Care Home: Loriner Place (49)

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What the care home does well People using the service expressed positive comments about living at Loriner Place and said they were happy there. People using the service are thoroughly assessed prior to admission and are given opportunity to visit the service beforehand to ensure it meets their needs. There is good regard for the diverse needs of the people living at the service and their requirements related to their disabilities, lifestyle choices and personal preferences are sought, recorded and met by the staff team, respecting their rights, choices and individuality. Activities are available to people using the service to provide them with stimulation and contact with family, friends and the community is supported to maintain social links. Food is well prepared and presented attractively to make sure that nutritional needs are met and respecting people`s preferences. The health and personal care needs of people living at the service are well met, promoting health and well-being, taking into account their preferences and ensuring that they receive medication in a safe and consistent manner. Complaints and safeguarding are effectively managed to listen to views of people who live at the service and reducing the risk of harm to them. The premises are clean, well decorated and adequately maintained, promoting a positive environment for the people who live there. The service provides staff cover to meet needs and undertakes thorough recruitment procedures, coupled with effective training to ensure staff have the right skills and competencies to support the people who live there. The management and administration of the service promotes continuity and quality of care for the people who live there and ensures that risk is safely managed to reduce the likelihood of injury or harm. What has improved since the last inspection? No requirements were made at the last inspection. What the care home could do better: Safeguarding training needs to be brought up to date, where applicable, to make sure staff skills are refreshed. Key inspection report Care homes for adults (18-65 years) Name: Address: Loriner Place (49) 49 Loriner Place Downs Barn Milton Keynes Bucks MK14 7PU     The quality rating for this care home is:   three star excellent 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: Chris Schwarz     Date: 2 1 0 1 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 29 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 29 Information about the care home Name of care home: Address: Loriner Place (49) 49 Loriner Place Downs Barn Milton Keynes Bucks MK14 7PU 01908201985 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): www.fremantletrust.org The Fremantle Trust Name of registered manager (if applicable) Type of registration: Number of places registered: care home 7 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 7 The registered person may provide the following category/ies of service only: Care home only - 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 Date of last inspection Brief description of the care home 49 Loriner Place is a service registered for seven adults with learning disabilities. The building was originally built as two separate semi-detached homes and has been converted into one dwelling. The service is situated on a residential estate in Milton Keynes within easy access of the city centre, which is approximately one mile away. There is a wide range of shopping, leisure and recreational facilities in the city centre. Milton Keynes has good public transport networks and service users have access to all Care Homes for Adults (18-65 years) Page 4 of 29 Over 65 0 7 Brief description of the care home modes of transport. Service users also use taxis and buses, as and when required. Fees for the service were £553.98 per week. Care Homes for Adults (18-65 years) Page 5 of 29 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: three star excellent service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This unannounced key inspection was conducted over the course of a day from 9.35 am until 3.20 pm and covered all of the key National Minimum Standards for younger adults. The last key inspection of the service took place on 24 May 2007. Annual Service Reviews took place in 2008 and 2009 and concluded that good standards of care were continuing to be provided at the service. Prior to this inspection, a detailed self-assessment questionnaire, the Annual Quality Assurance Assessment (AQAA), was sent to the manager for completion. It provided a good standard of information about the service and statistical information needed to plan the visit and assess standards of care being provided. Surveys were sent to a selection of people living at the service, staff and visiting professionals. We received completed surveys from five staff and seven service users. Information received by the Commission since the last inspection was also taken into Care Homes for Adults (18-65 years) Page 6 of 29 account. The inspection consisted of discussion with the manager and other staff, opportunities to meet with people using the service, examination of some of the required records such as care plans, staff recruitment files, training records and risk assessments, observation of practice and a tour of the premises. A key theme of the visit was how effectively the service meets needs arising from equality and diversity. Feedback on the inspection findings and areas needing improvement was given to the manager at the end of the inspection. The manager, staff and people who use the service are thanked for their co-operation and hospitality during this unannounced visit. Care Homes for Adults (18-65 years) Page 7 of 29 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. Care Homes for Adults (18-65 years) Page 8 of 29 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 29 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 29 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service are thoroughly assessed prior to admission and are given opportunity to visit the home beforehand to ensure it meets their needs. Evidence: We were advised in the Annual Quality Assurance Assessment that the service had a statement of purpose and service users guide in place, in formats accessible to people using the service. The process of assessing prospective service users was described as being thorough and offered people opportunities to visit, meet the current service users and to ask questions. We were told that a full assessment of needs would be undertaken by staff including needs arising from equality and diversity. We were advised that the views of the person and the service user group are noted. Placements are then reviewed after six weeks. We were advised that each person has a contract. Statistical information provided by the manager showed that there had been one new admission in the past year. A statement of purpose was in place at the service, which had been updated this month. It provided a wide range of information for prospective users and their families Care Homes for Adults (18-65 years) Page 11 of 29 Evidence: or representatives. There was also a well designed service users guide produced in picture and plain text format to give people a good idea of what to expect of life at Loriner Place. Service users had their own copy of the service users guide in their rooms. Pre-admission records for the person newest to the service were looked at. These showed that information had been received from the local authority care manager to outline needs and the reason for the placement. A full care needs assessment had also been undertaken by the manager and was dated and signed. There was a record of the placement being reviewed and confirmed as permanent. The service user was met during the course of the inspection and said she was happy living at Loriner Place. Most service users said in surveys that they had been asked if they wanted to move into this service and had received enough information about it to help decide if it was the right place for them. During the inspection, one of the service users showed us a talking and photographic version of the service users guide which had been produced. Care Homes for Adults (18-65 years) Page 12 of 29 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is good regard for the diverse needs of the people living at the service and their requirements related to their disabilities, lifestyle choices and personal preferences are sought, recorded and met by the staff team, respecting their rights, choices and individuality. Evidence: We were advised in the Annual Quality Assurance Assessment that person centred plans were in place for each person and that these had been developed with service users involvement and input from their key workers. We were told that these are kept updated and reviewed as necessary. We were also informed that risk assessments were in place to support people to take responsible risks. We were told that service users have helped develop a service users rights document and that they are consulted about how the service is run and have opportunities to voice their opinions. Care plans were in place for each person. Each service user had a corporate care plan which covered areas such as a pen picture, essential health information, aids and Care Homes for Adults (18-65 years) Page 13 of 29 Evidence: equipment needed, mobility, communication, washing and bathing, continence, food, drink and meal times, personal grooming and dressing, going to bed and getting up, social skills, finance issues, family and spiritual beliefs, leisure and recreation and cultural issues. Behavioural guidelines were in place where needed and assessments for managing identified risks such as using transport, likelihood of developing pressure damage and nutritional screening. These assessments had been kept under review and updated where necessary. The care plan of a service user with higher care needs had recently been updated to reflect changing needs. Service users also had photographic versions of their care plans which they were going to produce in talking and picture versions. People spoken with during the inspection said they can make decisions about what they do each day and at weekends. They said that residents meetings take place to discuss a range of issues and that they felt they were consulted about the running of the service. Records showed that seven meetings had taken place so far this year. Service users said they were also looking forward to producing the talking versions of their care plans. Things they considered were managed well included I have one to one support during the day, looks after all the service users and gives us support, activities, cleans my bedroom, and everything. Staff said in surveys that they are always given up to date information about the needs of the people they support. Care Homes for Adults (18-65 years) Page 14 of 29 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. Activities are available to people using the service to provide them with stimulation and contact with family, friends and the community is supported to maintain social links. Food is well prepared and presented attractively to make sure that nutritional needs are met and respecting peoples preferences. Evidence: We were advised in the Annual Quality Assurance Assessment that people are supported to enjoy activities of their choice and are supported by staff to go on one to one holidays. Peoples interests and routines were said to be noted in their care plans and we were told that the service promotes them being involved in all areas of their lives and to be independent. Mealtimes were described as relaxed and social occasions and we were advised that service users are given guidance on eating a balanced, healthy diet. Statistical information showed that nutritional screening is carried out on all people admitted to the service and that action is taken to meet the needs of people Care Homes for Adults (18-65 years) Page 15 of 29 Evidence: at risk of malnutrition. People using the service said they have contact with the community, such as local shops, facilities in the city centre and one said she travels into the city independently by bus to go to her job as a voluntary worker. People confirmed that they attend day services during the week and have access to their family and friends without restriction. Several people spoke about holidays they had enjoyed, either arranged by the service or their families. One person said he goes to church nearby. In the surveys we received back, service users said the service could improve by more trips to Blackpool, buy new games and more interesting things for me to do. The routines of the service were flexible and unrushed. One person who had gone out for the day had locked her room to keep her room private. People could choose whether to be alone or in company and had unrestricted access around the building. People using the service said they liked the food and took part in shopping and meal preparation. Menus were being maintained with the current one pinned to the fridge. The manager advised that she is looking to set up a pictorial menu to make it more accessible to people. One of the service users was heard being asked what he would like for his lunch and this was provided, with staff joining him for a social and pleasant occasion. Nutritional needs had been assessed with copies of the assessments in care plan folders. One person was receiving a liquidised diet to meet her needs. The freezer was well stocked with a range of foods. Fresh fruit was available in the dining room. Care Homes for Adults (18-65 years) Page 16 of 29 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care needs of people living at the service are well met, promoting health and well-being, taking into account their preferences and ensuring that they receive medication in a safe and consistent manner. Evidence: We were advised in the Annual Quality Assurance Assessment that peoples health and personal care needs and dietary requirements were recorded in their care plans and that last wishes were recorded. Support from staff was described as being flexible to meet peoples needs with specialist advice sought where necessary. People using the service were said to be encouraged to manage their own health care and, where possible, their own medication. We were advised that people have access to community health care facilities and home visits are arranged where necessary. Training for staff on health related topics was said to take place. We were advised that there are policies in place for managing medication and that the service has a good track record of managing medicines safely. The manager advised us that staff receive training on handling medicines and that she audits medication practice. People spoken with during the inspection said they are supported to attend health care Care Homes for Adults (18-65 years) Page 17 of 29 Evidence: appointments when they need to, such as one person who was supported to go to the doctor on the day of this visit. Care plans provided a very good outline of peoples health and personal care needs and how these were to be met, with evidence of review and amendment. Service users had been supported to look clean, tidy and wear co-ordinating clothes. Correspondence on the files showed that people had been referred to specialists such as the dietician, occupational therapist and consultant in learning disabilities and records were being kept of appointments attended, and the outcomes. Records were being kept of peoples weight and aids and equipment to daily living were provided as necessary. In line with increased needs for one person, the service had purchased a hoist, profiling bed and safety mats. The manager had also swapped the office and the persons bedroom to be able to provide more space for the service user and for safe use of moving and handling equipment. Medication was being managed using a monitored dose system. Medication was kept in each persons room in lockable facilities. Medication administration records were being maintained appropriately; there was a query over one persons weekend medication where it was not clear if one dose had been taken, which the manager said she would look into. Care plan files provided information on the medicines people were prescribed and use of any as required medicines. A medication audit record was seen in one of the service users files looked at, dated December 2009. Staff training records showed they receive input on the safe handling and administration of medicines. Records also showed courses attended on diabetes, arthritis, dysphagia and epilepsy. Care Homes for Adults (18-65 years) Page 18 of 29 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. Complaints and safeguarding are effectively managed to listen to views of people who live at the service and reducing the risk of harm to them. Evidence: We were advised in the Annual Quality Assurance Assessment that the service had policies and procedures in place to safeguard service users and that there is a complaints procedure in place. The manager told us that service users have developed a document in photograph format about how to make a complaint and that one was being developed on safeguarding. We were told that safeguarding training is included in the induction programme for new staff and updated in-house, training was also said to be provided on responding to challenging behaviour. We were told that there is also a whistle blowing procedure in place. We were advised that the views and experiences of people using the service are valued and that families are also given opportunity to comment on the quality of care in consultation meetings. Statistical information showed that there had not been any complaints during the past year; eight safeguarding referrals had been made. We had been made aware of each safeguarding referral at the time it occurred. People spoken with during the inspection said they would speak with the manager if they were unhappy about anything and that she would listen and act on what they said. One person described a situation which had been resolved satisfactorily. Staff said in surveys that they knew what to do if anyone had any concerns about the Care Homes for Adults (18-65 years) Page 19 of 29 Evidence: service. There were procedures for making a complaint in the operations manual in the office, in the service users guide and statement of purpose, including accessible versions for people using the service. A log book was in place to record any complaints although the service had only received compliments about quality of care since the last inspection. There was a safeguarding procedure in place and people using the service had a pictorial version to explain about abuse in their copies of the service users guide. There was a copy of the local authority inter agency safeguarding procedures in the office to refer to. Discussion took place with the manager about the safeguarding incidents we had been informed of, which mostly related to incidents of challenging behaviour. Referral had been made to the community team for people with learning disabilities for support and advice. It was acknowledged that there had not been any further incidents. In the sample of staff training records that was looked at, staff had not attended a safeguarding update since 2008. It had been identified in the quality audit of April 2009 that an update was needed although there was no record to show that it had been actioned. The manager agreed to address this. Training records showed that staff receive input on responding to challenging behaviour. Management of peoples money was looked at. Each person had a wallet held for safekeeping with larger sums held in the safe. A sample of wallets and records was checked and found to be in good order with each balance tallying with the records. Recruitment practice at Loriner Place was seen to be robust enough to make sure that thorough checks were carried out on staff before they started working at the service. Care Homes for Adults (18-65 years) Page 20 of 29 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The premises are clean, well decorated and adequately maintained, promoting a positive environment for the people who live there. Evidence: In the Annual Quality Assurance Assessment we were advised that the service has a warm and friendly atmosphere which is kept clean and homely. We were told that rooms are well decorated and modern and that people using the service have taken ownership of the garden and how it is planted. We were told that bedrooms have been personalised and that people have keys to their rooms. The manager told us that people using the service are supported to use kitchen and laundry equipment and to take part in household chores. We were told that there are maintenance and redecoration programmes for the building and that health and safety checks are undertaken. Statistical information showed that the service had an action plan to deliver best practice in the prevention and control of infection and that all staff had received training on infection control. The service is located close to the city centre on a residential estate and blends in with other properties. Accommodation downstairs consists of a bedroom, two shower rooms with toilets, the lounge, dining room, laundry, the office and kitchen. There are two sets of stairs to the first floor, one has a stair lift fitted for anyone with mobility Care Homes for Adults (18-65 years) Page 21 of 29 Evidence: difficulties. There are a further six single bedrooms and two bathrooms with toilets upstairs. All parts of the building were clean and had been arranged to look and feel homely. Service users had personalised their rooms to reflect their interests and tastes. At the front of the building there are parking spaces for four cars. There is an enclosed garden at the rear which was well maintained and had seating areas. The manager had identified some areas of the building that needed upgrading to improve facilities and had recently received quotes for this work. Cleaning products were kept locked away when not in use. Kitchen, laundry, bathroom and toilet floors had impermeable flooring to make sure they could be kept in a hygienic condition. There were no odours around the building. Cleaning products were kept locked away when not in use. People using the service said they take part in household chores and one person assisted with some food shopping on the day of the visit. In surveys, they said the premises are always kept fresh and clean. One person said the service could improve by bigger rooms, swimming pool. Care Homes for Adults (18-65 years) Page 22 of 29 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 service provides staff cover to meet needs and undertakes thorough recruitment procedures, coupled with effective training to ensure staff have the right skills and competencies to support the people who live there. Evidence: We were told in the Annual Quality Assurance Assessment that the staff team contained six permanent workers, four of whom had achieved National Vocational Qualification at level 2 or above. The manager confirmed that satisfactory recruitment checks had been undertaken for all staff and that there was a staff development programme that met the National Minimum Standards for the service. We were advised that there are regular relief staff who cover gaps in the rota. We were advised that staffing levels met the needs of people using the service and that the rota was arranged flexibly to meet changing needs and busy times of day. The manager said training was being kept up to date and that there are regular staff meetings and staff supervision sessions. People spoken with during the inspection said that staff were kind, friendly and helpful and that there was always someone around if they needed any support. This was confirmed in survey feedback too. One person said I am very happy here and I like all the staff. Care Homes for Adults (18-65 years) Page 23 of 29 Evidence: Staff said in surveys that their employer carried out checks before they started work, such as Criminal Records Bureau clearance and references. They said their induction had covered the areas they needed to know about and that they are given training which is relevant to their role, helps them to understand and meet the individual needs of people, keeps them up to date with new ways of working and gives them enough knowledge about health care and medication. Staff said they receive enough support from their manager and meet to discuss how they are working. They considered the ways in which information is shared worked well and that there were enough staff to meet the individual needs of people using the service. Staff considered they had enough support, experience and knowledge to meet the different needs of people who live at Loriner Place such as needs arising from equality and diversity. Things they felt were managed well included good team work, always putting residents first and provides a friendly, homely environment for all service users. Puts service users needs first and informs and consults service users of any changes that affect their lives. One added I am very proud to be working at Loriner and would recommend it to friends and family as it provides a very high standard of care to the service users. Another comment made by a staff member was the care given to service users is excellent, that is partly because of the team work that carers have. One person said the service could improve by seeking better ways to communicate with service users. Two new staff had started at the service since the last inspection. Records showed that thorough recruitment checks had been carried out including completion of an application form, two written references, a check of immigration status where applicable, health clearance and satisfactory Criminal Records Bureau clearance. Training records for three staff were looked at and were seen to be in good overall order. As referred to earlier in the report, there was a need to show that safeguarding training had been updated. A couple of certificates needed to be added to files to back up entries on the training matrix. A staff rota was being maintained to cover the twenty four hour day. Staff on duty were friendly and helpful. The manager confirmed that no external agency staff were being used to cover any gaps on the rota. The provider has its own staffing agency which it uses where any cover is required. Care Homes for Adults (18-65 years) Page 24 of 29 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management and administration of the service promotes continuity and quality of care for the people who live there and ensures that risk is safely managed to reduce the likelihood of injury or harm. Evidence: In the Annual Quality Assurance Assessment the manager told us that she has the necessary qualifications and experience to run the service and holds a National Vocational Qualification level 4, the Registered Managers Award and National Vocational Qualification Assessors Award. She informed us that she keeps her own development needs up to date. She told us that for part of the week she is included in the care rota which enables her to supervise and monitor care practices. She advised us that there is administrative support for the service and that the service has had an external financial audit. We were advised that the service is monitored by the provider and that quality auditing takes place. Policies and procedures were said to be in place to provide guidance to staff and the manager said that records were of a good standard. Statistical information showed that there is regular maintenance of equipment, such as electrical hard wiring, portable electrical appliances, the fire alarm Care Homes for Adults (18-65 years) Page 25 of 29 Evidence: and fire fighting equipment and gas appliances. The manager said there were written assessments on hazardous substances and that all permanent staff had received training in safe food handling. There had been a temporary change of manager at the service since the last inspection, with the current manager returning at the end of November 2009. People using the service said it was good to have her back. She had obtained the necessary forms to apply to register again as manager for Loriner Place. Throughout the inspection, the manager promoted person centred care and best practice and had drawn up a list of areas for improvement since she returned in November, which she was working through. The Annual Quality Assurance Assessment had been completed to a good standard. A compliment from a relative included I have had regular contact with Jackie who has always dealt with any issues I may have had, promptly and professionally. I understand this home has an excellent reputation, may this continue. The certificates of registration and current employers liability insurance were displayed on the wall in the office. Reports were available of monitoring visits undertaken by the provider to assess quality of care and a sample of these was read. A quality audit had been undertaken in April 2009. A food and nutrition audit also took place in August 2009. The service had a current gas safety certificate and electrical hard wiring certificate. Portable electrical appliances had been checked in February 2009 and water had been checked for Legionella and another micro-organisms in July 2009. The service had appropriate arrangements for the disposal of clinical waste and a pest control contract was in place. Accidents were being recorded and there were regular, routine health and safety checks such as hot water temperature monitoring. Staff training on health and safety related topics was in good order. Care Homes for Adults (18-65 years) Page 26 of 29 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 27 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 28 of 29 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 29 of 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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