Care Home: Lisieux House

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What the care home does well Staff spend time sitting talking to the people living in the home so that they feel valued.Each person living in the home has a care plan so that staff know how to support them to meet their needs and goals.The people living there go out and do things they enjoy with staff that know them well.The staff of Lisieux house provides positive support and encourage people to be as independent as they can. Staff help the people living there to keep in contact with their families and the people that are important to them.People have a choice of meals that they enjoy.Staff make sure that people get the medication they need when they need it to help to meet their health needs.Staff have the training they need so they know how to help people to meet their individual needs.Each person has their own bedroom that is decorated in the way they want it to be. They have the space in their bedroom to keep their personal things there.Checks of equipment are done to make sure it is safe for people to use. What has improved since the last inspection? The statement of purpose for the home had been updated in April 2009. This included the relevant and required information so that it was clear what the home provides. The home has implemented a formal feedback sheet for new people so they/their family can comment on the admission process.The home has purchased a Wii games console so that people have more choice of leisure activities and can have fun.Two people who live at the home have been elected to sit on a `steering group` this helps to decide on how the Trusts homes should be run.Some rooms had been decorated and new furniture bought so it was more homely and comfortable for people to live in.More staff have been employed to work there so that staff that know the people who live there well.Reports about how the home is being managed are available in the home to help ensure the home is being well run. What the care home could do better: Update the service user guide to include information about how much it costs to live at the home. So that people thinking of moving into the home have all the information they need to decide if they want to live there. Care plans should be improved to ensure they cover all of people`s assessed needs and include sufficient detail about exactly how support should be given, in accordance with individuals` needs and preferences.Where people are identified as being at risk of choking then a risk assessment must be completed to help ensure the risk is reduced.Food records should be more detailed so that staff can make sure that people`s dietary needs are being met.Where handwritten additions or amendments are made to medication administration records these should be checked and signed by two staff to help make sure they are accurate and reduce the risk of errors. More detailed information is needed about people`s health needs in their care plans to ensure they receive the support they need to stay healthy. Key inspection report Care homes for adults (18-65 years) Name: Address: Lisieux House 50 Birmingham Road Sutton Coldfield West Midlands B72 1QP 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: Kerry Coulter Date: 2 1 0 7 2 0 0 9 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. The first part of the review gives the overall quality rating for the care home:  3 stars – excellent  2 stars – good  1 star – adequate  0 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. They reflect the things that people have said are important to them: 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 39 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 39 Information about the care home Name of care home: Address: Lisieux House 50 Birmingham Road Sutton Coldfield West Midlands B72 1QP 01213551474 F/P01213551474 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) : Lisieux Trust care home 12 Number of places (if applicable): Under 65 Over 65 12 0 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 12 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 (LD) 12 Date of last inspection 0 7 0 8 2 0 0 7 Care Homes for Adults (18-65 years) Page 4 of 39 A bit about the care home Lisieux House provides accommodation, care and support for up to twelve adults with learning disabilities. It is run by the Lisieux Trust, a well-established local organisation providing a range of services for learning disabled people. The premises include the original house, which accommodates eight people, and a separate bungalow (on the same site) providing a further four places. The main house is a large detached property. The main house can be accessed on foot from Birmingham Road on the edge of Sutton Coldfield town centre. Access for cars is off College Hill to the rear of the property, Care Homes for Adults (18-65 years) Page 5 of 39 and there is parking space for five or six cars. On the ground floor is a large kitchen with dining space, a separate dining room, hallway and a spacious, comfortable lounge. The office and staff sleep-in room, the laundry, shower room and toilet are also situated on this floor. On the first floor are six single bedrooms, two bathrooms and toilets. On the second floor there are two more single bedrooms, shower room and toilet. The bungalow has four single bedrooms (two of which have en-suite facilities), a kitchen / diner, laundry, bathroom, separate toilet, and an office. Both houses have their own private gardens, which include patio and seating areas, flowerbeds and lawns. Care Homes for Adults (18-65 years) Page 6 of 39 The home is within easy walking distance of a full range of social and leisure amenities in Sutton town centre, and is well served by public transport links. Current details of how much it costs to live at the are not included in the service user guide. The reader should contact the home for this information. Copies of previous inspection reports are on display in the home for people who wish to read them. Care Homes for Adults (18-65 years) Page 7 of 39 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 Care Homes for Adults (18-65 years) Page 8 of 39 How we did our inspection: This is what the inspector did when they were at the care home One inspector visited the home to carry out the homes main inspection. We visited the home over one day, the home did not know we were going to visit. Before we visited we asked the manager to send us information about the home, this is called an AQAA. We met with people who live at the home when we visited. Some of the people who live at the home were not able to tell us their views because of their communication needs. We talked to three people using the service, and asked staff about those peoples needs. We also looked at the care plans, medical records and daily notes for these people. This is called case tracking. We also looked at parts of the home, staff and health and Care Homes for Adults (18-65 years) Page 9 of 39 safety records. We sent surveys to people who live at the home, their relatives, staff and care professionals so they could tell us what they thought about the home. What the care home does well Staff spend time sitting talking to the people living in the home so that they feel valued. Care Homes for Adults (18-65 years) Page 10 of 39 Each person living in the home has a care plan so that staff know how to support them to meet their needs and goals. The people living there go out and do things they enjoy with staff that know them well. The staff of Lisieux house provides positive support and encourage people to be as independent as they can. Staff help the people living there to keep in contact with their families and the people that are important to them. Care Homes for Adults (18-65 years) Page 11 of 39 People have a choice of meals that they enjoy. Staff make sure that people get the medication they need when they need it to help to meet their health needs. Staff have the training they need so they know how to help people to meet their individual needs. Each person has their own bedroom that is decorated in the way they want it to be. They have the space in their bedroom to keep their personal things there. Care Homes for Adults (18-65 years) Page 12 of 39 Checks of equipment are done to make sure it is safe for people to use. What has got better from the last inspection The statement of purpose for the home had been updated in April 2009. This included the relevant and required information so that it was clear what the home provides. The home has implemented a formal feedback sheet for new people so they/their family can comment on the admission process. Care Homes for Adults (18-65 years) Page 13 of 39 The home has purchased a Wii games console so that people have more choice of leisure activities and can have fun. Two people who live at the home have been elected to sit on a steering group this helps to decide on how the Trusts homes should be run. Some rooms had been decorated and new furniture bought so it was more homely and comfortable for people to live in. More staff have been employed to work there so that staff that know the people who live there well. Care Homes for Adults (18-65 years) Page 14 of 39 Reports about how the home is being managed are available in the home to help ensure the home is being well run. What the care home could do better Update the service user guide to include information about how much it costs to live at the home. So that people thinking of moving into the home have all the information they need to decide if they want to live there. Care plans should be improved to ensure they cover all of peoples assessed needs and include sufficient detail about exactly how support should be given, in accordance with individuals needs and preferences. Care Homes for Adults (18-65 years) Page 15 of 39 Where people are identified as being at risk of choking then a risk assessment must be completed to help ensure the risk is reduced. Food records should be more detailed so that staff can make sure that peoples dietary needs are being met. Where handwritten additions or amendments are made to medication administration records these should be checked and signed by two staff to help make sure they are accurate and reduce the risk of errors. More detailed information is needed about peoples health needs in their care plans to ensure they receive the support they need to stay healthy. Care Homes for Adults (18-65 years) Page 16 of 39 If you want to read the full report of our inspection please ask the person in charge of the care home. If you want to speak to the inspector please contact CQC West Midlands Citygate Gallowgate Newcastle Upon Tyne NE1 4PA Tel 03000 616161 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 17 of 39 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 18 of 39 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. Prospective service users have most of the information they need to make a choice about whether or not the home can meet their needs. Their needs are assessed before they move in and they have an opportunity to visit to help them make a choice about whether or not they want to live there. Evidence: The statement of purpose for the home had been updated in April 2009. This included the relevant and required information so that it was clear what the home provides. The manager is currently working on an easy read service user guide that includes pictures making it easier for people to understand. We advised the manager that this needed to include the range of fees to live at the home so that people know how much it costs to live there. It is good that there is a DVD available about the home, this enables people who are thinking of moving to the home to see what it is like. As it is now five years since this was produced the manager said it was intended to update this. We looked at the admission procedure that had been followed for one person who had Care Homes for Adults (18-65 years) Page 19 of 39 Evidence: moved into the home since we last visited. The person had the opportunity to visit the home before they moved in to see if they would like to live there. An assessment of their needs had been completed that included gathering information from other professionals and the persons relatives to help ensure the home could meet their needs. People who live at the home told us that they have enough information about the home and were asked if they wanted to live there. Care Homes for Adults (18-65 years) Page 20 of 39 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. Staff have most of the information they need so they know how to support each person to meet their needs and make choices about their lives so ensuring their well being and safety. Evidence: We looked at the care records for three people. Each person had a care plan that was up to date and generally gave staff enough information on how to meet peoples needs. However some of the plans we looked could be improved. For one person their care records indicated they can suffer from constipation but there was not a care plan in place detailing the support they need to manage this. One person had a letter in their file to their social worker agreeing a list of actions to manage their behaviour. However their care plan for this behaviour lacked detail and did not include all the agreed actions. For one person there was conflicting information about their ability to tell staff if they are unwell. Peoples goals are included in their plan, this is titled dream path. Some people wanted to do things such as go to college, play snooker , go to a show or develop gardening Care Homes for Adults (18-65 years) Page 21 of 39 Evidence: skills. It was good that people had been supported to achieve their dreams. Some people who live at the home are unable to communicate their views verbally. For one person who we case tracked the home had sought advice from the speech and language therapist regarding their communication needs. Staff had received training about the way in which the person communicates and information on this was included in their care plan. A care professional told us that the speech and language therapy recommendations had been put in place and used by staff at the home to include an accessible activities timetable and accessible fire drill notice. People are fully supported to make decisions about their lives. It is good that regular care reviews are held, records sampled showed that the person is fully involved in their review. During the course of the visit, members of the care team were directly observed offering people choices about what they wanted to do, supporting them to make decisions appropriately, and encouraging them to do things for themselves, so as to promote personal independence. Nine people who live at the home told us that they always make decisions about what to do, three people told us they usually make decisions. People living in the house have regular meetings to discuss issues of interest. A volunteer worker who is independent of the staff team facilitates this. This practice supports consultation with people at the home. At our last visit the manager said that the Lisieux Trust wanted people who live at the home to be able to influence policy decisions. To facilitate this they intended to do elections for people to sit on a board that will have an independent chair. This has now happened and two people who live at the home have been elected to what is now called the steering group. Information about the group and what it does is available to people in the home. Records sampled included individual risk assessments. These detailed how staff are to support the person to take risks in their daily lives but reduce any risks to their safety as much as possible. However for one person there was information in their care file that showed they were at risk from choking. A risk assessment needs to be completed to assess the level risk and what action needs to be taken to reduce the risk of the person choking. Care Homes for Adults (18-65 years) Page 22 of 39 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Arrangements ensure that the people living experience a meaningful lifestyle so ensuring their well being. Evidence: People living at Lisieux House enjoy a wide range of opportunities for social, education and leisure activities. Several attend local centres and colleges for structured activities during the day. The home is well placed for accessing local amenities in Sutton Coldfield, and people make full use of these, in groups and individually, with support as required. Records show that people regularly take part in activities such as cinema, church, shopping and clubs. People have also done activities such as going to concerts, day trips, snooker and gardening as identified in their dream paths. Since our last visit the home has purchased a Wii games console and during our visit several people were seen to be having fun playing this. Staff told us that it has proved to be enjoyable for people but has also benefited in helping some people to become more active. Other activities on offer to people that help them to lead a healthy lifestyle include Care Homes for Adults (18-65 years) Page 23 of 39 Evidence: Pilates, step,and aqua aerobics. People who want to, go on holiday. Most people have chosen to go on holiday to Butlins, one person who wanted a quieter holiday has already been away with staff. People are supported to seek employment if they want to. One person works at Mencap and proudly showed us a newspaper article on display in the home about the work they do there. People are supported by staff to learn, develop or maintain skills by taking responsibility for things around the house. This might include maintaining their own rooms, doing domestic tasks around the house, and preparing and cooking food. One person was helping to prepare the evening meal during our visit, they told us they enjoy doing this. People living in the house are supported and encouraged to keep in touch with families and friends in a number of ways. Some regularly spend time at their relatives homes, others have visits at Lisieux House and keep in touch by telephone, according to the wishes of those involved. Two relatives were at the home during our visit and we saw they were made to feel welcome by staff. Events and social evenings are often held at the home where peoples family are welcome to attend. The manager told us that at Christmas a medieval themed banquet had been held that relatives attended. One person who lives at the home told us about their 60th birthday party at a hotel that staff were arranging for them. They said that their family and friends would be invited. Menus were varied, nutritious and were appropriate to the cultural background of the people living there. Discussions with people at the home and minutes of their meetings show they are consulted about what they want to eat. People living at the home told us that the food is good. We saw that there were satisfactory stocks of food in the home to include fresh fruit that was available to people. Staff keep a record of what people have eaten so that they can monitor if people are having a healthy diet. We advised the manager that she needed to make sure that the detail of what people eat is recorded as sometimes staff had recorded veg or roast beef dinner. This lack of detail would not enable staff to fully track if people are having a healthy and varied diet. People who live at the home told us- We go on holidays and activities and shopping, I enjoy it all. Its a nice home and they look after me, I go out a lot with my friends, I go on holiday. They take me to church every Sunday, take me on holiday, take me to visit my family, do lots of activities. I have choices of what I like doing and holidays, choose the menu for the week. Peoples relatives told usThe home could organise more weekend activities. We are delighted with our daughters high quality of life. Annual Christmas dinner dance is held at a hotel, it was a superb event... this illustrates the dignity with which our Care Homes for Adults (18-65 years) Page 24 of 39 Evidence: daughter is treated. My daughter is very happy at Lisieux and always wants to return there after home visits. Has a full and contented life. Care Homes for Adults (18-65 years) Page 25 of 39 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. Arrangements generally ensure that the personal care and health needs of the people living there are met so ensuring their well being. Evidence: Care plans stated how staff are to support people to meet their personal care needs. Peoples attire and personal grooming provided clear evidence that they receive a good standard of personal care. Staff were directly observed giving support to people, and interactions were seen to be warm and friendly and appropriately respectful. Both staff and people who live at the home appear to be at ease in each others company. One relative commented all staff from management down know x and support x in all aspects of her life, she is extremely fortunate to live there. Records showed that each person has an annual health check to ensure that any underlying health needs can be detected so they can get the help needed to meet their health needs. Records showed that staff supported people to go to the GP when they are unwell and to have regular eye, hearing and dental checks. Where appropriate people had regular chiropody treatment. We received one survey from a health care professional, they told us that the home seeks and acts on advice about peoples health care needs. Care Homes for Adults (18-65 years) Page 26 of 39 Evidence: Records sampled included an individual health action plan. This is a personal plan about what support the person needs to meet their health needs and what health care services they need to use. These included pictures and photographs making them easier to understand. The health action plans need to be developed further so that they contain information about all of the persons health needs. For example one person may sometimes have constipation but this was not recorded in their health action plan. There was also no detailed information about peoples nutritional needs to include if they were at a healthy weight. One person had changing health needs in recent months. We looked at their health records because of this. These showed that staff had monitored their well being and made contact with health professionals as needed to ensure they got the care and treatment they required. They had also moved from the main house to the bungalow as this was more suited to their mobility needs. The manager told us it was intended to have an occupational therapist assess the bungalow to see if any adaptations or equipment are needed. Records and discussion with the manager indicates that all staff who administer medication have been appropriately trained to do so. Some people at the home look after their own medication, risk assessments were seen to ensure people are safe to do this. At the front of the persons Medication Administration Record (MAR) there is a photograph of them so that unfamiliar staff would know who to give the medication to. Some people are prescribed as required (PRN) medication and protocols were in place stating how, when and why this should be given so it is not misused. Medication administration records were examined. There were no gaps in recording and the record included copies of prescriptions so that it is clear that people are getting the medication they are prescribed. We saw that where medication administration directions had been handwritten on MAR charts these had not been checked and signed by two staff to make sure they were accurate and reduce the risk of errors. The manager was not aware that this was considered good practice and so we advised that the home should obtain a copy of the Royal Pharmaceutical Society guidance on medication practice in care homes. Care Homes for Adults (18-65 years) Page 27 of 39 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. Arrangements help to ensure that the views of the people living there are listened to and they are safeguarded from harm. Evidence: The complaints procedure is available to people who live at the home. They also have information about how to access independent advocate support. Each person has a stamped, address envelope that is addressed to us so they can let us know if they are unhappy with the service provided. The home also seeks peoples views about if they are happy or not through key worker meetings and independently facilitated residents group meetings. People who live at the home told us they are aware of the complaint procedure and know who to speak to if they are unhappy. Relatives also told us they are aware of the procedure. We have not received any complaints about the home in the last twelve months. The home has received two complaints directly and records were available in the home to show that these had been responded to appropriately. The Annual Quality Assurance Assessment stated and staff records sampled showed that all staff have training in how to safeguard the people living there from abuse. We spoke with two staff about what they would do if they suspected abuse was occurring, their responses show they would take action to protect people. We looked at the procedures in place to look after peoples money. Financial risk Care Homes for Adults (18-65 years) Page 28 of 39 Evidence: assessments were in place on sampled files. Peoples money is checked by staff at each change of shift to ensure the money is correct. Money is also checked as part of the monthly visit to the home by a Trustee from Lisieux Trust. We looked at the financial records for two people and found that staff had not fully recorded how money had been spent on two occasions. The manager said she would ensure this was addressed. Care Homes for Adults (18-65 years) Page 29 of 39 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 enjoy living in accommodation that is homely, comfortable and welcoming. Evidence: We looked at parts of the main house and the bungalow during our visit. As indicated in previous inspection reports, the standards of furnishing and decoration are good. The homes annual quality assurance assessment told us that several communal rooms and bedrooms have been redecorated and re carpeted. New seating has also been purchased for the lounge in the main house. People at Lisieux House clearly enjoy their home, which is a comfortable and welcoming place. Comments from people included I Like my bedroom and Happy with my room, Ive just had it decorated. People at home on the day of the inspection were happy and proud to show their rooms. Everyone has their own bedroom. Some people who live in the bungalow have en suite bathrooms. Bedrooms had been personalised to individual tastes, ages, cultural backgrounds and interests. Communal spaces, including the gardens, are attractive places to be. Garden furniture is provided so that the people living there can enjoy relaxing in the garden. Care Homes for Adults (18-65 years) Page 30 of 39 Evidence: The home is kept clean and tidy, and good standards of hygiene maintained throughout making it pleasant for people to live in. People who live at the home told us it is always kept clean. The home were awarded a good rating for the level of cleanliness and food hygiene practices by Birmingham City Council following an unannounced inspection of the premises in June 2008. Care Homes for Adults (18-65 years) Page 31 of 39 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. Arrangements are generally sufficient to ensure that an effective, competent and supervised staff team who can meet individuals needs support them. The people living there are protected by the homes recruitment practices. Evidence: Staff spoken with had good knowledge of the needs of people who lived at the home. People who live at the home told us staff treat them well and listen to them. One person told us that the home has good staff. Training records show that the majority of staff have a National Vocational Qualification in care, some at level three. This exceeds the standard and means that care staff have the skills and knowledge to meet the needs of the people living there. Staff spoken with indicated that they enjoyed working at the home, one member of staff had left the home to work elsewhere but returned as they missed working there. One staff told us working at Lascaux house has always been a pleasure for me. At the last inspection it was identified that sometimes when people were on holiday from colleges and the day centre there were not enough staff on duty to support them to do the activities they wanted to. At this visit when some people were on holiday from college there were enough staff on duty to meet peoples needs. Staff meeting minutes also Care Homes for Adults (18-65 years) Page 32 of 39 Evidence: indicated that extra staff had been provided over the Easter holidays. Staff surveys received and staff spoken with indicated that there are usually enough staff on duty. One member of staff is due to leave the home soon. The manager told us that this vacancy would be covered by an agency member of staff until recruited to. It is good that it will be the same agency staff every day so that people do not have to get used to lots of different staff working with them. Recruitment is dealt with from a central point within the organisation. Sample checking of two staff files provided evidence of a robust recruitment procedure so that people are not put at risk by having unsuitable people working with them. The annual quality assurance assessment told us that new staff work shadow shifts for their first three weeks in the home. We looked at the staff rota when we visited, this showed that a new member of staff was working shadow shifts so they were extra to the other staff on duty. Staff training records showed that staff had regular training in how to meet the needs of the people living there. Staff told us they receive the induction and training they need, one staff commented that training was brilliant. Recent training undertaken by staff has included medication, infection control and health and safety. We saw that some staff had not had refresher training in manual handling however the manager was able to show that manual handling training has been booked. Some staff have had training about the new Mental Capacity Act and training is booked for Deprivation of Liberty Safeguard legislation. This is needed to ensure that all staff are aware of the implications this legislation may have for the people living there. Records showed that staff had regular supervision to support them in their role and identify any training or development needs they have. Staff meeting minutes showed that these were held regularly. These provided an opportunity for staff to keep updated with the changing needs of the people living there and with best practice. Staff told us they receive the support they need. Care Homes for Adults (18-65 years) Page 33 of 39 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. Management arrangements ensure that the home is well run so to promote the health, safety and welfare of the people living there ensuring their well being. Evidence: The registered manager is appropriately qualified, and experienced in supporting people with learning disabilities. Members of staff indicated that she is approachable and direct observations confirmed that she has a good rapport with the care team and operates an open and inclusive style of management. One person who lives at the home told us my manager always helps me when I have a problem and helps me to sort it out. The manager completed and returned the annual quality assurance assessment (AQAA) to us when we asked for it. The information in the AQAA let us know about changes they had made and where they still needed to make improvements. A Trustee from Lisieux Trust visits the home monthly to speak with the staff and the people living there and ensure the home is being well managed. Reports of these visits were available in the home. A quality audit was completed in 2009 using questionnaires from people who live at the home, staff, relatives and professionals. A report of the audit Care Homes for Adults (18-65 years) Page 34 of 39 Evidence: was available that includes actions and responses. Fire records showed that staff test the fire equipment regularly to make sure it is working. An engineer regularly services the fire equipment to ensure it is well maintained. Regular fire drills are held so that staff and the people living there can practice what to do if there is a fire. A fire risk assessment was in place that stated what action was to be taken to minimise the risks of there being a fire. It is good that the home has a pictorial version of the fire procedure on display. This has been designed with the help of the speech and language therapist to meet the communication needs of one specific person at the home. The Landlords Gas Safety Certificate and the electrical hard wiring certificate were both in date. Certificates were available to show that portable electrical appliances had been checked. Records showed that staff test the water temperatures weekly to make sure they are not too hot. Records indicated that the temperatures were within the recommended temperatures so that people were not at risk of being scalded. Care Homes for Adults (18-65 years) Page 35 of 39 Are there any outstanding requirements from the last inspection? Yes  No  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 36 of 39 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 Description 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 Description Timescale for action 1 9 13 31/08/2009 Regulation 13(4) Where people are identified as being at risk of choking then a risk assessment must be completed. To assess the level of risk and what action needs to be taken to reduce the risk of the person choking. 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 1 Update the service user guide to include information about how much it costs to live at the home. So that people thinking of moving into the home have all the information they need to decide if they want to live there. Care plans should be improved to ensure they cover all of peoples assessed needs and include sufficient detail about Page 37 of 39 2 6 Care Homes for Adults (18-65 years) 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 exactly how support should be given, in accordance with individuals needs and preferences. 3 17 Food records must be fully maintained so that the home can monitor effectively if peoples dietary needs are being met. The health action plans should be expanded to make sure they cover all aspects of the persons health and the support they need to stay healthy. Where handwritten additions or amendments are made to medication administration records these should be checked and signed by two staff to help make sure they are accurate and reduce the risk of errors. 4 19 5 20 Care Homes for Adults (18-65 years) Page 38 of 39 Helpline: Telephone: 03000 616161 or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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