Care Home: Lindisfarne

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What the care home does well The home gives people plenty of information before they are admitted and encourages new people to visit the home to meet the existing group. Everyone had an up-to-date care plan and plans that help manage any risks. We saw plenty of evidence to show that people in the home enjoyed going out locally, have different interests and are encouraged to be as independent as possible. People who live in this home get the right kind of medical attention, are encouraged to take a pride in their appearance and receive good levels of personal care. During the visit people were eager to show us their rooms and we could see that they were content and happy in their own home. Medicines in the home are ordered, stored and given out correctly. There had been no complaints received about this home in the last year. We had evidence to show that the staff in the home and Walsingham managers check regularly to make sure that no one is unhappy at Lindisfarne. The staff team were fully aware of their responsibilities in keeping people safe. They understood that people who live in the home might be vulnerable to abuse and they know how to make reports to people who can deal with this. The home is in a residential area of Frizington and is only a short distance from village amenities. The home has been designed with people`s mobility needs in mind. The home has two vehicles for residents use and this means that people get lots of opportunities to go out. During our visit we judged that people who live in the home are safe and relaxed in the building. Each person has their own bedroom; there is a comfortable lounge area and a pleasant dining room that leads out to secure patio and garden areas. The home was clean and tidy on the day and staff knew how to make sure infection was kept to the minimum. Staff only start to work in this home after the manager makes sure that they are the right kind of people to care for vulnerable people. After all the checks are completed staff work alongside more experienced members of the team and are given basic training with more specialised training as time goes on. Staff told us that they had received a lot of training in the past year. We could see that a lot of this had been specially designed to help staff understand the needs of the six people who live in Lindisfarne. We saw staff working patiently with people in the home and there was a lot of humour and kindness seen on the day. " We have very good team work... the relationship between staff and management is excellent and you feel confident in knowing that any problems you may have will always be dealt with. The training is excellent."The home has a suitably trained and experienced manager who has herself been trained to train other people. Staff felt confident in her ability to lead them and to care for the people in the home. " I feel that the management and team work hard to be person centered and to value the people we support." There are good systems in place that make sure this manager keeps everything in the home as up-to-date as possible and helps people to get the best quality care possible. We checked on health and safety systems and on things like the management of people`s finances. These were in order and there were some good examples of things being done especially to suit the people who live in the home. For example each person in this house has their on fire risk assessment so that staff know the best thing to do in a fire situation. What has improved since the last inspection? At the last inspection we asked the manager to make improvements in four areas. These things had all been completed successfully. The staff have now been trained to help people manage their behaviour if they are challenging the service. There are now enough staff so that the home does not rely on temporary staff from agencies. All staff now receive regular training and updates on fire safety. The staff who handle medicines have all completed a course on this and are fully aware of how to use the special system for administering drugs. The written plans that help staff to give people good care are now much more detailed, centred around the person and use more photographs so that people know they have the right level of care for their needs. People who live in the home now have the chance to go out with the staff to an activities club in a setting where people have more space to do activities. There have been improvements to the house with new carpets and several rooms have been redecorated. What the care home could do better: We judged that people in the service received good levels of health and personal care, however we want the manager to make sure that staff receive updates to their skills and knowledge of nutritional planning and managing peoples` continence. We also advised the manager to buy a printed book to record any controlled drugs that might come into the home so that the handling of medicines will be a safe as possible. One resident has a bed that looks like it should be in a hospital setting and we want the company to buy a new bed that can be ajusted but fits in to a domestic setting. Key inspection report Care homes for adults (18-65 years) Name: Address: Lindisfarne Greenvale Court Frizington Cumbria CA26 3SZ     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Nancy Saich     Date: 2 1 0 5 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 27 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) 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 Care Homes for Adults (18-65 years) Page 3 of 27 Information about the care home Name of care home: Address: Lindisfarne Greenvale Court Frizington Cumbria CA26 3SZ 01946813402 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: griffinclse@walsingham.com www.walsingham.com Walsingham care home 6 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The registered person may provide the following category of service only: Care home only - Code PC. To service users of the following gender: Either. Whose primary care needs on admission to the home are within the following categories: Learning disability - Code LD. The maximum number of service users who can be accommodated is: 6 Date of last inspection Brief description of the care home Walsingham are the Registered Company for Lindisfarne. They have similarly registered homes in Cumbria and throughout the Country. Lindisfarne is located in the village of Frizington on the West Coast of Cumbria. There is a large enclosed garden and patio area. Car parking is available and there is level access into the home. Lindisfarne is on a lower level to the nearby residential court of flats and houses and the incline to the home is graduated. Accommodation is on one level and the corridor and door entrances are designed for people who may use wheelchairs. There is a kitchen, dining room, lounge, office and utility room, with private bedrooms situated off the two corridors leading from the entrance hall. Toilets and bathrooms are specially equipped and designed. The current scale for charging is £1,283 per week. Care Homes for Adults (18-65 years) Page 4 of 27 Over 65 0 6 Brief description of the care home A Handbook is available for prospective residents, and the latest Commission for Social Care Inspection report is made available on request. Care Homes for Adults (18-65 years) Page 5 of 27 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 was the main or key inspection for the year. The lead inspector Nancy Saich asked the manager to fill out a form called the Annual Quality Assurance Audit (the AQAA). This asks for details of what has improved in the home since the the last inspection and for the plans for the coming year. This was completed promptly with plenty of detail. We then sent out postal surveys to the staff group. We had a good response to these surveys and we quote from them in the report. The responses were positive and gave us a good picture of what its like to work in the home. We made an unannounced visit to the home and met five of the six residents, spoke to the staff on duty and walked around the building and shared a meal with residents. We also looked at files and documents that backed up what was said and what was seen. Care Homes for Adults (18-65 years) Page 6 of 27 What the care home does well: The home gives people plenty of information before they are admitted and encourages new people to visit the home to meet the existing group. Everyone had an up-to-date care plan and plans that help manage any risks. We saw plenty of evidence to show that people in the home enjoyed going out locally, have different interests and are encouraged to be as independent as possible. People who live in this home get the right kind of medical attention, are encouraged to take a pride in their appearance and receive good levels of personal care. During the visit people were eager to show us their rooms and we could see that they were content and happy in their own home. Medicines in the home are ordered, stored and given out correctly. There had been no complaints received about this home in the last year. We had evidence to show that the staff in the home and Walsingham managers check regularly to make sure that no one is unhappy at Lindisfarne. The staff team were fully aware of their responsibilities in keeping people safe. They understood that people who live in the home might be vulnerable to abuse and they know how to make reports to people who can deal with this. The home is in a residential area of Frizington and is only a short distance from village amenities. The home has been designed with peoples mobility needs in mind. The home has two vehicles for residents use and this means that people get lots of opportunities to go out. During our visit we judged that people who live in the home are safe and relaxed in the building. Each person has their own bedroom; there is a comfortable lounge area and a pleasant dining room that leads out to secure patio and garden areas. The home was clean and tidy on the day and staff knew how to make sure infection was kept to the minimum. Staff only start to work in this home after the manager makes sure that they are the right kind of people to care for vulnerable people. After all the checks are completed staff work alongside more experienced members of the team and are given basic training with more specialised training as time goes on. Staff told us that they had received a lot of training in the past year. We could see that a lot of this had been specially designed to help staff understand the needs of the six people who live in Lindisfarne. We saw staff working patiently with people in the home and there was a lot of humour and kindness seen on the day. We have very good team work... the relationship between staff and management is excellent and you feel confident in knowing that any problems you may have will always be dealt with. The training is excellent. Care Homes for Adults (18-65 years) Page 7 of 27 The home has a suitably trained and experienced manager who has herself been trained to train other people. Staff felt confident in her ability to lead them and to care for the people in the home. I feel that the management and team work hard to be person centered and to value the people we support. There are good systems in place that make sure this manager keeps everything in the home as up-to-date as possible and helps people to get the best quality care possible. We checked on health and safety systems and on things like the management of peoples finances. These were in order and there were some good examples of things being done especially to suit the people who live in the home. For example each person in this house has their on fire risk assessment so that staff know the best thing to do in a fire situation. What has improved since the last inspection? What they could do better: We judged that people in the service received good levels of health and personal care, however we want the manager to make sure that staff receive updates to their skills and knowledge of nutritional planning and managing peoples continence. We also advised the manager to buy a printed book to record any controlled drugs that might come into the home so that the handling of medicines will be a safe as possible. One resident has a bed that looks like it should be in a hospital setting and we want the company to buy a new bed that can be ajusted but fits in to a domestic setting. Care Homes for Adults (18-65 years) Page 8 of 27 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 27 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 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. This service is good at making sure that the home is the right place for each individual. Evidence: There had been no new admissions since the last time we visited this home. However we did see evidence to show that there were good systems in place to carry out an assessment of need. The company has good policies and procedures on this and the manager has both experience and training in needs assessment. During the visit we spoke to the Operations Manager for the service and we learned that assessment was ongoing so that any person whose needs changed would be supported so that they would always receive the most appropriate levels of care. Care Homes for Adults (18-65 years) Page 11 of 27 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 who live in this home are supported so that they can live a safe and fulfilled life. Evidence: We looked at all of the care plans in the home. We found these to be of a good standard and we could see that there had been improvements in the last year. All of the plans were centred around the person and things like photographs were used effectively. The plans gave good strategies for delivering personal care and for helping people with things like behavioural issues. They also highlighted strengths and showed how staff were going to support people in future planning. There were one or two issues that needed to be written up in more specific ways but these are related to delivering health care and are discussed later in the report. The AQAA tells us that the manager and the staff team are committed to improving peoples independence in the next 12 months as they feel that they need to focus on this a little more.We observed staff helping people to make the right kind of decisions Care Homes for Adults (18-65 years) Page 12 of 27 Evidence: on the day and we also saw good evidence of this in individual person centered planning. The manager of this home is a trainer in person centered thinking and staff said that this had helped them to help people in the service. The manager asks for support from social workers or other professionals when there is an issue about decision making. Staff are aware of their responsibilities under the Mental Capacity Act. Each of the individual care plans contained good risk assessments and suitable risk management plans. When we looked at the records in the home we also discovered that there were general risk assessments for things like fire safety or potential accidents. The manager of the service has also made sure that these general risk management strategies are focused on individuals. For example there is a good fire risk management plan but she has also detailed the risks and how to deal with them for each person in the home if there were to be a fire situation. Care Homes for Adults (18-65 years) Page 13 of 27 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 in this home have a good lifestyle that staff continue to develop and work on so that people may reach their potential. Evidence: No one in this service is in employment or education. People who live in this home are not at the stage in their lives where they wish or are able to do this. Staff explained to us that they did look into possibilities for some people in these areas. We had evidence to show that people who live in this service go out into the local community to shop or go to the hairdresser or to have coffee. Staff are working with individuals so that some people may choose to go out for an evening meal. One or two residents go to the local community centre and to the local pub. Residents go bowling, swimming and to local discos as they choose. They mix with other people with learning disability and with people who live near them. There were a number of Care Homes for Adults (18-65 years) Page 14 of 27 Evidence: activities offered within the home and people enjoyed participating in household tasks if they wanted.During the visit we learnt from people in the home that they were going on holiday. Some people were going abroad and others were staying in this country. The manager has set up a club so that some people from the home can go out with staff and enjoy activities in a different environment. This also means that the house is much quieter for people who remain in the building and this is when staff give people one-to-one time. We had lunch with the two remaining residents as three other people had gone out to the club and one person had gone to a day centre. These two people ate well and were given suitable choices for a snack type lunch. We checked on the food available in the kitchen and we discovered that there was a good range of different types of food available. The manager was developing a new menu and we talked to staff about how they encouraged people to eat. We judged that staff paid good attention to peoples nutritional needs but we now want the manager to make this a little more formal in the care plans. Care Homes for Adults (18-65 years) Page 15 of 27 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. People who live in this home are given good levels of health and personal care support so that they are helped to be as well and comfortable as possible. Evidence: The staff in the service are suitably trained so that they can help people with their personal care and support. The staff group are planning to develop the way they help people with the ageing process. Most of the care plans outlined peoples personal preferences. On the day of the visit the people living in the home were well groomed and staff gave them lots of attention and encouragement in these matters. Two people wanted us to look at new clothes that had been bought and were very interested in maintaining a good appearance. People were dressed appropriately in the type of clothing they preferred and which was suitable to their age and personality. People in the service looked quite well and we read files that showed people saw G.Ps, chiropodists, dentists and other health care professionals on a regular basis. Every resident has a health action plan that looked at preventing ill-health as well as treating it. The manager had recently made referrals for people who have continence problems. One or two people have problems maintaining a healthy weight because Care Homes for Adults (18-65 years) Page 16 of 27 Evidence: they dont eat very well. These problems were recorded in the individual plans. We judged that these two areas of health care need - nutrition and continence- are being addressed. However we had discussions with the staff because we thought that the people in the home would benefit from staff developing their skills and knowledge in meeting these needs and in updating the way they deal with these things in practice. We checked on the medication held on behalf of people who live in the home.We could see that the ordering, administration, storage and disposal of drugs was being dealt with correctly. We also observed staff giving people medication in the correct manner. There are detailed instructions in some peoples plans because of their reluctance to take medicines. These were very well written and staff followed them so that people would get the right kind of treatment that was in their best interest. There were no controlled drugs on the premises but it is possible that some time in the future these may be used. We noted that the service does not have a proper controlled drugs book and we made a recommendation that a printed book is obtained in case this is needed in the future at short notice. Care Homes for Adults (18-65 years) Page 17 of 27 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. This home makes sure they act swiftly when people seem unhappy or when they may be at risk of abuse. Evidence: We had not received any complaints or concerns about this service. The person in charge on the day said there had been no complaints. We could see in individual files that the manager and her team continually monitor residents reactions to make sure they are safe and happy. The operations manager for the service visits regularly and was there during our inspection. One of the reasons he comes is to make sure all is well with people in the house. We asked staff about how they would help with a complaint and how they would deal with matters of adult safeguarding. Staff told us they had received training in this and individual training and supervision records and staff meetings showed us that the manager of this service has the protection of residents high on her agenda. There were copies of the local protocols for safeguarding available for staff. We saw reports sent to social services when people were vulnerable to abuse and we judged that this service is dealing with any concerns correctly. The operations managers are working with the local safeguarding teams to make sure any issues are dealt with quickly and appropriately. Care Homes for Adults (18-65 years) Page 18 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have a comfortable home where they can feel relaxed and secure. Evidence: Lindisfarne is a purpose-built bungalow that has been designed with the needs of the six residents in mind. It is situated in a quiet cul-de-sac but is near to the local GP surgery and is a short drive to the amenities of the village. The people who live in this service have access to two specially adapted vehicles so that they can be out and about in the community as much as possible. The living area for the residents is all on one floor.Each person has a single bedroom with ensuite facilities that they are encouraged to personalise. There are suitable toilets and bathrooms, a small laundry that has recently been upgraded, large kitchen and dining room that lead out to a pleasant enclosed garden. Residents share the comfortable lounge area. All areas of the home were suitably decorated and furnished and it was obvious that staff help residents to make their environment as homely as possible. There have been a number of difficulties doing this but staff continue to strive to make this home as pleasant and comfortable as possible. We did, however, notice in one persons bedroom that their bed was somewhat clinical in appearance. We suggested that the company may want to buy a more up-to-date adjustable bed that did not look as if it should be in a hospital setting. Apart from this we judged that people are very comfortable in their environment. Care Homes for Adults (18-65 years) Page 19 of 27 Evidence: We also noticed that the two side doors in the property that are used as evacuation points in case of fire were ill fitting and that some debris from improvements to the home had been left near to one of these doors. When staff realised that these things they dealt with these problems swiftly. The house was generally clean and free from unpleasant odours. There is a member of staff who is responsible for maintaing good levels of cleanliness. We thought that some areas were a little untidy and some minor things - like a broken toilet roll holder - need to be kept on top of. We checked the laundry and this was tidy and well organised. Residents clothing was clean and well cared for. Reasonably good infection control measures were being followed. Care Homes for Adults (18-65 years) Page 20 of 27 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. This home is suitably staffed so that people receive good levels of care and services. Evidence: We checked on the staff rosters for a number of months and we discovered that this home is suitably staffed. On the day of our visit there was enough staff around to take people out and to give individual one-to-one attention. We talked to the staff team about the care of people at night. This home does not have waking night staff but instead one member of staff sleeps in the building. There had been no worrying accidents or incidents at night and staff told us that people in the home sleep well and this means the current arrangements are suitable. However we want the manager and the company to keep this under review in case peoples dependency levels change. We observed staff on the day working patiently with people who need a lot of support or who may challenge the service. They followed the guidelines in care plans whilst also showing a warmth and empathy towards each person in an individual way. We checked on the last two recruitment files and found these to be in order. Staff confirmed that they had been recruited fairly and that all the required checks had been completed before they started to work. We had already looked at the recruitment procedures when we visited Walsinghams Carlisle office and we found this Care Homes for Adults (18-65 years) Page 21 of 27 Evidence: to be in order. The manager told us in the AQAA that their recruitment had been much more successful this year and there were no vacancies on the roster. This is an improvement as previously this home relied on agency staff sometimes. Staff in the service are suitably trained so that they can meet all the needs of the people who live there. Several members of staff told us how much they had benefited from attending courses on understanding autism. They also spoke to us about their safeguarding training, challenging behaviour training and a special five day training that everyone has attended. This was tailor-made to help people to understand how to prevent and manage challenging behaviour within the home. We spoke to some relatively new members of staff and they confirmed that they had had induction training and were being helped to develop their skills and knowledge. The manager has a training plan that covers all the core knowledge that staff need to work with people with learning disability. A good proportion of staff have qualifications. The team is aware of the specialist training needs they have and the manager has an action plan to make sure this happens. Care Homes for Adults (18-65 years) Page 22 of 27 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. This service has good management systems in place that allow people in the home to have a safe and fulfilling life. Evidence: The manager of this home has a number of years of experience of working with people with learning disabilities. She has a qualification at NVQ level 4 and is also trained as a trainer. We had plenty of evidence to show that she makes sure the staff follow the policies and procedures of the company and treat people with learning disability in an appropriate manner. She is given regular support by the operations manager and by other people in the company. We saw different systems in the home that proved to us that this manager checks on the quality of care and services on a regular basis. For example care plans are checked and updated regularly, risk assessments are updated regularly and things like fire and food safety records are closely monitored. The manager has regular staff meetings and consults residents and their advocates about their opinions. She does have an annual plan for the home and staff confirmed that they are involved in Care Homes for Adults (18-65 years) Page 23 of 27 Evidence: planning their own development. Staff confirmed that they had been trained in manual handling techniques. We had evidence to show that they were competent in supporting people who may have mobility problems. They had also been trained in suitable ways to help people when they had difficulty controlling their own behaviour. Staff had not had to use any restraining techniques but they felt confident that they could manage this in a safe way. We checked the fire log book and we found that there were risk assessments for the building and for each person who lives in Lindisfarne. The staff make regular checks on the fire alarm system and on the emergency lights. Staff receive regular drills and instructions. Staff note the responces of residents when the fire alarm is sounded. Care Homes for Adults (18-65 years) Page 24 of 27 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 25 of 27 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 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 19 It is recommended that all members of staff have updates to their training in the management of continence and in nutritional planning. It is recommended that a printed controlled drugs book is purchased for the home. It is recommended that a new adjustable bed is bought to replace the hospital bed that is currently in use. 2 3 20 24 Care Homes for Adults (18-65 years) Page 26 of 27 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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