devised with the help of people who live at Lifestyles. This menu does not provide a choice. However, people often ask for an alternative if they do not fancy the advertised meal, and this will be provided. There is fresh fruit available between meals, which the manager said people are free to help themselves to. People said the food is good. One said it was ‘lovely’, and confirmed that the staff will change the menu at people’s request. Where people needs supervision with their meal, staff provide this in an unobtrusive way, and make sure that it is served according to their plan of care, and following information provided by the dietician and other health experts who have been involved. However, weight loss needs to be better monitored, and a nutritional assessment completed where there are ongoing issues with a person’s weight. This is so it can be monitored more closely, and the right professional advice sought quickly when problems are identified. It was not clear in one case why the person’s weight had fallen. The manager was advised to seek further advice from the dietician, to check that the right steps are still in place to maintain the individual’s well being. Lifestyles DS0000062824.V376859.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 and 20 People using the service experience good quality outcomes in this area. People’s health care needs are met, although better systems of monitoring changes and risks to them are needed. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: People are mainly independent, and need little support in meeting their personal care needs. Where people need help, the care and support they need, and how this should be provided in order to maintain their independence, is recorded in their care plans. Nobody at the home needs regular support from the district nursing services. However, the home had provided a special mattress for one person in order to keep their skin in good condition, because it was identified that this could be an area of risk to them. Staff had also completed a risk assessment to measure the extent to which the person was at risk. However, it was not signed, dated, nor had it been formally reassessed since being completed. As stated in ‘Individual Needs and Choices’, reviewing risk assessments allows staff to tell at what point the risk to the person had changed, and whether more specialist advice and support was needed. The person’s care plan should Lifestyles DS0000062824.V376859.R01.S.doc Version 5.2 Page 16 also say what staff should look out for when monitoring and reviewing this area of the person’s care. A requirement has been made about this. People attend health appointments, with support if required. Where required, regular support by professionals such as the Community Psychiatric Nurse is maintained, so that people’s mental health can be monitored carefully. Two professionals had congratulated Lifestyles, and the staff there, for the good care they had provided for a person they support. One person living there said ‘Staff are one hundred percent’, and that they get the ‘best care’. Some people look after their own medication. We were told that locked facilities have been provided in people’s rooms to keep it safely stored. These people had signed a ‘consent to self medicate’ form, but they did not have a completed risk assessment to check that this arrangement remained safe for, and acceptable to, the person. Although the manager said she receives the medication on behalf of the person, and checks each week that the medication has all been taken. A formal system for measuring risk must be introduced, and information kept on the care plan about current medication must be kept up to date. This information may be needed in an emergency situation, if the person was unable to give accurate information themselves. Some medication, such as injections, is obtained and given by health professionals at the person’s doctor’s surgery. The manager said that a record of when this medication has been given is recorded in the person’s daily records. However, there should be a full list of the person’s prescribed medication, and when it is due, kept in their care plan. This will make this information easy to access when professionals need it in a hurry, such as a doctor who may not know the individual. Staff look after medication for a small number of people at the service. The records staff keep were signed and up to date, and the stock levels balanced, which suggests that they receive their medication as prescribed. Staff have received training in the safe handling of medication. This is good practice, because it means that only suitably qualified staff hold this responsibility. The home does not have a separate dedicated fridge for the storage of medicines which need to be kept cool, although there is not a constant need for this facility, because it is not often prescribed. However, we were told that when it is, this medication is stored in the kitchen fridge. The registered provider intends to obtain a separate secure fridge so that this medication can be stored safely and securely in the future. The staff need to make sure that, when in use, the temperature of this fridge is monitored, to make sure the medication is stored correctly. Staff need to keep a record of what, if any, medication has been returned to the pharmacy. This is so that they have a clear record of what medication has left the home, and when. Lifestyles DS0000062824.V376859.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 People using the service experience good quality outcomes in this area. People’s complaints are listened to, and staff take people’s concerns seriously, and take action. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Everyone who returned their surveys agreed that they know who to speak to if they are not happy, and they know how to complain. Nine out of ten said that the manager and staff ‘always’ treat them well, and ‘always’ listen and act on what they say. People on the day of the site visit said the manager and the registered provider are approachable, and that they can talk to them if they have any concerns. The manager said that as well as operating an ‘open door’ policy, there are daily meetings where everyone talks about what is happening at the home. The complaints procedure is included in the Statement of Purpose, which is displayed in the hallway of the home. However, we were told that people do not get a written copy of this procedure, because it is not included in the service user’s guide. The manager has agreed to make sure that this information is available in writing to people, so people know about the different ways in which they can complain if they are not happy with the service they are receiving. There have been no formal complaints made to the home in the last year. Neither have there been any complaints made direct to the commission, or to its predecessor, the Commission for Social Care Inspection. Lifestyles DS0000062824.V376859.R01.S.doc Version 5.2 Page 18 Staff have received training to help them understand about abuse, and what to do if they suspect, witness, or are told about a situation where a person living at Lifestyles may have been abused. Staff who returned their surveys all said that they knew what to do if someone had concerns about the service. Those spoken to on the day knew that they cannot keep secrets should anyone disclose information to them of this sort. They also knew that the local authority lead on investigations into abuse, and that they could go direct to them to report their concerns if for any reason they did not want to report to the management. This helps to protect people. Whilst the management have demonstrated in the past that they take such matters seriously, and that they also know who to report their concerns to, the abuse policy at the home suggests that the management would investigate incidents brought to their attention. This does not support the safeguarding policies of the local authority. The manager arranged to get a copy of the multi agency policy on the day of the site visit, and will then amend the policy at the home so that it is correct. This will save confusion for staff who may refer to it should an incident arise which they have to deal with, and will help to ensure that the right people are informed quickly. Lifestyles DS0000062824.V376859.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 People using the service experience adequate quality outcomes in this area. Whilst improvements have been made to the environment, more work is needed to make all areas a clean, safe and pleasant place for people to enjoy. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The home is situated within approximately fifteen minutes walking distance from the centre of York. There is a bus service which runs regularly from near to the service, into the town centre. There is a patio area to the rear of the house, and an undercover smoking area. People were seen to congregate here, as well as the communal areas. The laundry is also situated off the patio. The majority of people do their own laundry. There was a washing machine with a sluice facility, and a drier for their use. Accommodation is provided on three floors. There are also two ‘flats’, attached to the service, where people who are more independent live. People living at Lifestyles are responsible for keeping the home clean and tidy. Seven people Lifestyles DS0000062824.V376859.R01.S.doc Version 5.2 Page 20 who returned their survey said the home was ‘always’ fresh and clean. The majority of areas were kept up to a good standard of cleanliness, although three of the bathroom/toilets identified on the day of the site visit were not clean enough, and two did not have anything for people to dry their hands on after washing them. The bathroom leading to the flats was in a poor state of repair, as was the corridor where it was situated. The manager explained that work was planned to improve this area, although gave her assurance that the bathroom would be refurbished before the end of this year. This would make it much more pleasant for people to use, and easier to keep clean, thus reducing the risk from cross infection. The registered provider has told us since the site visit that she is now obtaining quotes in order to get the work done. Until then, it must be maintained in a suitable state so that it does not pose risk to the people who use it. The manager told us she has a budget which she uses for ongoing redecoration and refurbishment of the premises, and areas of the home have already been redecorated. The dining room had just been painted, and new furniture supplied. This provided a pleasant area for people to enjoy their meals together. There have also been improvements made to the kitchen area. Fridges and freezers in the kitchen have been replaced with new ones. One small area of the tiling needed some attention so that it could be kept clean more easily. The manager agreed to get this done. The environmental health officer last visited in 2006, when the home was awarded two stars ‘fair’ following the inspection of the kitchen area. Since then, when their report stated ‘excellent cleanliness noted’, there has been a new floor laid, so that it is easier to keep clean. The fire officer has not visited since February 2007, when they reported that the arrangements at the home were ‘satisfactory’. They made some recommendations, including the fitting of fire doors throughout the home. Since then, exit from the home has been made easier in the case of fire, because the ground floor front doors have been fitted with devices which do not require a key to unlock them. And the internal fire doors have been replaced on the ground floor. We were told that the remaining fire doors will be fitted by October of this year. People said they like their home, and that they find it comfortable. Their bedroom is private to them, and they have a key, so it can be kept locked when they do not want others to enter. One person said the home provided ‘very nice board and lodgings’. Lifestyles DS0000062824.V376859.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience adequate quality outcomes in this area. Staff now get good training to help them understand their role. But the recruitment process needs to improve to ensure that people are protected from unsuitable workers. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: There have been very good improvements made to the training that staff get, since requirements were made at the last inspection. A staff member said ‘I have been on several training courses and my manager keeps me up to date with other things’. Staff have received a range of training that they are required to undertake by law, as well as attending courses which help them understand the needs of the people they support. This includes mental health foundation training, provided by the hospital, understanding challenging behaviour, the Mental Capacity Act, and understanding about people with learning difficulties. The manager has designed a matrix to show what training staff have completed. It would be better if the date at which the training was actually completed, or is next due, was included on the matrix. This would help to make sure that future training updates do not fall behind. Lifestyles DS0000062824.V376859.R01.S.doc Version 5.2 Page 22 New staff undergo a full induction. Four out of five staff agreed that this covered everything they needed to know ‘very well’. The fifth said that this was ‘mostly the case’. This induction includes specific reference to mental health and learning disability standards. Staff agreed that they are supervised regularly, and records are kept to show what has been discussed. This is good practice, because having records to refer to keeps future supervision focussed upon the individual’s training needs, every day practice, and where improvements could be made. Some staff have now been enrolled on, or are completing, National Vocational Qualifications in Care. This award promotes good, consistent practice in relation to current minimum standards. All staff told us in their surveys that the right employment checks were carried out before they were allowed to work at the home. And from discussion with a staff member at the site visit, it could be confirmed that the recruitment process followed when she was employed was thorough. However, we looked at the files of two recently recruited staff. They had been allowed to work with people before their references or police check had been returned, and there was no evidence as to whether or when the manager had received confirmation (called a POVAFirst check) that they had not been barred from providing care. The registered provider has since told us that the POVAFirst check had been obtained by her, but not placed on these staff files. She said that staff were supervised until the full police check was returned. However, it is still the case the written references were not obtained at the point they were deployed. Although she believed that verbal references may have been obtained from the administrator, this practice is not robust enough, and does not protect people from unsuitable workers. There are two staff available at all times, twenty four hours a day. During the night, one of these staff sleeps on the premises, and is available if needed. It was difficult to see from the staff rota who provided the sleeping cover. This needs to be recorded clearly, so that the records show who has worked, and when. There is an overlap of staff for one and a half hours each afternoon which allows them time to accompany people out. However, the manager gave assurance that should extra cover be needed to allow health appointments or social activities to go ahead, then additional staff would be provided. The two staff spoken with thought that there were always enough staff available. Staff surveyed said that this was ‘always’ or ‘usually’ the case. One person living at Lifestyles commented that the staff are ‘irreplaceable’ Lifestyles DS0000062824.V376859.R01.S.doc Version 5.2 Page 23 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. The management have demonstrated that they will take action where shortfalls in the running of the home, identified by them or others, and which may affect the wellbeing of the people living there, are identified. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The manager has held this position for fifteen months. However, she has worked in this sort of care for a number of years, so has built up experience of working with the people who live at Lifestyles. She thought that she could not apply to the commission to become registered manager until she had completed a relevant management award. This is not correct. She now needs to apply. This will give people assurance that she has been assessed by the commission as being a suitable person to manage the home. She told us that she has just completed her management award, and awaits confirmation that she has been successful. Lifestyles DS0000062824.V376859.R01.S.doc Version 5.2 Page 24 Staff spoke positively about her input. One said ‘The good thing about (the manager) is that you know where you stand’. Another said that the manager ‘doesn’t miss a trick’ and that she will take time to explain when things in relation to their work ‘haven’t been done right’. We were told by staff that they have regular staff meetings. Staff have the opportunity to add to the agenda for discussion before the meeting, and minutes from the meeting are produced so that those who cannot attend, can see what was discussed. This helps to aid good communication. The manager confirmed that she gets good support from the registered provider to help her in her role. The registered provider is at the home regularly. As well as this, she undertakes a formal assessment of the service every month, and provides a written report to show what she has done as part of her visit. This will help to maintain good standards for the people who live there, who knew her well. When we asked people what the service does well, we received comments like ‘Julie and Ivor (the registered providers) are wonderful people. They do a wonderful job – so does (the manager)’, ‘Whatever you want, they will sort it out for you. This is the best house I’ve lived in’, ‘Everything’, ‘Support me, keep me on the straight and narrow, cook good food, choice of activities, going on good holiday’, ‘The staff does an excellent job in the care home looking after me’, ‘I would not want to live anywhere else as this is the only home that I know and love’. The home gives the people who live there surveys to complete, anonymously if they wish, so they have the opportunity to write down what the home does well, and where it could improve. These had not been sent to relatives or to health professionals, who may also welcome the opportunity to pass on their views. The manager agreed, and will carry this out. Analysing this collective information is a good way of identifying trends, and can be used when making changes based on people’s views. This should be done, and the results published, so people can be assured that the information they have provided is being used effectively when making changes at Lifestyles. The information received from the manager and registered provider before the site visit identified that the home is kept maintained. Testing of portable appliances had been overlooked, but the registered provider arranged for this to be done when it was brought to her attention on the day. The fire alarm is checked regularly, and staff and people living at Lifestyles are involved in regular fire drills. This keeps people refreshed about what to do in the case of fire. Fire training was due to take place the week following the site visit. The registered provider has told us that the people who live at Lifestyles will also be involved in this training, so they too know what to do in the event of a fire. Lifestyles DS0000062824.V376859.R01.S.doc Version 5.2 Page 25 Staff have completed training in first aid, infection control and food hygiene. Moving and handling training has not been provided as we were told that staff do not undertake any moving and handling activities. Hot water temperatures accessible to people are not regularly checked. The exact date when the last check was completed was not recorded. Only baths and showers, where people would be fully immersed, have the temperature regulated with special valves. One of these recorded bath temperatures was rather cool, and may have beeen unpleasant for people to bathe in. The manager was confident that people are independent, and that they were not at risk from scalds, although the temperature of some hot water outlets were way above that which is recommended. People have risk assessments in place to check they know they should put hot water in their sink before cold, but the manager agreed that within forty eight hours from the date of the site visit she would: • • Check straight away all hot water temperatures accessible to people. Complete a risk assessment for everyone where the temperature proved to be above normal acceptable limits, so that there is a formal check in place for each individual. This must be reviewed regularly. Put safety measures in place to protect people from scalds where the assessment concludes that the temperature is too hot for people. • As well as this, the hot water temperatures must be checked periodically, to make sure that the valves where fitted have not failed, and continue to mix the water to a suitable temperature. However, the registered provider has told us since the site visit that a plumber was organised to visit straight away. They will be making improvements to the system. She has confirmed that the action required by the manager will be carried out. Lifestyles DS0000062824.V376859.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 X 33 X 34 1 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 X 3 X X 2 X Version 5.2 Page 27 Lifestyles DS0000062824.V376859.R01.S.doc Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA6 Regulation 13 and 15 Requirement Timescale for action 30/09/09 2 YA17 13 3 YA20 13 4 YA30 13 People’s care plans must be kept up to date, signed, dated and regularly reviewed to reflect current risks identified by the home’s staff and other professionals. This is so staff and the person to whom the plan belongs have clear information about how these risks are to be managed, and what action will be taken if issues or problems arise for the individual. The person identified at the site 31/08/09 visit should be referred to the dietician if it transpires that they have not maintained the weight that they previously gained when under the dietician’s care. People who want to self 31/08/09 medicate must first have a risk assessment completed to check that they are safe and able to do so. This must be regularly reviewed, to check that the person remains willing and capable of doing so. Bathroom areas must be kept 31/07/09 clean and maintained to a satisfactory standard, and suitable hand washing facilities DS0000062824.V376859.R01.S.doc Version 5.2 Lifestyles Page 28 5 YA34 19 provided, so the risk from cross infection is kept to a minimum. Thorough recruitment checks 28/07/09 must be carried out before staff are allowed to work at the home. This includes: A Criminal Records Bureau check, or in extreme circumstances where staff need to be employed quickly, a POVAFirst check, when the staff member must be supervised at all times, and written evidence of how this is being achieved kept. Two satisfactory written references, one from their current employer, to check why they are leaving. This action will help to protect people from potential unsuitable workers. The following action must be taken to reduce the risk to people from scalds: Check straight away all hot water temperatures accessible to people. Complete a risk assessment for everyone where the temperature proved to be above normal acceptable limits, so that there is a formal check in place for each individual. This must be reviewed regularly. Put safety measures in place to protect people from scalds where the assessment concludes that the temperature is too hot for 6 YA42 13 10/08/09 Lifestyles DS0000062824.V376859.R01.S.doc Version 5.2 Page 29 people. Check and record hot water temperatures accessible to people periodically, to make sure that the valves where fitted have not failed, and continue to mix the water to a suitable temperature. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA20 Good Practice Recommendations A full list of medication prescribed for and administered to people living at Lifestyles should always be readily available in their care plan so it can be passed on quickly in emergency situations. This includes people who manage their own medication. A record should be kept to evidence what medication has been returned to the pharmacy each week. This so that it can be seen what medication belonging to the people living at Lifestyles has been disposed of on their behalf, and by whom. People should be given written details about how to complain when they move in, so that they have this information to hand to use in the future if they need to. The abuse policy should be amended to reflect the role of the local authority. This will save confusion for staff who may need to refer to this policy in an emergency, so that they take the agreed action when protecting people from further harm. The registered provider should pursue plans to refurbish the bathroom nearest ‘the flats’, so that it provides pleasant and safe surroundings for the people who use it. The manager should apply by 30 September 2009 to the Care Quality Commission to become registered manager of Lifestyles, so people can be assured that she has been assessed as being a fit person to carry out the DS0000062824.V376859.R01.S.doc Version 5.2 Page 30 2 3 YA22 YA23 4 5 YA30 YA37 Lifestyles 6 YA39 management duties expected of her. Surveys should be sent to relatives and professionals with an interest in the home, as well as to the people who live there. The collective information should be used to decide what the service does well, and where improvements need to be made. This way, people will be certain that the home is run in according to their views and wishes. Lifestyles DS0000062824.V376859.R01.S.doc Version 5.2 Page 31 Care Quality Commission Yorkshire & Humberside Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries.yorkshirehumberside@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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