Care Home: Loppington House

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What the care home does well People are enabled to keep in touch with family and friends and staff know how important family contact and support is to the people living at the home.The home makes sure that that people who come to work at Loppington House are suitable for the work they are to do.The newly appointed manager and deputy manager offer effective leadership and direction to the home, thus improving the quality of the service provided. What has improved since the last inspection? Over recent months there have been a number of changes at Loppington House that have led to people receiving a better, and safer service.Staff are able to recognise and feel confident to report incidents of poor practice within the home and this means that any issues will be promptly reported and responded to to ensure peoples protection from abuse.Opportunities for people to enjoy activities have improved meaning that people can lead fuller and more active lives.Care plans and risk assessments are up to date and reflect peoples care and support needs meaning that staff can follow them to ensure safe and consistent support how people prefer.Staff feel well supported and well trained meaning they are better able to offer safe and effective support to people living at Loppington House.Staff told us that morale at the home has improved and staff think that the new manager and deputy manager are responsible for this. What the care home could do better: The managers and staff at Loppington House still need to work hard to make sure that changes made to date to improve the quality of the service continue.Care plans, although detailed are not written in a user friendly way and do not yet reflect individual goals, life choices and plans for the future.The buildings that make up Loppington House still require refurbishment to make them safer and more homely.The home needs to make sure that staff know how to carry out all tasks required of them safely or people could get hurt. Key inspection report Care homes for adults (18-65 years) Name: Address: Loppington House Loppington House Wem Shrewsbury Shropshire SY4 5NF The quality rating for this care home is: one star adequate 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: Sue Woods Date: 2 3 0 2 2 0 1 0 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 38 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 © (2010) 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 38 Information about the care home Name of care home: Address: Loppington House Loppington House Wem Shrewsbury Shropshire SY4 5NF 01939233926 01939235255 Telephone number: Fax number: Email address: Provider web address: www.loppingtonhouse.co.ukEmailoffice@loppingtonhouse.co.uk Loppington House Ltd care home 36 Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 36 0 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 36 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) 36 Date of last inspection Care Homes for Adults (18-65 years) Page 4 of 38 A bit about the care home Loppington house is made up of a further education college, two detached houses and two bungalows. All buildings are situated in beautiful open countryside. Up to 36 people with a learning disability can live at Loppington House. Because of the rural location of the home people need transport to get to the local village and nearest towns. The home has some vehicles and is looking to purchase more to enable this to happen. Care Homes for Adults (18-65 years) Page 5 of 38 All houses have their own kitchens where people can help prepare meals and make drinks. Two houses have to take their laundry down to the main house to do it as they do not have laundry rooms in their houses. Information is shared with people who live at the home in the Service User Guide. Care Homes for Adults (18-65 years) Page 6 of 38 The home asks people what they think of the service they receive informally when the manager meets with them and also in regular questionnaires. The home has a new manager who is working hard to make Loppington House a nice place to live Care Homes for Adults (18-65 years) Page 7 of 38 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: one star adequate 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 38 How we did our inspection: This is what the inspector did when they were at the care home We visited Loppington House on 23rd February 2010 and stayed there for six and a half hours. The home did not know we were coming. During the time that we were there we looked at what it is like to live at the home. We did this by meeting and speaking with the people who live at Loppington House and talking with the new home manager, the deputy manager and staff on duty. We also observed how staff support people to live their lives. Care Homes for Adults (18-65 years) Page 9 of 38 We looked in more detail at how the home meets the care and support needs of three people by meeting and observing the people chosen, talking about their care with staff and looking at their care files. We also looked at medication arrangements within the home. Care Homes for Adults (18-65 years) Page 10 of 38 We looked at staff training files to see how the home supports the staff team to meet the needs of people living at the home and we also looked at other records to see how the home is run. What the care home does well People are enabled to keep in touch with family and friends and staff know how important family contact and support is to the people living at the home. Care Homes for Adults (18-65 years) Page 11 of 38 The home makes sure that that people who come to work at Loppington House are suitable for the work they are to do. The newly appointed manager and deputy manager offer effective leadership and direction to the home, thus improving the quality of the service provided. What has got better from the last inspection Care Homes for Adults (18-65 years) Page 12 of 38 Over recent months there have been a number of changes at Loppington House that have led to people receiving a better, and safer service. Staff are able to recognise and feel confident to report incidents of poor practice within the home and this means that any issues will be promptly reported and responded to to ensure peoples protection from abuse. Opportunities for people to enjoy activities have improved meaning that people can lead fuller and more active lives. Care Homes for Adults (18-65 years) Page 13 of 38 Care plans and risk assessments are up to date and reflect peoples care and support needs meaning that staff can follow them to ensure safe and consistent support how people prefer. Staff feel well supported and well trained meaning they are better able to offer safe and effective support to people living at Loppington House. Care Homes for Adults (18-65 years) Page 14 of 38 Staff told us that morale at the home has improved and staff think that the new manager and deputy manager are responsible for this. What the care home could do better The managers and staff at Loppington House still need to work hard to make sure that changes made to date to improve the quality of the service continue. Care Homes for Adults (18-65 years) Page 15 of 38 Care plans, although detailed are not written in a user friendly way and do not yet reflect individual goals, life choices and plans for the future. The buildings that make up Loppington House still require refurbishment to make them safer and more homely. The home needs to make sure that staff know how to carry out all tasks required of them safely or people could get hurt. Care Homes for Adults (18-65 years) Page 16 of 38 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 Sue Woods 77 Paradise Circus Queensway Birmingham W Midlands B1 2DT 01216005300 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 38 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 38 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management team at Loppington House are aware of their responsibilities in relation to admitting people to the home ensuring that they fully assess people before they move into the home to make sure that no one is admitted whose needs they cannot fully meet Evidence: There have been no admissions to Loppington House since the time of our last visit and so we are unable to assess this outcome group in relation to pre admission assessments and planning however we have seen the file of one of the latest people to move in to the home and we are now satisfied that the person is being supported by a detailed care plan and assessment of need that shows that the person can be supported safely and effectively. The manager is in the process of updating the Statement of Purpose and Service User Guide to reflect new management arrangements at the home and is confident this information will be available to support future admissions or expressions of interest in the home. Care Homes for Adults (18-65 years) Page 19 of 38 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Loppington House can now feel more confident that their personal care and support needs are being met because plans are in place to show staff how to meet those needs consistently and safely meaning that they will receive a better quality of service. Evidence: We looked at three care files as part of our inspection and we also spoke with people who receive a service and the staff team who support them. We found that staff know how to meet peoples care and support people safely and use care plans to enable them to do so consistently. Two people who live at Loppington House said that staff supported them well. We also observed people being supported sensitively and discreetly and in accordance with their support plans. The manager of Loppington House told us that she plans to improve care and support plans in the future to make them more user friendly and she wants to involve the people living at the home to develop their own individualised support plans that not only focus on peoples basic care and support needs but also look at what people want to do with Care Homes for Adults (18-65 years) Page 20 of 38 Evidence: their lives. This will ensure that peoples quality of life improves and also that people are empowered to make decisions and choices about how they live their lives. Plans are now in place to support people when they are anxious or displaying behaviors that place themselves and others at risk of harm and staff are confident that these plans (along with the training they have received) will enable them to keep people safe and support people consistently during times when they are agitated or anxious. We found that the home ensures that daily activities are as safe as possible for people to enjoy. Risk assessments were seen in place for community and home based activities and they had recently been reviewed to ensure they were still appropriate. Care Homes for Adults (18-65 years) Page 21 of 38 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at Loppington House are now starting to access a variety of activities both within the home and in the local community enabling them to enjoy a better quality of life. People are involved in carrying out household tasks, where possible, enabling them to remain as independent as they are able. People continue to benefit from supported family contact and involvement meaning that they are able to stay close to the people that matter to them Evidence: Since our last visit to the home staff tell us that people are enjoying more activities both within the local community and within the home. Activities coordinators play a key role in arranging and supporting activities and new vehicles are being made available to support community activities and these will be a valuable resource given the location of the Care Homes for Adults (18-65 years) Page 22 of 38 Evidence: home. The home has work to do in relation to developing meaningful activities that take into account peoples wishes, goals and preferences but the new manager is working with the staff teams to ensure this happens meaning that people will be able to enjoy a full and active life doing activities of their choice. Staff told us that activities have improved over the last six months and care records show that people have activity programs in place (although these need to be developed further). Staff told us that people are now more involved in developing independent living skills and on the day of the inspection one person was seen helping prepare her lunch and one person told us how he does his own washing. The home has plans to have laundry facilities in all of the houses in the future to promote peoples independence. People value the opportunities they have for spending time with their families. People told us that they visit their families and families and friends visit them at the home. People spoke enthusiastically about this and records showed that visits take place regularly. One family member recently wrote to the home to say thank you for supporting them to spend quality time with their son. Care Homes for Adults (18-65 years) Page 23 of 38 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The personal and health care needs of the people who live at Loppington House are generally well met enabling them to enjoy good health and receive support in a way that they prefer. Evidence: Peoples health care and support needs are recorded in their care plans to enable staff to offer consistent and appropriate support to people to keep them fit and well. When peoples needs increase the home can now show that they take steps to access services and support that will enable them to better meet those needs. The home manager is aware of the limitations of support that can be provided at the home meaning that people will only remain at Loppington House if their needs can be met there fully and safely. One person who has been in poor health recently told us that the staff at Loppington House are looking after him well and he is now feeling much better. The home introduced a new care plan to support the person while he was unwell so that staff were aware of his increased needs and could support him safely while he recovered. The home however had not yet developed a way of safely helping this person up off the floor if he fell and as a result the person (or staff supporting him) are vulnerable to personal injury if they need such help. The pharmacist inspector also visited the home during the inspection to carry out an Care Homes for Adults (18-65 years) Page 24 of 38 Evidence: audit of the medication systems and try to establish whether there were any failures in these systems that could be contributing to the recent medication errors reported to CQC. We did not find any major failings in the systems that would account for the errors being made however we found that some practices could be improved. We found that the management team had already instigated some changes in order to reduce the risk of further errors. We found that the management team had already changed the staffing model for each of the houses so that there was a permanent and consistent team working in them at all times. We found also that there were plans to install individual cabinets in the rooms of the people who lived at the Poplars. This was because it had been identified that the administration of medicines was being carried out at present within a very chaotic atmosphere as all of the people living in this home descended on the one location at the same time. We suggested that whilst the home was waiting for these cabinets to be installed the home could purchase a lockable container to transport the medicines to the rooms of each individual. The administration of the medicines could then take place in a more private and calming atmosphere. We found that the systems for the recording of the receipt administration and disposal of medicines were being carried out well and these records showed that people were receiving their medicines as prescribed. We found that the management team were carrying out regular audits to ensure that medicines were being administered properly. We found that some of the people using the service had been prescribed when required medicines. We found that additional information about the administration of these medicines was available in the form of protocols. We found however that these protocols did not contain enough information to ensure that the medicines would be administered appropriately and consistently by care staff. A number of discussions took place during the inspection on what information should be contained in these protocols. We found that a number of homely remedy preparation were available around the houses. We found that information about whether these preparations were safe to administer on an individual basis and did not interact with any of the persons prescribed medication was not available. The home was informed that now it was expected that homely remedies were only administered if the safety of the administration had been investigated on an individual basis rather than having a generalised homely remedy protocol. We found that when individuals went on external activities medicines they may have been required whilst away from the home were not being taken with the individual. We found that the policy and procedures document for the safe handling of medicines did not contain any guidance on how to manage these situations. A discussion took place on how these situations could be managed and the management team agreed to write a procedure to inform staff. We found that six members of staff who had recently been involved in the medication Care Homes for Adults (18-65 years) Page 25 of 38 Evidence: errors were on the day of the inspection attending a training course on the safe handling of medicines. We were told that following the training each member of staff would undergo a series of competency assessment before they were allowed to administer medicines again. The management team also had plans to ensure that all staff that were engaged in the administration of medicines completed the Certificate in the Safe Handling of Medicines within the next three to four months. We found that there was a Controlled Drugs cabinet located in each of the homes. We examined two of these cabinets and found that they complied with the Misuse of Drugs (Safe Custody) Regulations. We found that the home was recording the receipt administration and disposal of Controlled Drugs in a Controlled Drugs register. We found in one of the homes that a new supply of the Controlled Drugs was not being entered into the register until the previous supply had been completed. It was recommended that the home recorded the receipt of the Controlled Drugs as soon as they arrive on the premises in order to ensure that these medicines can be readily accounted for. We found that there was one fridge being used to store medicines that required cold storage conditions for all of the homes. We found that staff were measuring and recording the maximum and minimum temperatures of the fridge on a daily basis. We found that the temperature being recorded were not the same as the temperatures recorded by the pharmacist inspector on the day of the inspection. The home was recording the maximum temperature as being 5 degrees Celsius and the minimum temperature as being 2 degrees Celsius. The pharmacist inspector recorded the temperatures on the day of the inspection and found that the minimum was 0 degrees Celsius and the maximum was 22 degrees Celsius. We also found that after recording the temperatures the staff were not resetting the thermometer in preparation to record the temperatures over the next 24 hours. Care Homes for Adults (18-65 years) Page 26 of 38 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home can now feel more confident that the home operates with their best interests at heart as staff and managers are knowledgeable of the homes complaints procedures and local safeguarding processes to protect people from abuse. Staff now feel more confident to speak out if they have any concerns. Evidence: Since the time of our last visit the interim manager, and now the home manager have worked hard to support staff to feel able to share concerns and speak out about poor or abusive practice within the home. Staff have received training to recognise and report abuse and the home continues to work openly with the local multi agency safeguarding team to investigate referred incidents. All staff who spoke with us on the day of our inspection were aware of complaints and safeguarding adults procedures and said that they would be confident to recognise and report any incidents of abuse or poor practice within the home. This offers protection to the people living at the home to live safely and free from abuse. Likewise the home is now taking prompt and robust action following allegations of abuse and incidents that occur within the home where peoples health and welfare are put at risk. The home is currently working with the safeguarding team to investigate issues of institutional abuse within the home. Changes have been made as a result of this process to ensure peoples safety for the future. There have been no recent complaints made about the home. The manager is making Care Homes for Adults (18-65 years) Page 27 of 38 Evidence: contact with family members and health and social care professionals to improve communication with them and the home. As a result three people have already complimented the home on support provided to their relatives. Care Homes for Adults (18-65 years) Page 28 of 38 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at Loppington House are provided with a safe place to live however planned refurbishment and redecoration will make the houses nicer places to live. Evidence: Since the time of our last visit the organisation that owns Loppington House has identified money to refurbish the home and has started work to redecorate the college. Some people have been supported to paint their living areas and new furnishing and pictures have been purchased to make all houses more homely. People told us that they liked the rooms that have been decorated. Bedrooms seen were warm, spacious and had been personalised. The laundry room in one house had been painted to make the walls washable and thus more hygienic. The manager is working to produce a list of repairs and refurbishment tasks. She said that senior managers have committed the money to support these projects and are also providing some money to landscape the gardens. These improvements will make the houses nicer places to live. On the day of the inspection we found all houses that we visited to be clean and no hazards were identified although staff were reminded not to prop open fire doors to ensure peoples protection in the event of a fire. A recent outbreak of a virus within one of Care Homes for Adults (18-65 years) Page 29 of 38 Evidence: the houses was managed well. Staff told us that they managed to contain the outbreak and support people to get well soon, however the manager was advised to ensure that she notify the relevant parties of the outbreak to identify its origin. A recent visit from the Environmental Health officer resulted in the home being given an action plan to make the home more hygienic and the manager is working through these recommendations to improve standards of hygiene within the home making it a safer place for People to live. Care Homes for Adults (18-65 years) Page 30 of 38 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who live at Loppington House receive appropriate care and support from an increasingly better trained and committed staff team enabling their needs to be effectively met within the home. Appropriate pre employment checks on staff who work at Loppington House ensure that the home only appoints people who are suitable to work with vulnerable people Evidence: Since the time of our last key inspection of the home staff have received training to enable them to carry out their roles safely and effectively within the home and this has made people living at Loppington House safer and more consistently supported. Records show that the majority of staff have received all required training and staff told us that they feel they have the skills and knowledge to support people safely and competently. New staff told us that they received a thorough induction. There is now a plan in place for all staff to receive regular formal and informal supervision and support and staff spoke highly of the new manager and deputy manager who they Care Homes for Adults (18-65 years) Page 31 of 38 Evidence: say are approachable and reliable. This enables staff to feel valued and supported to provide a good service to the people living at the home. As a result morale is improving within the home and ultimately people are receiving a better service. Staff told us Staff respect service users and enjoy the relationships formed. The new managers seem to be doing things more quickly. Staff work with residents and fellow staff with dignity and respect. When we asked staff what had improved they said that training was better. One staff member said Training has improved 110 While recognising the homes improvements staff also thought there were a number of areas where the home could do better. All felt that more activities would mean that people could enjoy a better quality of life and staffing levels were still described as poor by some staff although the majority recognised they were improving. The manager said that she is monitoring staffing levels regularly. We did not find evidence that staffing levels are currently affecting peoples quality of life although some staff told us they were often rushed but we shared the managers conclusion that more staff would mean that more individualised activities could take place and this will ultimately enable people to lead fuller and more rewarding lives. There have been no staff recruited since the appointment of the new manager so we did not look at staff recruitment files during this visit . However when we visited in September 2009 we said that that we have been consistently satisfied that the home operates a thorough recruitment process to ensure that people who come to work at Loppington are suitable for the work they are to do. We consider that this process is still operated safely to protect vulnerable people. Care Homes for Adults (18-65 years) Page 32 of 38 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at Loppington benefit from the home being supported and monitored by a competent and knowledgeable manager. The health, safety and welfare of people living at Loppington House is now being promoted and protected enabling people to be safe in their homes Evidence: Over the last twelve months we have had concerns about the overall management of Loppington House however the home is now being managed by an experienced and well qualified manager who has already made a positive impact on staff morale. She has a good understanding of person centred planning processes and is committed to ensuring that people, for the future, receive an individualised serviced tailored to their assessed care and support needs. This will mean that people living at Loppington House will be able to enjoy a better quality of life. The manager is aware of the strengths of the home and also the areas where improvements are needed. Staff speak highly of the manager and have confidence in her Care Homes for Adults (18-65 years) Page 33 of 38 Evidence: abilities to make Loppington a fun place to live and work. During our visit she interacted well with people living at the home suggesting that she is approachable. The home is supported by a senior management team who monitor the quality of the service provided and identifying action points for improvements. The manager feels well supported by the organisation and said that she received a good induction to the home meaning she is aware of processes used by the organisation. This enables her to better monitor staff practices and offer consistent support to her team. The home is now taking prompt action when staff do not follow policies and procedures and this will demonstrate the organisations commitment to ensuring that staff have a responsibility to work safely and professionally at all times. We looked at records of incidents that have happened within the home and saw that the manager now looks at all of these and takes action when changes to plans or work practices need to be made. This means that she can be sure that people are supported safely and consistently. The home has a fire risk assessment in place to support people living at the home and staff in the event of a fire. Records seen were up to date showing that processes are checked regularly to ensure that they work properly. Care Homes for Adults (18-65 years) Page 34 of 38 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 35 of 38 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 18 12 The home must ensure that 19/03/2010 people can be supported safely at all times (in relation to moving and handling people) This is to ensure the safety of people receiving a service and the staff supporting them. 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 20 Medicines that need storing in a fridge should be stored at between 2 and 8 degrees Celsius. The maximum and minimum temperatures should be accurately measured on a daily basis. Information about the administration of when required medicines needs to be improved to ensure that the administration of these medicines is effective and 2 20 Care Homes for Adults (18-65 years) Page 36 of 38 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 safeguards the individuals concerned. 3 20 The administration of homely remedies should only be carried out when staff have documented information that the homely remedy will not interfere with any prescribed medication for that particular person A system should be developed to ensure that people who use the service are able to have their medicines administered when they are away from the home on an external activity. The policies and procedures document should reflect the system that is adopted by the home. 4 20 Care Homes for Adults (18-65 years) Page 37 of 38 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 © (2010) Care Quality Commission (CQC). 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