Care Home: Lime Lodge

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What the care home does well People who want to move to the service will have their needs assessed before moving in so staff know how to support them. Care plans are written in a person centred way and so show staff how people want to be supported. People are able to live their lives as they choose to.Lime LodgeDS0000073208.V378617.R01.S.docVersion 5.3People live in a well maintained and homely environment and they are able to personalise their bedrooms. What has improved since the last inspection? This is Lime Lodge’s first inspection since its registration on 9th June 2009. What the care home could do better: The manager must ensure that staff receive suitable training in safeguarding adults to ensure that people who live at the home are protected from abuse. The manager must ensure that full and satisfactory information is obtained about staff before they are allowed to work in the home unsupervised. The manager must ensure that suitable references are obtained about staff to show that they suitable to work with vulnerable adults. The manager must obtain all the information listed in schedule 2 of the Care Homes Regulations to ensure that they are suitable o work with vulnerable people. Staff need to receive up to date training to ensure that they have the skills to work with vulnerable people. Confidential information must be stored according to the Data Protection Act 1998. Key inspection report CARE HOME ADULTS 18-65 Lime Lodge 575 Nuthall Road Nottingham NG8 6AD Lead Inspector Susan Lewis Key announced Inspection 9th December 2009 09:00 Lime Lodge DS0000073208.V378617.R01.S.doc Version 5.3 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. Lime Lodge DS0000073208.V378617.R01.S.doc Version 5.3 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 Lime Lodge DS0000073208.V378617.R01.S.doc Version 5.3 Page 3 SERVICE INFORMATION Name of service Lime Lodge Address 575 Nuthall Road Nottingham NG8 6AD 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) 0115 8544866 Susan Jaques Tee McNally Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Lime Lodge DS0000073208.V378617.R01.S.doc Version 5.3 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following categories of service only: Care Home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Learning Disability - Code LD The maximum number of service users who can be accommodated is 6 2. Date of last inspection New service Brief Description of the Service: Lime Lodge is large detached house situated on the corner of Nuthall Road and Lime Tree Avenue. It provides accommodation for 6 people with learning disabilities each bedroom has ensuite facilities. The home is also conveniently situated for public transport, local shops and community facilities. The property has a small enclosed patio area. Fees are dependent on assessed needs. Fees do not include toiletries, newspapers and clothing. Information about the service is available on request. Lime Lodge DS0000073208.V378617.R01.S.doc Version 5.3 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The focus of inspections undertaken by the Care Quality commission (CQC) is upon outcomes for people and their views on the service provided. This process considers the providers capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provision that need further development. One inspector conducted the announced visit. The main method of inspection used was called case tracking which involved selecting people and looking at the quality of the care they receive by speaking to them, observation, reading their records and asking staff about their needs. The manager, members of staff and visitors to the home were spoken with a part of this visit. Documents were read as part of this visit and medication management was inspected to form an opinion about the health and safety of residents at the home. A review of all the information we have received about the home since its registration was considered in planning this visit and this helped decide what areas were looked at. A range of additional information was used to determine the outcome of this visit, including information provided by the registered provider within an Annual Quality Assurance Assessment (AQAA). The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. What the service does well: People who want to move to the service will have their needs assessed before moving in so staff know how to support them. Care plans are written in a person centred way and so show staff how people want to be supported. People are able to live their lives as they choose to. Lime Lodge DS0000073208.V378617.R01.S.doc Version 5.3 Page 6 People live in a well maintained and homely environment and they are able to personalise their bedrooms. What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. Lime Lodge DS0000073208.V378617.R01.S.doc Version 5.3 Page 7 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. Lime Lodge DS0000073208.V378617.R01.S.doc Version 5.3 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 Lime Lodge DS0000073208.V378617.R01.S.doc Version 5.3 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): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Appropriate procedures are in place to fully assess the needs of any person considering moving into the home so that they can be assured the home can meet their needs EVIDENCE: The manager described the admissions procedure this included the person having a trial visit before making a decision to move to the service. During the inspection we saw a person who was currently having a trial visit and staff were seen interacting with them in a positive manner. We looked at the records of one recently admitted people and saw that staff recognised the importance of obtaining sufficient information about them from external professionals involved in their care to make sure that people were properly represented about how they wished to live and be supported in the home. Lime Lodge DS0000073208.V378617.R01.S.doc Version 5.3 Page 10 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): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have an individually appropriate lifestyle determined by assessment, suitable support and consultation with them. EVIDENCE: We looked at the records of one person and saw how they had a key worker and that plans were created in a person centred way. This ensured that staff would be supporting them to be fully involved in deciding how their individual aspirations would be considered and met. People had signed their own plan to show they were involved with them and agreed to them. People living at the home told us that they had been involved in their care plan and were happy it was being followed. Lime Lodge DS0000073208.V378617.R01.S.doc Version 5.3 Page 11 Support staff complete daily records that inform changes to plans and risk assessments to make sure people have any changes in their needs identified and addressed safely. We saw that people were able to make decisions about their lives, what they did each day, what activities they participated in and what social events they attended, key workers recognised that people could take risks as part of their independent lifestyle and assess risks to peoples safety to support them in achieving their goals safely. Lime Lodge DS0000073208.V378617.R01.S.doc Version 5.3 Page 12 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: People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service has a strong commitment to enabling residents to develop or maintain their skills. Individuals are supported to identify their goals, and work to achieve them. EVIDENCE: Care Plans and activity plans we viewed showed evidence of people living in the home being supported to be independent and involved in all areas of daily living in the home including where appropriate taking responsibility for shopping, planning meals and meal preparation. Staff spoken with also talked about external learning opportunities that people could access. People who use the service also spoke abut training opportunities that staff were helping to arrange. Lime Lodge DS0000073208.V378617.R01.S.doc Version 5.3 Page 13 On the day of the inspection people who use the service spoke to us about how they spent their time and how staff supported them to do this. The manager told us that as currently they are not full they do not have residents meetings but she talks to the people individually to find out what they want to do. People who live at the home confirmed that the manager talks to them about what they want to do. Meals are developed by the people who live at the home and on the day of the inspection people who live their. People spoken with said that they can eat what they want and when they want. They choose the menus and go shopping with staff to buy the food. Samples of menus were seen and showed that a varied diet was provided. One person spoken with told us ‘I enjoy cooking my own meals here’. Lime Lodge DS0000073208.V378617.R01.S.doc Version 5.3 Page 14 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): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People receive personal and healthcare support using a person centred and it is responsive to their varied individual needs and preferences. Medication procedures are safe. EVIDENCE: We viewed the care plans of people living in the home and they showed how people liked to spend their days and how much support they needed with their care. Staff spoken with told us Care plans are always up to date and accessible to carers and Staff follow care plans to ensure people get the support they need’. People who use the service told us that they receive the care and support they need in a way they want it and see a doctor if they need to with support from staff. Lime Lodge DS0000073208.V378617.R01.S.doc Version 5.3 Page 15 Staff also told us that they provide support and information in maintaining people’s sexual health, evidence was seen in care plans. We looked at the medication procedures in the home this showed that people receive the medication prescribed for them safely. . Lime Lodge DS0000073208.V378617.R01.S.doc Version 5.3 Page 16 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): People using the 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 service has a complaints procedure that is clearly written and easy to understand. Staff understand the importance of protecting people from abuse. EVIDENCE: There was information about how to make a complaint on display and both people who lived at the home and staff were aware of what the procedure was. People we spoke with said they would speak to the manager or to team leader if they wanted to complain and they felt happy it would be dealt with. The manager told us due to the fact they have only admitted their first service user in October they have not received any complaints yet. However she showed us the complaints file where any received would be recorded. The Commission has not received any complaints about this service since it’s registration in June 2009. The recruitment files of two staff were looked at to form an opinion on recruitment practices within the home. Both files had ISA (Independent Safeguarding Authority Vetting and barring scheme prevents unsuitable people working with children or vulnerable adults); however neither had a full Criminal Records Bureau check. This means staff who do not have full clearance may only work when supervised by Lime Lodge DS0000073208.V378617.R01.S.doc Version 5.3 Page 17 someone with full clearance This was brought to the manager’s attention who made arrangements for all staff without full clearance to work supervised until the Criminal Records Bureau checks were received. The home has the current local safeguarding procedures in place. Staff training files were viewed and these showed that all staff had previously worked in the care profession and had received training in Safeguarding adults at their previous place of work but not in the last two years. This was brought to the manager’s attention who immediately arranged training for all the staff. Evidence was seen that this was arranged. However staff spoken with were able to demonstrate how they would respond to abuse in the home. The spending money and records of people living in the home were examined and they were being managed appropriately and held securely. Lime Lodge DS0000073208.V378617.R01.S.doc Version 5.3 Page 18 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): People using the 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 clean, safe and comfortable environment. EVIDENCE: During the course of the inspection parts of the building were viewed and showed that the home was clean and well maintained. Staff handover notes show that staff are to keep the home clean as part of their duties and the manage monitors this. A selection of bedrooms were viewed and these were clean and pleasant, each having ensuite shower facilities. People who move to the home are encouraged to personalise them, this was seen during the tour. The dining room and lounge were seen and these were bright and the furniture was of good quality and domestic in nature. Lime Lodge DS0000073208.V378617.R01.S.doc Version 5.3 Page 19 People who live at the home told us that they were able to bring their own things in and decorate the room as they wanted. Staff training files were looked at and Infection control training had been last completed in 2006. There is suitable equipment to maintain the infection control procedures. Lime Lodge DS0000073208.V378617.R01.S.doc Version 5.3 Page 20 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. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are not always protected by the home’s recruitment policies and procedures. EVIDENCE: The recruitment files of two staff were looked at to form an opinion on recruitment practices within the home. Concerns raised over the lack of Criminal Records Bureau checks is looked at under Concerns, Complaints and Protection outcome section Although both files had two references one reference on one file showed areas of concern. The manager had not followed this up to show why she had employed the person despite these concerns. Only one file showed any evidence of training certificates and neither file provided suitable identification that included a photograph of the employed person. The manager made immediate arrangements to rectify this situation. Lime Lodge DS0000073208.V378617.R01.S.doc Version 5.3 Page 21 Although training has been arranged the manager has yet to create a training matrix showing what training staff have and what is arranged for the future. Staff spoken with said that they had discussed their training needs with the manager and were looking to attend training in the near future such as National Vocational Qualification level 3 as well as NAPPI training level 2 (Non abusive psychological and physical intervention). People who use the service were asked if they felt if the staff new what they were doing and did they feel safe with them. They told us they did and commented ‘Staff treat me well. They help me when I need help and leave me to get on with things when I can do it myself’. Lime Lodge DS0000073208.V378617.R01.S.doc Version 5.3 Page 22 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. We have made this judgement using a range of evidence, including a visit to this service. The home is run in the best interests of the people who live there. EVIDENCE: The manger is registered with the Commission as a fit person to manage a care home. She is currently undergoing her National Vocational Qualification in Leadership and management in Care level 4. Staff spoken with said that they felt the manager was approachable and supportive, creating a good working atmosphere. People who live at the service told us that the manager was ‘good and helpful’. Lime Lodge DS0000073208.V378617.R01.S.doc Version 5.3 Page 23 During the course of the inspection a number of shortfalls were noted and the manager responded promptly to resolve them. The manager made it very clear that she wants to work closely with the Commission to improve the standard of care provided and maintain it. As the service has only recently opened they still have yet to implement a full Quality Assurance review, however the manager told us that she sits with people who live at the home and talks to them about any changes they want to see. People who live at the home confirmed that this happened. The person who owns the service visits regularly to carry out their statutory visits, we saw that these were recorded and showed that the owner spoke to people who use the service as well as staff. Accidents are recorded but they are not stored according to the Data Protection Act 1998 to ensure people’s information is stored in a confidential manner. The manager made arrangements for this to happen during the inspection. We looked at the maintenance records and these showed that the manager is ensuring that these are kept up to date and they are kept in good working order. Staff spoken with said that their health and safety was maintained and the manager was good at making sure things were up to standard. Lime Lodge DS0000073208.V378617.R01.S.doc Version 5.3 Page 24 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 2 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 X 33 X 34 2 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score X 3 3 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X 2 3 X Version 5.3 Page 25 Lime Lodge DS0000073208.V378617.R01.S.doc No Are there any outstanding requirements from the last inspection? 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 YA23 Regulation 13 Requirement Suitable arrangements must be made by training staff or other measures to prevent people being harmed or suffering abuse. This ensures people who live at the home are protected from abuse. Full and satisfactory information must be obtained about staff before they are recruited. Including Criminal Record Bureau checks. This is to ensure that only staff who are suitable to work with vulnerable are employed. Full and satisfactory information must be obtained about staff before they are recruited. Including suitable references. This is to ensure that only staff who are suitable to work with vulnerable are employed. Information listed in schedule 2 of the regulations must be obtained for each person working at the service. Timescale for action 14/01/10 2 YA23 19 14/01/10 3 YA34 19 14/01/10 4 YA34 19 14/01/10 Lime Lodge DS0000073208.V378617.R01.S.doc Version 5.3 Page 26 5 YA35 18 This is to ensure that they are suitable to work with vulnerable people. Staff must receive training appropriate to their work. This is to ensure that staff are able to support people who live at the home. Records held by the home must be stored according to the Data Protection Act 1998. This is to ensure people’s personal information remains confidential. 31/03/10 6 YA41 Data Protection Act 1998 14/01/10 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 YA22 Good Practice Recommendations Place copies of the complaints policy in other areas such as the pool room. Lime Lodge DS0000073208.V378617.R01.S.doc Version 5.3 Page 27 Care Quality Commission East Midlands Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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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