Care Home: Loveys Lodge

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What the care home does well People living in the home told us in their surveys that: `I like to go out and this usually happens. At weekends I like to see my family and this happens most weekends`, and `staff are always ready to listen and offer me time`.Staff told us that: the home `communicates very well` and there are regular staff meetings, we `treat all residents as individuals and as much as possible maintain the individual things they like to do`, the home `provides a homely existence for the clients as much as possible`, `the home works hard to ensure that the needs of the residents are metand that they are well cared for`, `we work well as a team, share information, maintain a high standard of care for the residents`, and `Loveys Lodge is a residential home that offers a high standard of care, puts the residents first and the staff work well together`.We found that most of the people living in the home had been there since it opened and a number of the staff have worked at the home for a few years or have known the people living there for a long time. As a result, staff know the people living in the home very well and understand their preferred styles of communication.It is a small home providing a relaxed and homely atmosphere. The registered provider, the registered manager and the staff team appear to work well together focusing on providing quality outcomes for the people living there. When things are needed, they are provided, or there is a plan in place to improve things on a priority basis. Staff try to provide consistency of care by covering any vacant shifts themselves, rather than using agency staff.The home has kept its 2 star/good rating. What has improved since the last inspection? All the requirements from the last inspection report have been met. The manager is trying to make information easier to understand for people living in the home and has started by introducing a photo board so that people know which staff are on duty.There are also plans to make picture menus. Staff have helped people living in the home to make life story books which contain lots of useful information and photographs all about them. The registered provider and manager are looking at how well the home is run and looking at new ways to see if there are any improvements that need to me made.The home`s policies and procedures have also been reviewed. The home has joined a dental `smile award` which encourages people to look after their teethand to eat more healthily.A new summer house has been built in the garden which has created more space for people living in the home.New technology has been introduced within the home to help people to stay in touch with their families - even if they live in another country. What the care home could do better: We think that this is a good service but we think that that the home could do even more by supporting people to learn new skills and build on the ones they already have.We also think that more work could be done to update some of the paperwork and to make more information easy to understand for people who cannot read. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Loveys Lodge 14 Beresford Road Bedford Bedfordshire MK40 3SD 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: Rachel Geary Date: 0 8 0 9 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. 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 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 41 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (20092008) 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 41 Information about the care home Name of care home: Address: Loveys Lodge 14 Beresford Road Bedford Bedfordshire MK40 3SD 01234214942 01234241942 loveyslodge@tiscali.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Mr Brian Taylor care home 4 Number of places (if applicable): Under 65 Over 65 4 4 0 0 learning disability physical disability Additional conditions: Date of last inspection Care Homes for Adults (18-65 years) Page 4 of 41 A bit about the care home Loveys Lodge is a residential care home for people whose primary care need on admission is a learning disability. The home is registered to accommodate up to four adults of either gender. The home is a two storey semi-detached house with communal space consisting of a lounge, dining room and separate kitchen. There are four single bedrooms - one is on the ground floor and has its own shower. There is a toilet on the ground floor and a bathroom with toilet, Care Homes for Adults (18-65 years) Page 5 of 41 bath and overhead shower on the first floor. An office which doubles as the staff sleeping in room is also located on the first floor. Parking is available at the front of the house and there is an enclosed garden to the rear, which includes a good size summer house. There are plans to develop this into a sensory facility in the future. The home is situated on a quiet street near to Bedford Town centre. It is close to the river, parks and other local amenities including shops, cinema, Care Homes for Adults (18-65 years) Page 6 of 41 restaurants, pubs, places of worship and transport links. The people currently living in the home have agreed to share the cost of a vehicle and staff use this to drive them to where they need to go to. The home would not be able to cater for people who use a wheelchair or people who would have difficulty in managing the stairs. The fees for this service currently range from £1005.14 to £1009.78. Care Homes for Adults (18-65 years) Page 7 of 41 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home Care Homes for Adults (18-65 years) Page 8 of 41 How we did our inspection: This is what the inspector did when they were at the care home A key inspection is a thorough type of inspection when we look at all of the key aspects of a service. For this key inspection, we looked at all the information that we have received or asked for since the last inspection of this service on 26th October 2007. This included surveys which we sent to the home to give out to people who live there and staff. We received 3 surveys back from people living at the home, some of whom received help from a family member to Page 9 of 41 Care Homes for Adults (18-65 years) complete them, and 6 surveys from members of staff. We looked at information that we received from the home. This is information about the service that the home has to tell us about by law. We also looked at information that we asked the home to send us following our visit. We carried out an unannounced visit to the home on 8th September which lasted about 7 hours. Care Homes for Adults (18-65 years) Page 10 of 41 During the visit to the home we met all of the people who live there. Some people were able to talk about what it is like to live at the home. Some people did not use words to communicate, so we observed the way that the staff were supporting them. We also looked at some of the paperwork that the home has to keep such as care plans, risk assessments, staff records, menus and health and safety records. What the care home does well Care Homes for Adults (18-65 years) Page 11 of 41 People living in the home told us in their surveys that: I like to go out and this usually happens. At weekends I like to see my family and this happens most weekends, and staff are always ready to listen and offer me time. Staff told us that: the home communicates very well and there are regular staff meetings, we treat all residents as individuals and as much as possible maintain the individual things they like to do, the home provides a homely existence for the clients as much as possible, the home works hard to ensure that the needs of the residents are met Care Homes for Adults (18-65 years) Page 12 of 41 and that they are well cared for, we work well as a team, share information, maintain a high standard of care for the residents, and Loveys Lodge is a residential home that offers a high standard of care, puts the residents first and the staff work well together. We found that most of the people living in the home had been there since it opened and a number of the staff have worked at the home for a few years or have known the people living there for a long time. As a result, staff know the people living in the home very well and understand their preferred styles of communication. Care Homes for Adults (18-65 years) Page 13 of 41 It is a small home providing a relaxed and homely atmosphere. The registered provider, the registered manager and the staff team appear to work well together focusing on providing quality outcomes for the people living there. When things are needed, they are provided, or there is a plan in place to improve things on a priority basis. Staff try to provide consistency of care by covering any vacant shifts themselves, rather than using agency staff. Care Homes for Adults (18-65 years) Page 14 of 41 The home has kept its 2 star/good rating. What has got better from the last inspection All the requirements from the last inspection report have been met. The manager is trying to make information easier to understand for people living in the home and has started by introducing a photo board so that people know which staff are on duty. Care Homes for Adults (18-65 years) Page 15 of 41 There are also plans to make picture menus. Staff have helped people living in the home to make life story books which contain lots of useful information and photographs all about them. The registered provider and manager are looking at how well the home is run and looking at new ways to see if there are any improvements that need to me made. The homes policies and procedures have also been reviewed. The home has joined a dental smile award which encourages people to look after their teeth Care Homes for Adults (18-65 years) Page 16 of 41 and to eat more healthily. A new summer house has been built in the garden which has created more space for people living in the home. New technology has been introduced within the home to help people to stay in touch with their families - even if they live in another country. What the care home could do better Care Homes for Adults (18-65 years) Page 17 of 41 We think that this is a good service but we think that that the home could do even more by supporting people to learn new skills and build on the ones they already have. We also think that more work could be done to update some of the paperwork and to make more information easy to understand for people who cannot read. If you want to read the full report of our inspection please ask the person in charge of the care home Care Homes for Adults (18-65 years) Page 18 of 41 If you want to speak to the inspector please contact Rachel Geary 33 Greycoat Street London SW1P 2QF 02079792000 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 19 of 41 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 20 of 41 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective users of the service have the information they need to make an informed choice about where they live, and admissions are not made to the home until a full needs assessment has been undertaken. Evidence: The manager provided us with copies of the homes most recent Statement of Purpose and Service User Guide. We made some minor recommendations about providing further information within these documents, but on the whole they contained some comprehensive and useful information for current and prospective users of the service. The Service User Guide however had not been produced in a format suitable for the people for whom the home is intended - we were told that some of the people living in the home could not read. It is acknowledged that the current group of people living at Loveys Lodge have all lived there since 1996/7 when the home opened, and there have been no new admissions since this time. Information about the homes admission procedures can be found in the Statement of Purpose. Care Homes for Adults (18-65 years) Page 21 of 41 Evidence: Each person living in the home had a Health and Social Care Assessment, which contained some comprehensive information and demonstrated that individual needs and aspirations are assessed by the home. A written contract/statement of terms and conditions was in place for each person living in the home too. The ones that we looked at had not been updated for a while. This was discussed with the manager at the time about ensuring that contracts reflect any current terms/conditions, fees charged by the home and any cost of facilities that are not covered by the fees. Care Homes for Adults (18-65 years) Page 22 of 41 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 are person centred and staff understand the preferred communication style of each person living in the home. The management of risk in the home is also positive. Evidence: Care plans were in place which provided up to date and clear information about the health, personal care, social, independent living and day care needs of the people living in the home. The plans we saw were not user friendly however and had only been signed by staff from the home, so there was no evidence that the plan had been reviewed with the person and/or significant people with an interest in their well being. However there was evidence of family involvement in other records, and of family members advocating on behalf of some of the people living in the home. There was also evidence of annual reviews taking place which involved the relevant funding authority and family members. Individual PCPs (person centred plans) were in the process of being developed. We were told that these were being designed more as life stories. The PCPs that we saw, contained communication passports, achievement certificates, lots of photographs and Care Homes for Adults (18-65 years) Page 23 of 41 Evidence: memorabilia from outings and special occasions. There was some written information included too. The home might want to look at ways to try to make this more accessible because we were told that some of the people living in the home could not read. PCPs were being held by staff in the office. We were told that this was because some people might damage them if they looked after them themselves. It was discussed that the home might need to look at different ways of promoting ownership of these documents. Three of the four people living in the home did not communicate verbally and both of the two files that we looked at had communication passports which provided clear information about the communication support people needed in order to make decisions about their own lives. Another person was seen using a communication aid in the form of a small book which contained useful pictures and symbols. We observed during the course of the inspection that staff knew the people living in the home very well, and were able to understand their individual needs and responded appropriately. We saw a Quality - risk assessment and corrective actions sheet which had been developed to list actual and potential risks to the people living in the home, staff and other stake holders. We were told that this document would be live from 1st October 2009 and would involve both the registered manager and registered provider. A number of individual risk assessments were in place for people living in the home. These included areas such as the use of the stairs, interaction with others, any specific behaviours, kitchen access, going out, transport and outings. The information we read was concise, but in the main supported people by promoting safe practice rather than imposing restrictions upon them. It was discussed with the manager that this could be enhanced further by identifying and breaking down small tasks to work on with each person living in the home, to build on and develop their independent living skills. There was evidence that risk assessments were regularly reviewed and updated as required. Care Homes for Adults (18-65 years) Page 24 of 41 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 are involved in meaningful daytime activities based on their individual interests, diverse needs and capabilities. People are encouraged to maintain family links and individual rights are respected. Evidence: Care plans made reference to independent living skills but then recorded statements like encourage (the person) to make choices for herself. There was nothing specific to show what the home was supporting people to learn or to make choices about - or any particular way to measure any achievements. We spoke to the manager about this and she was able to describe some of the things that people living in the home had learnt to do for themselves but these had not necessarily been recorded. We arrived at lunch time and found that two of the people who live at Loveys Lodge were at home. The registered provider and manager were also present as well as another member of staff. We were told that people do attend day care but can also spend days at home pursuing their own interests. Records indicated that funding had been agreed for one person to increase the number of days they spend at home each Care Homes for Adults (18-65 years) Page 25 of 41 Evidence: week but the home was still waiting for this funding to be released. Staff told us that they were looking to increase the options already available to people on their days at home including a new swimming facility and a local leisure centre. There was evidence of peoples rights being respected by staff. For example one person preferred to be called by their middle name and all the records we saw reflected this. And records indicated that people living in the home often went to their bedrooms very early in the evening - around 6pm. The manager said that this was their choice. On the day of the inspection, 2 people were helped to bath and get into their night wear before the inspection finished at 6.50 pm. We heard one person asking for this to happen. We also heard one person living in the home making some loud verbal noises around this time. We were told that it was possible that this was one reason for some people choosing to go to their bedrooms early. The majority of the people living in the home are young adults so the home should keep this situation under review to ensure that people are making a positive choice to go to their rooms early and to ensure that options are made available to people to participate in evening activities on a regular basis. It is acknowledged that some people do attend evening activities from time to time, and that people can be very tired by the evening if they have been at day care all day. The manager told us that staff are on duty until 10 pm to support evening activities. Daily activity and observation records were being maintained for each person. Records for 1 person showed that they had recently done the following activities: day care, swimming, watching TV, visiting family, putting photos up in their room, aromatherapy, a ride out, a pub visit and using their tactile box in the new summer house in the garden. Some other activities that people had attended since our last inspection of this home included holidays away, an imagination and creation exhibition, trips to Wickstead Park, a Model Village, Blackpool, a Dancing on Ice show, The Black Country Living museum, Woburn Safari Park and Hunstanton. The manager told us that the house was planning another holiday for everyone in the near future. There was evidence that the home maintains a positive relationship with the relatives of people living there and that people are encouraged to have regular contact with their families. For example the home has supported people to travel to family occasions and to use new technology within the home to keep in touch with family abroad. Menus are planned by staff based on the known likes and dislikes of the people living in the home. The manager said they try to promote healthy eating in line with a dental smile award’ that the home is taking part in. Peoples likes and dislikes regarding food and drink had been recorded in their individual health and social care assessments which were seen on file. Menus were in a locked cupboard in the kitchen and were not pictorial or easy read. However, the homes Annual Quality Assurance Assessment (AQAA) told us that Care Homes for Adults (18-65 years) Page 26 of 41 Evidence: pictorial menus were in the process of being developed. The evening meal on the day of the inspection was corned beef cakes, chips, peas and cheesecake. We were told that people living in the home help with preparing drinks and snacks, but that currently people do not help with preparing hot meals because of the risks involved. Care Homes for Adults (18-65 years) Page 27 of 41 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. Personal health care needs are clearly recorded in each persons health action plan and personal support is responsive to the varied and individual needs of the people living in the home. Evidence: Comprehensive information about personal and healthcare needs was clearly recorded in each persons care plan and/or health action plan (HAP). There was evidence that the home supported people to access health care services on a regular basis and any concerns were being referred to appropriate specialists. Some attempts had been made to make HAPs easier to understand for people who cannot read. And although there was evidence that new information, for example about medical appointments and changes to medication, was being added to HAPs, records indicated that some of the information had not been reviewed for a while. The manager told us that people were taking part in a smile award which is a scheme aimed at promoting good dental hygiene and a healthy diet. As a result some changes had been made such as the purchase of sugar free drinks, and each person had a teeth cleaning chart in their file. Medication and medication administration records (MARs) were being stored in a Care Homes for Adults (18-65 years) Page 28 of 41 Evidence: medication cupboard in a kitchen food store cupboard - also near to the laundry and boiler cupboards. There was a window in this area, but the manager was advised to monitor the temperature to ensure that medication was always being stored at the correct temperature. We talked about medication with staff and were told that some people have their medication with food because they cannot take it with a drink. We saw someone getting ready to have their evening medication with some cereal. We were told that this was not being done in a covert manner, and that the home had requested Mental Capacity Act (MCA) capacity assessments specifically around medication to ensure that this practice was above board. MCA Assessments that we looked at stated that decisions needed to be made in the persons best interests as they did not have capacity to make decisions regarding medication. The manager told us that the home plans to request further general capacity assessments in the near future. Care Homes for Adults (18-65 years) Page 29 of 41 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. Systems are in place to protect people living in the home from harm and abuse. Evidence: A complaints procedure was in place and an easy read version was on display in the staff office. It did not contain contact details for anyone though, and was more about reassuring people that there was always someone there to help them. Information about how to complain had been included in the homes Service User Guide but this was not an easy read version. The Statement of Purpose did not include full details of the complaints procedure including who to contact and the timescales for dealing with complaints. The homes Annual Quality Assurance Assessment (AQAA) told us that no complaints had been received by the home in the last 12 months. We saw some records which highlighted some possible concerns relating to incidents involving one person living in the home. These were discussed with the manager who provided an explanation for each, suggesting that appropriate follow up action had been taken at the time but had not been recorded. In the case of one incident it was said that the word to describe something that had happened was not appropriate and that it did not reflect the reality of the described incident. The manager was advised to monitor records and to always record any follow up actions taken. Accident/incident records were being maintained in individual files. There was evidence Care Homes for Adults (18-65 years) Page 30 of 41 Evidence: that potential safeguarding of vulnerable adults (SOVA) matters were reported properly to the local authority who have a safeguarding responsibility for the people living in the home. There was some evidence of staff receiving SOVA training but records indicated that some people now needed a refresher in this area. We looked at the financial arrangements in place for people living in the home. Everybody had an individual bank account and the manager helped people with regard to managing personal monies and paying for things such as the home fees and transport costs. All of the people currently living in the home share a car and the payments towards this. Written agreements for this arrangement were seen, but needed to be updated to reflect the current monthly cost. Similarly, contracts for people living in the home needed updating to reflect the current cost of their care contribution. Monies that were checked were in order and the manager had a system for storing financial paperwork and larger amounts of personal monies on behalf of people living in the home. It was said that people could access the bulk of their monies through the manager or deputy manager. Care plans included information about the support each person needed with their finances, benefits and making contributions to the house fees. Care Homes for Adults (18-65 years) Page 31 of 41 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 environment meets the needs of the people who live there and is homely, clean, safe and comfortable. Evidence: The home is suitable for its stated purpose and can meet the needs of the people currently living there. It would not be suitable for anyone who might have a problem with stairs as the only bath, and the majority of the bedrooms, are on the first floor. We found the premises to be homely, comfortable, safe and clean. There was evidence that the manager and registered provider regularly checked the building and records of completed and planned maintenance and refurbishment works were seen. There was evidence that unplanned maintenance issues were responded to in a timely manner using a priority/risk based approach. Recommendations made by an Occupational Therapist - referred to in our last inspection report - had been actioned. The manager told us that some decoration and refurbishment works were due to take place. To minimize disruption to the people living in the home, this had been timed to coincide with a holiday that had previously been booked for everyone. A summer house had been built in the homes enclosed garden, providing some additional space for people living in the home. Some work had already been done to make this a comfortable area but further work was being planned to develop this into a sensory facility. Bedroom doors were lockable but had not been fitted with override Care Homes for Adults (18-65 years) Page 32 of 41 Evidence: devices. The manager said that no one currently used their keys. This will need to be reviewed on a risk assessed basis, if peoples needs change, or if new people are admitted to the home. Laundry equipment was in a cupboard beyond the kitchen. There was no hand basin in this area. We were told that 2 of the people living in the home used continence aids and that the home used red (water soluble) bags for laundry, as required. It is possible for staff to access the laundry area without walking through the kitchen - minimising the risk regarding the spread of infection. Care Homes for Adults (18-65 years) Page 33 of 41 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. On the whole, people living in the home are supported by competent and qualified staff. Evidence: Observations during the inspection indicated that staff had a good relationship with people living in the home. Some staff had known people for a long time and they were able to understand their needs and individual methods of communication. Support was provided in a respectful but friendly and relaxed way. The manager told us that were 2 unfilled staff posts. We were told that the staff team try to cover any additional shifts between themselves to promote consistency of care for the people living in the home. On the day of the inspection the manager worked a long day and another member of staff provided extra cover. A photo board had been developed to help people living in the home to know who was next on duty. There was evidence that the staff team worked well together and that there was a good working relationship between the manager and the registered provider. We looked at a sample of staff files to assess whether people living in the home were being protected through safe recruitment checks, training and regular supervision. We found recruitment checks were generally in good order although there was no written record for some anomalies seen on 1 persons file. The manager was immediately able to provide an explanation about this, indicating that this had been discussed with the Care Homes for Adults (18-65 years) Page 34 of 41 Evidence: person at the time. The manager was advised to always keep records of such discussions and to refer to the most recent guidance regarding the storage of criminal record bureau (CRB) disclosures. There was evidence that staff were completing relevant training courses but some of these had been attended a while back and people may now benefit from a refresher course. For example one person had completed some protection of vulnerable adults (POVA) training in 2001 - prior to them working in the home. The manager acknowledged this as an area needing further development. Other people had yet to complete training around the assessed needs of the people living in the home. There was evidence that staff supervision was taking place, but for the records we checked, this had only happened 4 to 5 times a year. The national minimum standards (NMS) for care homes for adults (18-65) state that recorded supervision meetings should take place at least 6 times a year. There was evidence that staff meetings were taking place. Care Homes for Adults (18-65 years) Page 35 of 41 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 manager has a clear understanding of the key principles and focus of the service and people living in the home benefit from a well run home. Evidence: The registered manager and registered provider were both present during this inspection. The manager has worked at the home since it opened in 1996. The registered provider was carrying out regular inspections of the home and compiling reports from these visits as required. We saw the most recent report which told us that the home had a contingency plan in place in the event of an out break of swine flu. In addition, a new quality and risk assessment form had been developed and was due to go live the following month. We were told that the purpose of the form was to identify any actual and potential risks regarding the environment, people living in the home, staff, other stakeholders, transport and medication. It was said that this would lead to a detailed correction plan with timescales. The manager sent us the homes Annual Quality Assurance Assessment (AQAA) when we asked for it. It was clear and gave us all the information we asked for. It was written in a person centred way and addressed a number of issues that have been included in this report - showing us that the manager has a good understanding of Care Homes for Adults (18-65 years) Page 36 of 41 Evidence: further improvements that could be made. A Quality Assurance policy was in place and there was evidence that the home sought feedback from other sources through annual surveys which are sent out to families/friends, day centres and staff. This had last been done in September 2008 and the manager told us that this years surveys were about to be sent out. One survey that had been completed by a day centre in 2008 stated that there was always good communication between Loveys Lodge and the (centre). The manager told us that there was no one living in the home who was subject to a (Mental Capacity Act) deprivation of liberty authorisation. Although the home had requested assessments to determine capacity in certain areas such as medication. The AQAA told us that the homes polices and procedures had recently been reviewed. There was evidence that the health, safety and welfare of people living in the home and staff was promoted and protected. For example we saw evidence from the local Environmental Health Authority who had previously noted good standards of hygiene within the home and still deemed the home to be low risk. We also saw up to date information which told us that the homes gas and electrical systems had been checked and deemed safe. There was also evidence that the home carried out its own checks on a regular basis regarding health and safety, emergency lighting systems and hot water temperatures - although it wasnt clear whether the water being tested was from a sink, a bath or the shower. This was discussed with the manager who agreed to make this clearer in the future. A fire risk assessment had been completed by an external company in 2007 and systems were in place for the disposal of clinical waste. Care Homes for Adults (18-65 years) Page 37 of 41 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 38 of 41 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 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 2 1 5 Information about the home should be available in a format suitable for the people for whom the home is intended. Contracts must contain up to date information about current terms and conditions, fees charged and the cost of facilities or services that are not covered by the fees. Care plans and information intended for people living in the home should be available in a format the person can understand and held by that person unless there are clear, recorded reasons not to do so. Further support should be provided to people living in the home to help them to maintain and develop their independent living skills. This should be done in such a way that the home is able to demonstrate year on year development for each person, linked to their individual care plans. 3 6 4 11 Care Homes for Adults (18-65 years) Page 39 of 41 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 5 16 The home should keep under review the practice of people going to their bedrooms early to ensure that they are making an informed and positive choice about how they spend their evenings. The home should try to involve the people living in the home more in menu planning. A training and development plan should be drawn up to ensure that there is a training programme in place that meets any statutory requirements and those set out in the NMS. 6 7 17 35 Care Homes for Adults (18-65 years) Page 40 of 41 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. 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. 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