Care Home: Lifestyles Care Home

What the care home does well People are helped by carers who understand their needs well and support them in an individualised manner. They are treated respectfully and consulted as much as possible about what they want to do and when they want to do it. One relative commented that `residents are well looked after in all different ways`. And a health care professional commented that `staff seem to care`. Mediation systems at the home are robust and good checks are carried out regularly to ensure that people`s drugs are stored, administered and disposed of properly. Staff are well trained and feel well supported so that they recognise and understand what good care is, and how it can be provided. A relative commented that `the staff are very compassionate and caring`. A new manager now works at the home and he has implemented a lot of changes at the home, including improving the environment, so it is a nicer place for people to live. This work is still ongoing. One person living at the home said in their survey that `it`s a lot better`. And a relative commented. `The new manager has made a significant impact on the home and should be congratulated for his efforts`. What has improved since the last inspection? A new manager is in post who has had the support of the owners to make changes to improve the home. This includes redecorating and refurbishing the home both indoor and outdoor space which is still ongoing. Information about the facilities and services provided at the home have been reviewed and updated and are made available for people to read so that people and their families can make a more informed choice as to whether they want to live there. The owner now makes an unannounced visit to the home each month so that he can carry out his own checks that the home is running well. He writes a report and these are kept at the home, so the manager and the owner can check that issues identified on these visits are being sorted out properly. Fire safety checks are now more robust. A visit from a fire safety officer required some improvements to be made, which were addressed in a timely way. Good fire safety systems help to keep people safe. The manager is trying to forge links with the local community, so that local people know more about the service and people can become more involved in local events. This will help people to live more interesting and fulfilling lives. What the care home could do better: All people expressing an interest in moving to the home could be assessed to find out what sort of care and support they need. This helps to confirm that the staff at the home are able to meet those needs and would help to prevent someone being admitted, then having to move to a different care setting because the home cannot meet their needs.More care staff could be made available to help people at mealtimes, so that the event is an unhurried social occasion. All staff working at the home could be made aware of the local authority`s contact details and how they can contact the local authority directly, about an incident where someone may have been mistreated, if they feel unable to approach a senior person from the organisation. Having as much information as possible about safeguarding people contributes to keeping people safe. Sufficient information could be gathered so that the manager is satisfied that a potential carer is suitable to work at the home. Good records could help to evidence that discussions about an individual`s suitability have taken place. These systems will help to keep people safe. The manager could apply to be registered with the commission. Being registered helps to demonstrate that a manager is fit to manage a care service. More formal ways of gaining the views of people who live there, their families or representatives and professionals who visit the home could be implemented. Acting on comments obtained from these people would show that these people are influencing how the home operates. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Lifestyles Care Home Weeland Road Eggborough Goole North Humberside DN14 0RX     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: Jean Dobbin     Date: 1 5 0 6 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: Lifestyles Care Home Weeland Road Eggborough Goole North Humberside DN14 0RX 01977661492 F/P01977661492 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Lifestyles Care (Yorkshire) Limited care home 20 Number of places (if applicable): Under 65 Over 65 0 physical disability Additional conditions: Date of last inspection Brief description of the care home 20 Lifestyles Care Home was last inspected on 10 July 2008. At that time it was called Lifestyles Care Centre, but the name has been changed earlier this year at the owners request. Lifestyles Care Home was originally a hotel, which has been converted into a care home. It offers permanent and respite nursing care for up to 20 adults, both male and female, with disabilities. The home is situated in Eggborough, a village 7 miles from Selby. Within quarter of a mile are a pub and some small local shops. The building is on two levels but people are currently accommodated on the ground floor only. There is ample parking at the front of the house and a secure patio area provides some safe, outdoor space. Details provided on 15 June 2009 outline the weekly fees as from 520 pounds according to individual assessments and extra funding provided for meeting healthcare needs. This does not include hairdressing, chiropody services, complimentary therapies Care Homes for Adults (18-65 years) Page 4 of 31 Brief description of the care home including physiotherapy, and activities away from the home. A Statement of Purpose and service user guide, which describe the services and facilities that the home provides is displayed in the entrance area. The latest inspection report written by the Commission for Social Care Inspection, as the predecessor of the Care Quality Commission is also made available in the entrance area for people to read. 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 is what was used to write this report. Information about the home kept by the Care Quality Commission. Information asked for, before the inspection, which the manager provides. This is called an Annual Quality Assurance Assessment or AQAA. Information from surveys, which were sent to people who live at Lifestyles Care Home, to staff and to other professional people who visit the home. 6 were sent to people at the home, and 2 were returned. 6 surveys were made available for peoples family members or representatives to complete and all were completed and returned. 4 were Care Homes for Adults (18-65 years) Page 6 of 31 sent to health care and social care professionals and 2 were completed and returned. 5 were sent to staff at the home and all were returned A visit to the home by one inspector, which lasted about six hours from 9 until 3pm. This visit included talking to people who live there, and to staff and the manager about their work and training they had completed. It also included checking some of the records, policies and procedures that the home has to keep. Some time was also spent watching the general activity and the way staff interacted with people to get an idea about what it is like to live at Lifestyle Care Home. Information about what was found during the inspection was given to the general manager at the end of the visit. We have reviewed our practise when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations - but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. What the care home does well: What has improved since the last inspection? What they could do better: All people expressing an interest in moving to the home could be assessed to find out what sort of care and support they need. This helps to confirm that the staff at the home are able to meet those needs and would help to prevent someone being admitted, then having to move to a different care setting because the home cannot meet their needs. Care Homes for Adults (18-65 years) Page 8 of 31 More care staff could be made available to help people at mealtimes, so that the event is an unhurried social occasion. All staff working at the home could be made aware of the local authoritys contact details and how they can contact the local authority directly, about an incident where someone may have been mistreated, if they feel unable to approach a senior person from the organisation. Having as much information as possible about safeguarding people contributes to keeping people safe. Sufficient information could be gathered so that the manager is satisfied that a potential carer is suitable to work at the home. Good records could help to evidence that discussions about an individuals suitability have taken place. These systems will help to keep people safe. The manager could apply to be registered with the commission. Being registered helps to demonstrate that a manager is fit to manage a care service. More formal ways of gaining the views of people who live there, their families or representatives and professionals who visit the home could be implemented. Acting on comments obtained from these people would show that these people are influencing how the home operates. 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 9 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 10 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The lack of admissions to the home means that the manager is unable to demonstrate that people are assessed properly to make sure their needs can be met. Evidence: All the people currently living at Lifestyles have lived there for a number of years. The sampled care records showed that an assessment of their needs had been made before they moved to the home. There has been one admission in the last year, but this person no longer lives at the home. The individual was admitted at short notice and had already stayed at the home before. The manager though confirmed that because of their particular circumstances the admission was arranged following a discussion with their family and an assessment of the persons care needs was not made until they moved to the home. The manager is aware that a pre-admission assessment is necessary so that an individuals total needs can be looked into, to check that the home has the facilities Care Homes for Adults (18-65 years) Page 11 of 31 Evidence: and staff have the skills to provide this care. This assessment also needs to include gathering information from other professionals who have been involved in the individuals care. A good pre-admission assessment can help to prevent people making the wrong choices and perhaps having to move again to a different care service. The home has a comprehensive brochure which is given to people thinking of moving there. The Statement of Purpose and service user guide are displayed in the entrance area and these give information about the facilities and services that the home provides. Both have been reviewed and updated earlier this year and can be printed out in a large print format, to make them easier to read. Care Homes for Adults (18-65 years) Page 12 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. People are given information and support to enable them, as far as possible, to live their lives in the way they choose. Evidence: Each person has a service plan which describes the care and support they need, as well as their interests, their social history and what they would like to achieve. This documentation has been changed recently, so it is not possible to check whether these records are amended as peoples needs change. Or whether they will be reviewed each month, to check they are still appropriate. The last inspection a year ago though, showed that peoples records were well maintained and reviewed each month and the individual or family member put their signature to them, wherever possible, to say they agreed with what was written. Care staff spoken with knew peoples needs well and what individual behaviours and Care Homes for Adults (18-65 years) Page 13 of 31 Evidence: gestures may signify. They were observed consulting with people about little everyday choices. Peoples records stated what individual mannerisms may mean, as well as describing what mattered to individuals, like always wearing perfume and where different items of clothing were to be stored in their wardrobe. This sort of detail is good practise to help to make sure peoples wishes are always respected. They also help to recognise that people are individuals, with very differing needs. There are detailed individualised risk assessments, which enable people to live as normal a life as possible. People are supported whenever possible to make decisions about what they do and when they do it. Breakfast is provided at a time that suits individuals and one persons decision to stay in their room practically all the time is respected. Care Homes for Adults (18-65 years) Page 14 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. People are supported to make their lives more interesting and fulfilling though the mealtime is not always a relaxing social event. Evidence: The way the home runs allows the people living there to say what help they need and when. There is no pressure on people to get up by a set time, or indeed to accept daily care if they dont want it. However because the staff know people very well they also know what aspects of a persons day to day routines are important to them. Peoples interests and hobbies are recorded, but because the documents are new there is no clear record of anything that may have happened earlier in the year. Care staff help people to achieve their goals and the manager says they have allocated time in the duty rota to spend with people on one-to-one activities. Care Homes for Adults (18-65 years) Page 15 of 31 Evidence: The home has a minibus and the manager says people are encouraged to go to the shop, whether in the village or the local town, to buy their own personal items themselves, with the help of a carer. Two relatives commented in their survey responses that they wished the people living there could get out in the community more and do things away from the home. Nobody currently living at the home is able to undertake any employment, but the manager is aware of the need to support people to find work,if appropriate. The home has a sensory room, which is well used. Complementary therapies are also provided for a small charge and a hairdresser visits regularly. Care staff were observed sitting and talking with the people living there. They listened to peoples responses, even when people couldnt communicate very easily. One person was sitting with one individual looking at the daily paper, which gets delivered to the home each day. Another person has their own newspaper delivered. The manager has forged links with the local community to try to integrate the home more with events that are happening locally. The local vicar visits monthly to provide a religious service and on the day of the visit the local policeman called into the home. Peoples family and friends can visit anytime. One persons records identified the importance of one individual having private time with their spouse and a carer spoken with stressed the importance of promoting this private time. There is a four week menu cycle. Whilst people are not offered a formal choice each day, which would be good practise, the records show that people have alternatives to the main menu. Staff know peoples dietary likes and dislikes very well and this guides them when offering meal choices. Practically all the meals on the menus though are traditional English fare and the manager needs to be satisfied that people would not like meals such as Italian or Chinese options. The dining room has been refurbished and redecorated in the last year. it is a bright and airy place in which to eat. People can choose whether to eat there, or in another part of the home. Various aids are used to promote peoples independence when eating. The mealtime experience on the day of the visit was not very positive. Two of the four people having lunch in the dining room could manage independently. The remaining two required assistance and one carer was providing that help, although the individuals were sitting at different tables. This way of working did not promote the meal as an unhurried social event. The manager stated that mealtimes are generally a Care Homes for Adults (18-65 years) Page 16 of 31 Evidence: more relaxed event however he needs to carry out his own checks to ensure that this is always the case. There is currently no cook working at the home, though the manager is hoping to recruit one very soon. 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. Peoples health and personal care needs are well met and medication systems are robust. Evidence: Staff know peoples individual needs very well and are able to work out what people may want, even when they are unable to speak. Staff were observed speaking with people in a gentle respectful manner and they used touch and non verbal communication, like smiling and nodding to help with communication. One carer commented that it was important to offer choices to people and always ask permission before helping people with their personal care, even if they could not easily respond. Both male and female care staff work at the home so that peoples preferences about who they receive care from can generally be respected. Care staff spoken with were aware of these preferences and explained how the allocation of work each day took these preferences into account. Care Homes for Adults (18-65 years) Page 18 of 31 Evidence: The personal care records are written in a way that promotes peoples independence and control. For example one record said that an individual is only able to shave one side of their face, then care staff should complete the other side. The care records also provide good detail of peoples health care needs and an unfamiliar carer could be guided about what they needed to do, by reading these records. For example they explain exactly how an individual is to be moved with special equipment. And how another person, who relies on the care staff to give them all their food and drink each day, needs extra fluids when the weather is warm. This information is clearly described, so that the individual will receive the same support, regardless of who is providing it. The home has a range of specialist equipment and they have good links with outside health care professionals like specialist nurses, dietitian and occupational therapist. A visiting health care professional stated that they felt that referrals to them had been appropriate and the staff at the home responds appropriately to their requests. One survey response commented that the staff at the home always respond speedily to my relatives needs and keeps me informed if they have to go to hospital. Medication systems at the home are generally good, though one shortfall in the record keeping was noted in the last twenty four hours. The manager said this would be addressed with the individual nurse involved. Records are otherwise well kept and the home has good systems in place to make sure the storage, administration and recording of drugs is well maintained. Whilst the nurse on duty said that equipment needed to manage the safe disposal of some drugs is to be obtained from the pharmacist on an as and when basis, this information needs to be included into the medications policy so that all staff work in a consistent manner. The manager said he would do this. 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. Peoples concerns and welfare are taken seriously, and whilst the right action is taken where necessary to keep them safe from abuse, the policy underpinning that action needs amending to help ensure the right action is always taken. Evidence: Neither the home nor the commission have received any complaints since the last inspection a year ago. The homes complaints policy is included in information available in the entrance area for people for people to look at. Two surveys completed by people living there both state that they know how to complain and can speak with someone informally if they are unhappy about something. Comments in the surveys completed by representatives of the people living there also state that they too know how to complain. Five of these six surveys state the home always responds appropriately to any comments or concerns raised, with the sixth saying this is usually the case. Staff have attended training in safeguarding people since the last inspection and the manager is sourcing refresher training for this year. One carer spoken with was very clear about different types of abuse and how changes in peoples behaviours may indicate that something untoward has happened, particularly if these responses were always towards a particular person. They said they would inform the managers of the Care Homes for Adults (18-65 years) Page 20 of 31 Evidence: home, but were unaware of the local authority number. All staff should know that they can contact the local authority directly if they feel unable to speak with a senior person from within the organisation. One member of staff though said they would telephone the local authority number immediately if they suspected people had been put at risk of harm. And these contact details are displayed in one of the offices. The homes abuse policy though states that any allegation of misconduct will be fully and openly investigated by the organisation. This is not in line with local authority and national guidelines, which states that the local authority is given the responsibility to investigate any allegation of abuse. The manager needs to amend the homes policy so that it is in line both with these guidelines and with the responses of the staff spoken with. Recruitment processes are generally satisfactory, with proper checks being carried out on the persons suitability to work in a care setting, before they are offered a position at the home. The manager though needs to ensure his record-keeping is robust to demonstrate that he is carrying out these checks properly and so that he has enough information about an applicants suitability to work in a care setting. One persons personal money records were looked at and found to be robust, with receipts to account for all money spent. A new safe has been installed at the home and advice has been sought from crime prevention officers to check whether safety precautions in place at the home are adequate. The owners are still the appointee for one person who has lived at the home for many years. 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. The improved decor has made the home a nicer, fresher place for people to live. Evidence: Lifestyles Care Home is built over two floors, but all the services and rooms currently in use, apart from the treatment room are on the ground floor. There have been a lot of changes to the environment in the past year and this work is still ongoing. The large lounge, dining room and entrance area have been decorated and refurbished. A sensory room has been relocated within the home so that people using that room can benefit more from the different experiences. A small quiet lounge and a conservatory also provide choices for people living there. Two courtyards have also been refurbished to improve the outside sitting areas for people. All the private rooms are being refurbished and redecorated and about half of this work has been completed. These are all single rooms, which have wash hand basins only. The rooms already occupied have not been refurbished yet. Those looked at contained individual, personal items, to make the rooms as homely as possible. The home is clean, warm and comfortable, with generally no unpleasant smells. One Care Homes for Adults (18-65 years) Page 22 of 31 Evidence: area of the home receives extra attention to make sure it remains that way. The rooms are spacious to allow people to move around more easily and one bathroom has a ceiling tracking system to make transfers smoother. The fire safety officer visited the home very recently and some requirements from their visit were still outstanding. The manager contacted us in the days following the visit to confirm that the work had been done. Staff were observed wearing protective equipment when carrying out care. This way of working helps to keep people safe. 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. People are cared for by enough staff, who get training so they know what good care is and how it should be provided. Evidence: The rota confirms that there is a trained nurse on duty all the time. There are also two carers on the early shift, one on the late shift and two at night. The higher number through the night is so that one person living there has extra care and support. These numbers are for six people living there. Agency staff have not been used at the home for several months, with staff working extra shifts to cover sickness and holidays. There is also a part time administrator, and part time housekeeper. The laundry is managed by the care team. There is currently a vacancy for a cook, who works until three oclock, and who prepares the evening meal before they finish work. This means that a carer has to work in the kitchen each afternoon. The manager needs to be satisfied that peoples care needs can still be promptly met whilst one member of staff is working in the kitchen. According to the staff rota some people are working more than forty eight hours a Care Homes for Adults (18-65 years) Page 24 of 31 Evidence: week and the manager again must be satisfied that staff are not too tired to do their work properly. Staff spoken with said they were supported to attend training and also to learn more about the specific needs of people living there. Staff spoken with knew about peoples individual needs and what mattered to those individuals. All staff have achieved or are studying for a National Vocational Qualification Level 2 in Care. This nationally recognised qualification helps carers to recognise what good care is. The staff surveys said that they regularly meet with the manager to discuss how they are working. Staff have also attended or are due to attend refresher training like fire safety, moving and handling and food hygiene, to ensure they provide safe and consistent care. They are also attending training in dementia awareness and palliative care so that care practise at the home can be up to date and staff have a good understanding of their roles. The manager keeps a training programme so that he can plan and organise training well in advance and check that peoples refresher training is completed in a timely way. Comments from relatives include. The staff are excellent. Very friendly and caring. And the staff are very compassionate and caring. One staff recruitment file was looked at as part of the inspection. Whilst checks had been completed before the person started working at the home, both references were character references only. The manager said that he was chasing up a professional reference. And the manager needs to be able to show that any issues, identified as part of the recruitment process have been discussed with the individual, to confirm that he is satisfied that an individual is still suitable to work at the home. All these systems are in place to help to keep people safe. The rota and staff surveys confirm that new staff attend an induction programme when they start working at the home. This helps to ensure new staff receive a consistent level of training about their role and the homes policies and procedures that they have to follow. 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 live in a home run by a competent, enthusiastic manager who has their best interests in mind. Evidence: A new manager has been recruited in the last year, who is a trained nurse and has worked in the social care setting for several years. He tells us he plans to apply to be registered with the Care Quality Commission, which he should do as soon as possible, as this will help to confirm his fitness to run a care home. He has introduced many changes since he became manager. One member of staff commented that things are much better now. We feel better supported. And he works on the floor as well so he understands peoples needs. One relative commented The new manager has made a significant impact on the home and should be congratulated for his efforts. Another said. It is a nice homely place that is being improved for the better. Care Homes for Adults (18-65 years) Page 26 of 31 Evidence: The home also won an award earlier this year from a trade magazine in recognition of the improvements which have been made there. Staff working at the care home know people well and how people who cannot voice their views may behave if they dont like something. The manager has introduced a newsletter sent out every four months, to inform relatives and other interested parties about what is happening at the home. However he needs to look at how he can get peoples views about how the home currently operates, so that they are able to influence how the home runs. This also includes professionals who visit the home. This information can then be looked at and an action plan produced. Telling people what changes are to be made as a result of their comments will help to show that these views are being listened to. A senior manager now carries out unannounced visits to the home to monitor and record how the home is running. A record of these visits is now kept at the home. This helps to check that the home is running properly and was a requirement made at the last inspection. A sample of health and safety records were looked at as part of the inspection and these were found to be up to date. Staff are supported to attend refresher training so that they can work and support people in a safe and consistent manner. Fire safety systems are checked regularly, hazardous substances are stored correctly and hot water temperature monitoring is carried out to help to assure the safety of the people living there. 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 2 14 People thinking of moving to 31/08/2009 the home must be assessed by a suitably qualified person before a decision about moving there is made. This is so that they can be confident that the home has the facilities and staff have the skills to meet those needs. 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 17 There should be enough care staff available at mealtimes to ensure that the meal is always relaxed and unhurried and an enjoyable social event. All staff should be reminded about the role of the local authority, who they can go to directly if they do not wish to raise their concerns about a potential abusive situation, with more senior staff within the organisation. Every effort should be made to ensure full and satisfactory information about an applicants employment history is obtained, so that the manager can be as certain as possible Page 29 of 31 2 23 3 34 Care Homes for Adults (18-65 years) that the individual is suitable to work in a care setting. Records relating to discussions about an applicants suitability should be recorded to help to show that the discussions took place. 4 37 The general manager should submit an application to be registered with the Care Quality Commission, to confirm his fitness to manage a care home. A quality assurance system should be implemented, where people with an interest in how the home operates are consulted, so that they can say what changes they would like to see, to improve how the home runs. 5 39 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. 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