Care Home: Little Heath Lodge

What the care home does well People received written information about the service and were able to visit and spend time in the home to see if they wanted to move in. Staff carried out an assessment before people moved into the home. The information obtained during the assessment helped staff to decide if they could meet the peoples needs. A care plan was prepared for each service user. The plan provided information about the support that people required and any signs that might show the service user was becoming unwell. People could choose how and where they spent their free time. Restrictions such as times for returning to the home were discussed with service users and included in their care plan, if necessary. Service users were prompted to attend health care appointments and meetings. Staff prepared detailed reports for other professionals about service users progress. The occupational therapist encouraged people to think about what they wanted to do in the future and what skills and courses they would need to meet their goal. Visting times were flexible and service users were supported to maintain contact with their relatives. There were regular relatives meetings. Service users were happy with the food provided in the home. Staff were aware of and were able to meet peoples special dietary requirements. Service users were encouraged to do some of the cooking. The home was clean and tidy and people were able to organise their rooms to suit their needs. The staff and management team was stable. This meant that service users were supported by staff that knew them well. Service users knew who they could talk to if they had any concerns or complaints. The home obtained feedback from people that use the service and regular audits and checks were carried out to identify and address concerns. What has improved since the last inspection? The statement of purpose was reviewed and updated and now provides clear information about the service. Service users receive a personal copy of their care plan. Risk assessments were reviewed and updated to take into account issues that had occcurred in the past. The management of medicines had improved significantly. Good records were kept about the use and administration of medicines. One person was supported to take their own medicines.The complaints procedure was reviewed and updated. Good records were kept about the use and balance of money that was kept in the home for service users. All of the staff that work in the home were included on the duty roster. The manager carried out thorough checks before new staff were permitted to work in the home. This protects people that use the service. Radiator covers were fitted to reduce the risk of burns and scalds and health and safety checks were carried out regularly. What the care home could do better: Ensure that care plans include service users comments and views. Introduce a system to monitor the balance of medicines supplied in packets/boxes and ensure that information that is written by hand on medication charts is checked and countersigned by a second member of staff. Discuss and agree the use of homely remedy medicines with the GP. Ensure that food records state if the meal included any vegetables, salad or fruit. Repair the lower ground floor toilet and shower room so that service users can use this facility and ensure that all curtains are properly fitted. Ensure that all staff receive adequate and suitable training. Staffing levels should enable staff to carry out uninterrupted work with service users. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Little Heath Lodge 68 Little Heath Charlton London SE7 8BH     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Maria Kinson     Date: 0 2 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 34 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 34 Information about the care home Name of care home: Address: Little Heath Lodge 68 Little Heath Charlton London SE7 8BH 02083177542 02083177534 enquiries@cognithan.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Cognithan Ltd Name of registered manager (if applicable) Ms Emilia N Endeley Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of service users who can be accommodated is: 5 The registered person may provide the following category of service only: Care home with nursing (CRH - N) to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Mental Disorder, excluding learning disability or dementia - Code MD (of the following age range: 18 years to 65 years) Date of last inspection Brief description of the care home Little Heath Lodge is registered with the Commission for Social Care Inspection to provide nursing care for five male or female service users, aged 18 to 65 years of age, with a mental health disorder. The home is located on a main road, in Charlton, which is served by several bus routes and is within 10 minutes walk of a train station. The property consists of a large Care Homes for Adults (18-65 years) Page 4 of 34 care home 5 Over 65 0 5 Brief description of the care home Victorian terraced house with five single bedrooms, dining room, kitchen, laundry, office/meeting room and lounge. Further information about the home can be obtained by requesting a copy of the Statement of Purpose or by sending an email to enquiries@cognithan.com Care Homes for Adults (18-65 years) Page 5 of 34 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: The last inspection on this service was completed on 5th January 2008. This inspection was carried out by one inspector in January 2009 and was unannounced. Before we visited the home we looked at all of the information that we had received about the service and sent surveys to some of the people that use or had an interest in the home. We spent one day in the home. During the visit we looked at some of the records and talked to the manager about how the service operated. We spoke to three service Care Homes for Adults (18-65 years) Page 6 of 34 users and two people showed us their bedroom. We viewed all of the communal areas. Four service users, four members of staff, two relatives and one health care professional provided written feedback about the service. We used the information that we obtained during our visit and responses from the surveys that we sent out to form a judgement about the service. The fees for living in this home range from £983.26 to £1200 per week. This does not include personal clothing, toiletries or community activities. What the care home does well: What has improved since the last inspection? The statement of purpose was reviewed and updated and now provides clear information about the service. Service users receive a personal copy of their care plan. Risk assessments were reviewed and updated to take into account issues that had occcurred in the past. The management of medicines had improved significantly. Good records were kept about the use and administration of medicines. One person was supported to take their own medicines. Care Homes for Adults (18-65 years) Page 8 of 34 The complaints procedure was reviewed and updated. Good records were kept about the use and balance of money that was kept in the home for service users. All of the staff that work in the home were included on the duty roster. The manager carried out thorough checks before new staff were permitted to work in the home. This protects people that use the service. Radiator covers were fitted to reduce the risk of burns and scalds and health and safety checks were carried out regularly. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 34 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 34 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. Information obtained during the pre admission assessment helped staff to decide if the home could meet peoples needs. People had access to written information about the service and could spend time in the home to see if they liked it and wanted to move in. Evidence: The home sent us a copy of their revised Statement of Purpose in June 2008. The manager had reviewed and updated the Statement of Purpose as recommended during the previous inspection. The Statement of Purpose provides up to date and relevant to information about the home. We looked at the assessments that were completed by staff before people moved into the home. One person was recently admitted for a short break whilst their carer was on holiday. Staff completed an assessment of the persons needs prior to a previous admission and arranged to meet the service user, their carer and their care manager to carry out another assessment prior to the recent admission. During the meeting Care Homes for Adults (18-65 years) Page 11 of 34 Evidence: staff obtained information about the service users needs, preferred routines and checked to see if there had been any changes or significant events in the period since the last admission. The second assessment was for a service user that had lived in the home for just over a year. Two members of staff visited the service user before they moved into the home to find out what support they required and to discuss their needs. Additional information was obtained from other professionals. This included a comprehensive assessment from the funding authority. People told us that they received adequate information about the service and were able to ask questions when they visited the home. Some service users visited the home several times and had weekend or overnight stays before making a decision to move into the home. Care Homes for Adults (18-65 years) Page 12 of 34 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. Care plans provided clear information about the action that staff should take to meet peoples needs but did not always include service users views. People told us that they were able to make decisions for themselves and could seek advice and support from staff if needed. Evidence: We looked at the care records for two service users. Staff had developed an individual plan of care for each person. All of the plans that we saw were reviewed regularly and were discussed and agreed with the service user. In the period since the last inspection the home had started to provide each service user with a personal copy of their care plan. The plans that we looked at provided good guidance for staff about the action they should take to support and meet peoples needs. Information was clearly presented and easy to follow. Discussion with service users indicated that care plans were up to date and reflected peoples needs. One of the care plans that we looked at was for a service user that had lost a significant amount of weight. Although their Care Homes for Adults (18-65 years) Page 13 of 34 Evidence: weight had stabilised in recent months the care plan said staff should weigh the service user once a week. The records showed that the service user was weighed once a month. The service user provided an explanation for the weight loss and told us that they were happy with their current weight, this information was important but was not included in the care plan. See requirement 1. There was evidence that staff tried to maintain service users existing routines and promoted peoples independence. This was particularly important for one service user who had a very rigid structure to their day and would find it difficult to be flexible or change their routine. There were regular meetings between service users and their key worker. The service users progress and care plan was discussed during these meetings. Service users were expected to return to the home before 11pm to avoid disturbing the other people that live in the home. One service user had persistently breached this rule. The issue was discussed with the service user and a behaviour contract was drawn up and agreed with the service user. Records showed that staff reviewed the contract regularly to see if the service user was keeping to the agreement. Service users told us that they were usually able to make decisions about what they did each day although some people had to attend appointments or work placements on specific days. Service users said they had to tell staff when they were going out and when they were likely to be home, but said there were no restrictions about where they went. Most people chose to spend the Christmas period with their relatives. Staff encouraged service users to help out round the house, tidy up after themselves and keep their bedroom clean and tidy. One service user said staff prompt him to clean his room but said he didnt mind this as it made him feel good if his room was clean. We saw service users making hot drinks, cleaning the bathroom floor and clearing the table after their meal. Service users were responsible for doing their own laundry and some people said they did some cooking. The occupational therapist provides support and written advice for service users that want to learn new skills. Risk assessments were completed for all of the service users. Staff had reviewed the risk assessments that we saw during the last inspection to ensure that all areas of risk including events that had occurred in the past were taken into account. It was evident that staff took a very common sense approach to risk. Events that had occurred in the distant past but had not re occurred for some time were still considered a potential risk but assessed as low risk. Risk assessments were clear and easy to follow. During the course of the inspection we observed staff following the strategies that were outlined Care Homes for Adults (18-65 years) Page 14 of 34 Evidence: in peoples risk assessments. Care Homes for Adults (18-65 years) Page 15 of 34 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 were able to follow their chosen lifestyle and were supported to develop new skills and pursue personal goals. Relatives could express their views during meetings and were encouraged to maintain regular contact with their family member. Evidence: The home employs a part time Occupational Therapist. The Occupational Therapist spends time with new service users to see what skills they have and how the service can support them to become more independent. The assessment also considers personal goals and interests. The manager had established links with other organisations that help people with mental health problems to learn new skills and gain employment and was always looking for courses and work opportunities that would help or be of interest to service users. The Occupational Therapist developed a weekly activity programme with each service user. The programme was based on Care Homes for Adults (18-65 years) Page 16 of 34 Evidence: peoples individual needs and interests and outlined how people would spend their time in the home and community. The activity programmes that we saw included attending work experience and college classes, visiting relatives and friends and doing household chores such as cleaning, laundry and cooking. Service users valued the support they received from the occupational therapist and told us how she encouraged and supported them to pursue personal interests and goals. One service user said they enjoyed playing football and games with the occupational therapist. Some people were very motivated and had a well established rehabilitation programme. Other service users required a significant amount of prompting and support from staff to follow their activity programme. Some people said they attended First Step Trust a local organisation that provides work experience and training opportunities for people with a mental health disorder. One person was undertaking a work placement at a printers and a computer training course. During their free time people said they liked to visit their family and friends, watch television and relax. Service users were told about local community facilities and services. People told us that they were supported to apply for a travel card and use local bus services regularly. Some service users said they had visited the local library and sports centre and told us about the facilities at the local park. All of the service users were registered with a local GP. We spoke with three service users during the inspection and received written feedback about the home. People told us that they were happy living in the home and were able to spend their time as they wanted. Service users said their relatives could visit them in the home at anytime and they could go to see their family members when they wanted to. We received written feedback from two relatives. Relatives said staff were usually able to meet their family members needs and always informed them about important issues. Relatives said staff are always helpful and willing to listen and another relative said staff get to know the person and their needs- which they said was particularly important for their family member. The manager had established regular meetings for relatives and carers. One relative said the meetings tell us what is happening in the care home and provide an opportunity to comment about the service. We looked at the minutes from the two most recent meetings, one of which was combined with the homes Christmas party. It was evident that relatives suggestions were considered and acted on. Carers meetings provide good support for relatives and promote good communication between staff and relatives. Care Homes for Adults (18-65 years) Page 17 of 34 Evidence: Staff encouraged service users to maintain good relationships with relatives. One service user was supported to contact a family member that they had lost contact with. Staff helped the service user to plan a journey to visit their relative and provided ongoing support via a mobile phone until they arrived at their destination. Two people were in the home during the lunch period. The manager prepared and cooked the meal. Information about what service users had eaten was recorded in the diary and was more detailed than during our last visit. However it was still difficult to judge the nutritional content of the diet. For example, the diary stated that service users had chicken casserole, one day, the previous week. The records did not indicate if the meal included any fruit, vegetables or salad. The manager said that vegetables were included with all meals. See recommendation 1. One service user did not eat some foods for religious reasons. The service user told us that staff were aware of his dietary needs and always provided an alternative when pork was on the menu. Service users said they could prepare a meal or snack for themselves if they got home late. Service users said there is always plenty to eat and described the food asOK and good. Care Homes for Adults (18-65 years) Page 18 of 34 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 could manage their own health care needs and medication but were also able to seek advice and support from staff if necessary. The arrangements that were put in place to improve the management of medicines were working well but some further work was required in respect of medicines that were supplied in boxes and packets. Evidence: One service user required support to wash and dress and some people required prompting. The arrangements for supporting people with personal care were flexible and staff encouraged people to take responsibility for their own care where possible. The occupational therapist had prepared and displayed a step by step, picture guide to help one service user to become more independent. Staff communicated effectively with other professionals and provided comprehensive reports about service users progress. People were supported to attend health care appointments and meetings, if necessary and records were kept about the outcome of these. Staff checked that service users attended appointments especially where the appointment involved receiving important medicine that helped them to stay well. One Care Homes for Adults (18-65 years) Page 19 of 34 Evidence: service user said they must be looking after me properly as I have never stayed well for this long. Care plans provided information for staff about health issues and signs of relapse. During discussions the manager demonstrated good knowledge and understanding of service users history and needs. It was evident that she took a keen interest in service users health and wellbeing. We received written feedback from one health care professional that was in contact with the home. The person said staff requested and followed their advice and were usually able to meet peoples health and social care needs. We looked at the records of medicines that were kept in the home for three service users. Staff maintained good records about medicines that were received in the home from the local pharmacy or were brought into the home by service users. We could see that service users received their medicines regularly and staff tried to administer medicines at the time that suited the service user. The balance of medicines supplied in blister packs were satisfactory but the balance of one boxed medicine did not correspond with the records. In view of the excellent progress the home had made in addressing the other medication issues that we identified during previous inspections we are confident that the manager will be able to resolve this issue. See requirement 2. The medicines listed on one medication chart were hand written by a staff member. The entries were not checked and countersigned by a second member of staff. See recommendation 2. One of the service users was responsible for taking their own medicines. Staff completed an assessment to identify potential risks and introduced strategies such as regular checks to ensure compliance and identify problems. The service user showed us where they kept their medicines and their medicine chart. Although there is no requirement for the service user to keep a medication record this can be maintained if it helps the service user. The service user knew they must keep their medicines securely and had a locked drawer for this purpose. Medicines were kept in a locked cupboard and the room temperature was monitored. New forms had been developed about the receipt and use of non prescription medicines such as paracetamol. The list of homely remedy medicines used by the home should be agreed and signed by service users GPs. See recommendation 3. Care Homes for Adults (18-65 years) Page 20 of 34 Care Homes for Adults (18-65 years) Page 21 of 34 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. People knew who to speak to if they had concerns and said staff usually listened and acted on what they said. There were procedures in place to safeguard peoples money and to protect people from abuse. Evidence: The home sent us a copy of their revised complaints procedure in June 2008. The procedure states that all complaints would be acknowledged within two working days and investigated within twenty eight days. Service users said they would speak to the manager if they had any concerns and most people said they knew how to make a complaint. Some service users were able to manage their own money. The home kept a record of money that was received in the home for service users. We looked at the money records for two service users. There was information in the records about how people used their money and each entry was checked and signed by two members of staff. Receipts were kept for items that staff purchased for service users. The balance of money kept in the home for service users was correct. The manager told us that the homes safeguarding procedure had not changed in the period since the last inspection and the home had not made any referrals to the local authority safeguarding team. Care Homes for Adults (18-65 years) Page 22 of 34 Evidence: Care Homes for Adults (18-65 years) Page 23 of 34 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a clean, comfortable and homely environment for service users and their visitors. The lower ground floor shower room was out of use due to a damp problem. Evidence: We visited all of the communal areas and two service users showed us their bedrooms. All areas were clean and tidy and service users said the home was always fresh and clean. All of the rooms were spacious and light and people were able to organise their bedroom furniture to suit their needs. One service user told us that they liked to sit in their chair to watch television and had arranged their television on the floor so that they could do this. Another service user said they particularly liked their bed which was much bigger than the bed they had in their previous placement. Although people said they had adequate furniture some people did not have enough space in their wardrobe for some of their clothing. The home should provide additional storage space for service users that require this. The curtains in both of the bedrooms that we visited were hanging down from the rail and did not cover the window properly. Although the service users using these rooms did not see this as a problem the home should ensure Care Homes for Adults (18-65 years) Page 24 of 34 Evidence: that curtains are properly fitted to promote restful sleep. See recommendation 4. The home was in good decorative order overall. Some work had been undertaken in the period since the last inspection to redecorate the lounge and fit sliding doors between the lounge and dining area. This provided more light in the lounge and made the area look more spacious. A new sofa was purchased. All of the communal areas were suitably furnished and comfortable. There were three bathing areas in the home but the shower/toilet area on the lower floor adjacent to the female service users bedroom was out of use. The room smelt damp and a number of wall tiles had fallen off the wall. See requirement 3. Care Homes for Adults (18-65 years) Page 25 of 34 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. The home has a stable team of staff. This provides good continuity of care for service users and support for their relatives. Staff were suitably qualified but require more consistent support to meet their professional development and training needs. The manager carried out thorough recruitment checks. This protects people that use the service. Evidence: Most of the staff employed by the home were mental health nurses who had experience of working in acute NHS and community mental health services. The home employs two support workers both of whom were reported to have a National Vocational Qualification in health and social care at level two or above. The home employs permanent, part time and bank staff. Staff usually work between two to four shifts in the home each week, dependent on their availability and contracted hours. Use of temporary staff was low. This meant that people were usually supported by staff that they knew. The staffing arrangements provide good continuity of care for service users. Care Homes for Adults (18-65 years) Page 26 of 34 Evidence: On the day of the inspection the manager was the only staff member on duty. Three service users were out for the day, leaving two service users at home. Staff were responsible for undertaking cleaning and cooking tasks in addition to managing the home and supporting service users. There was a second member of staff on some shifts but this did not occur regularly. Although the current dependency of service users is low one person does require frequent reassurance and support with tasks and activities in the home and community. In order to facilitate this the home should ensure there is a second member of staff on duty for at least part of the week and review this when peoples needs change. See recommendation 5. All of the people that work in the home including the occupational therapist were now included on the duty roster. We did not get an opportunity to speak to staff during the inspection but we did receive written feedback about the service from four members of staff. Staff said they always received up to date information about service users needs and changes are duly communicated to all relevant parties. Staff were satisfied with the training they received and said they received good support from the manager. We looked at two staff recruitment files. The manager carried out thorough checks before allowing staff to work in the home and had implemented some good practice recommendations such as confirming that references were genuine, exploring gaps in employment histories and including a service user on the interview panel. The files had been reorganised to make it easier to locate information quickly. Service users were protected by the homes recruitment practices. Most of the staff that work in the home are employed on a sessional basis and have other jobs in the NHS or private sector. Some staff had undertaken relevant training courses in connection with their other jobs. Certificates were kept on staff files and a separate record was maintained about the courses that staff attend. In the period since the last inspection the home had arranged medication, first aid and mental capacity act training sessions. There was some variation in the amount of training provided for staff with some staff not receiving any training in 2008 and others attending several courses. See recommendation 7. Training records had improved. The manager had contacted a new trainer and made arrangements for them to carry out a rolling programme of training in 2009. Although care staff received induction training there was no evidence that the course covered the common induction standards. See recommendation 6. Care Homes for Adults (18-65 years) Page 27 of 34 Care Homes for Adults (18-65 years) Page 28 of 34 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. The service was well managed overall and now meets most of the key standards. Service users and relatives could suggest improvements and influence the way the service was organised. Health and safety and fire safety checks were carried out regularly. Evidence: The manager is registered with the care quality commission. The manager has a degree in education, a post graduate diploma in counselling, is a Registered Mental Health Nurse and completed the registered managers award in 2007. Service users said the manager was approachable and listened to their views. There were regular opportunities for staff and service users to contribute ideas and make suggestions about the management of the service during meetings and shift handover. The home had made good progress with the requirements that we made during the previous inspection and is now meeting almost all of the key standards. The Care Homes for Adults (18-65 years) Page 29 of 34 Evidence: management of medicines and staff recruitment practices had improved significantly. The front door was now left unlocked so people could let themselves out. Service users were starting to become involved with staff recruitment. The outcomes for people that use the service had improved. The home had developed various systems to monitor and assess the quality of care provided in the home and to obtain feedback from people that use the service. Peoples views were obtained during community and carers meetings and a satisfaction survey was completed in February 2008. The home should consider reviewing the survey format as it is quite long and does not provide much space for service users comments. The results from the survey were discussed at a carers meeting and people were encouraged to make suggestions about how they thought the home could improve. Staff completed a weekly health and safety check and carried out regular medication and record keeping audits. An action plan was prepared if concerns were identified during audits. Fire exits were clearly marked and free from obstruction. The alarm, emergency lighting system and fire extinguishers were serviced regularly and staff carried out a weekly fire alarm test. Fire drills were taking place regularly. We sampled some of the health and safety records that were kept in the home. The gas boiler and portable electrical appliances were serviced regularly. Staff monitored hot water temperatures and had arranged for covers to be fitted over the radiators to minimise the risk of burns and scalds. Care Homes for Adults (18-65 years) Page 30 of 34 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 31 of 34 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 6 12 Staff must ensure that health issues are monitored in accordance with the instructions in the care plan and include service users views in plans. To demonstrate that staff are working with service users to maintain their health and welfare. 25/06/2009 2 20 13 A system must be implemented to monitor the balance of medicines supplied in boxes or packets. This will help staff to identify and trace concerns about the use of these medicines. 26/06/2009 3 27 23 Work must be undertaken to 21/07/2009 provide adequate toilet and shower facilities on the lower ground floor. Care Homes for Adults (18-65 years) Page 32 of 34 To ensure people have access to suitable toilet and bathing facilities and are afforded adequate privacy. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 17 Food records should be sufficiently detailed to enable any person inspecting the records to determine if the diet is satisfactory in relation to nutrition. The list of non prescription medicines used by the home should be agreed and signed by the GP. Hand written entries on medication charts should be checked and countersigned by a second member of staff. Curtains or window blinds should be properly fitted. There should be two staff members on duty, for part of the week, to support one service user to undertake activities in the home and community. Induction training for new care staff should cover all of the common induction standards. All staff should have an individual training and development assessment and profile and receive at least five paid training days (pro rata) each year. 2 3 4 5 20 20 26 33 6 7 35 35 Care Homes for Adults (18-65 years) Page 33 of 34 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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