Care Home: Lucerne House (21-23)

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What the care home does well One health professional wrote: `[The person] seems extremely content and calm. People that live in the home are able to chose how they spend their day. Staff offer support in a way that protects privacy and dignity. Involvement in the local community is promoted. Individuals are able to keep contact with significant people in their lives. What has improved since the last inspection? There has been significant improvement made since the last inspection in August 2009. Work has almost been completed on meeting requirements that were made at that time. These related to care planning, medication handling, recruitment and policies and procedures. The manager is working proactively to make sure that Lucerne operates in the best interests of those that live there. Lucerne is now able to evidence the good outcomes it achieves in delivering care. What the care home could do better: No requirements were made as a result of this inspection. We have recommended that the amount of medication received and any allergies are documented. Key inspection report Care homes for adults (18-65 years) Name: Address: Lucerne House (21-23) 21-23 Lucerne Road Thornton Heath Croydon Surrey CR7 7BB two star good service The quality rating for this care home is: 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: Janet Pitt Date: 3 0 0 4 2 0 1 0 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should:  Be safe  Have the right outcomes, including clinical outcomes  Be a good experience for the people that use it  Help prevent illness, and promote healthy, independent living  Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home:  3 stars – excellent  2 stars – good  1 star – adequate  0 star – poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area Outcome area (for example: Choice of home) These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement 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 Information about the care home Name of care home: Address: Lucerne House (21-23) 21-23 Lucerne Road Thornton Heath Croydon Surrey CR7 7BB 02082399547 02082391151 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mr Wayne Wallen,Mrs Naomi Wallen Name of registered manager (if applicable) Mrs Naomi Wallen Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 6 0 care home 6 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 6 The registered person may provide the following category of service only: Care Home Only (CRH - 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 - Code LD Date of last inspection 1 3 1 0 2 0 0 9 A bit about the care home Lucerne Road is a terraced house that accomodates up to three people with learning disabilities. Each person has their own room and can use communal areas. The premises is domestic in nature and owned and run by a family. The home is close to the town centre and accessible public transport. 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 How we did our inspection: This is what the inspector did when they were at the care home The quality rating for this service is two star. This means that people experience good quality outcomes. One inspector undertook this unannounced inspection. A site visit was made that lasted two hours. During this time we were able to speak with some people that live in the home. Records relating to staffing, and medication were examined. Members of staff were spoken with. We were able to have a look around Lucerne. The service sent us their Annual Quality Assurance Assessment [AQAA]. Information from all these sources has been used in this report. What the care home does well One health professional wrote: [The person] seems extremely content and calm. People that live in the home are able to chose how they spend their day. Staff offer support in a way that protects privacy and dignity. Involvement in the local community is promoted. Individuals are able to keep contact with significant people in their lives. What has got better from the last inspection What the care home could do better If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Janet Pitt National Correspondence Centre Citygate Gallowgate Newcastle upon Tyne NE1 4WH 03000 61 61 61 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 http:/www.cqc.org.uk/. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line - 0870 240 7535. 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 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. People can be confident that their health and social care needs will be assessed fully. A contract tells them what they can expect from the service. Evidence: People who use our service are confident that the care home can support them. This is because we work closely with the service users so we have an accurate assessment of their needs.[AQAA] No one new has been admitted since the previous inspection. However, the manager showed us their new assessment format. The document covers the Standards and provides space for information to be recorded. Areas covered include health professional involvement, medical and social needs and funding. People that currently live at Lucerne have had their assessment of needs reviewed. There is information on identified needs, what a person can and requires support with and a realistic aim. Each person had an occupancy agreement in place that detailed what is included in the fee. The manager told us that they will be reviewing the Statement of Purpose and Service User Guide in line with the new Regulations that are to come into force in October 2010. 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. People are supported to make choices and plan their time. Risk assessments are personalised and make sure there is no deprivation of liberty. Evidence: At Lucerne House we strive that peoples needs and goals are met. We ensure that our care plans are made with the involvement of the person or someone close to them. This makes people able to make key decisions about their life, including finances and the support which they need.[AQAA] The service considers that it could do better: We are trying to encourage service users to express more frequently what they would like their daily lifestyle to be made up of e.g. going to the shop when they feel to, instead of going when staff arrange. and they plan to improve: to have an individual folder for each service user, so new staff and key people can read and get a better view of what the service users needs and choices.[AQAA] During our site visit we were told that the care home community support team has been working with the home for past few months. The team have worked on areas such as communication, care planning and medication. We found that plans are now more organised and it was easier to find information. Daily records evidenced people going out to lunch and meeting others. People are involved in the care planning process and sign to show this. Evidence: One person does not speak much English and we saw that an interpreter had been involved in this persons reviews. A volunteer who speaks their language, is happy assist on day to day needs. Letters were on file to placing authorities requesting reviews, if they have not been organised. Generally most of the reviews have taken place, with the person and representative present. Individuals religious or spiritual needs are noted and they are able to practise if they wish. Activities are carried out within a risk assessed framework, that does not prevent people from doing what they want to. There were specific assessments in place, with information about minimising risk. 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 supported to live as they want to. Contact is maintained with family and friends. Evidence: At Lucerne House each person is treated as an individual and the home is responsive to his or her race, culture, religion, age, gender and sexual orientation. We encourage service users to take part in activities appropriate for their age and culture and also in the local community.[AQAA] When we visited one person was at home. They had just finished their lunch and was going to have a cigarette. Another individual was at their place of worship with a member of staff. The manager told us that one person attends a day centre regularly. Sometimes staff and the people that live in the home go to a local cafe for lunch. There was evidence in the daily records of visits made to the home by friends and family. Individuals are able to visit and stay overnight with friends and family. One persons records showed that this was something they did quite often. Care is taken to make sure that risk is minimised eg staff member accompanies [the person] when travelling. We found that daily records gave a good overview of what the individual had achieved during the day eg watching TV, going to the shops or out for walks. Evidence: Residents meetings enable people to talk about holidays and activities people want to do. Meetings were seen to be carried out monthly and minuted. Mealtimes are flexible and we saw that there was choice in foods available. There was fresh fruit and vegetables available. One health professional wrote: [They] tell me that [they are] happy at the care home, [they] get lots of nice food including plenty of vegetables and fruit. Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident that they will receive the right support to make sure that health and personal needs are met. Medications are handled and administered safely. Evidence: 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 follows.[AQAA 2010] The AQAA stated that: We have excellent reports from the Gps and hospitals on the progress of the people who use our service. We were able to see evidence of this in the care plans we looked at. A doctor had written: [They] seemed very well today and [they] look rested and well cared for. We found that care plans cover areas such as personal hygiene, emotional support, communication and health needs. Examples of these include: can wash [their] face wash hair prompting to moisturising [their] skin.and can tell if [they are] in pain by touching the parts of [their] body where the pain is. One person has Epilepsy and there were details of what to do if person had a seizure. Plans were regularly reviewed with the involvement of the individual. Daily records showed what people had been doing during the day and when they had attended health appointments. Each person had a keyworker who is responsible for overseeing support given. Handling of medications has improved since the previous inspection. The medications are Evidence: now supplied in blister packs from the local pharmacy. There were no gaps in recording on record sheets. It is recommended that the amount of medicine received and allergies are written on the record. Peoples medicines were seen to be stored securely. The manager said that they would be putting photos of the person on record sheets. Recommendations made by the Care Home Support Team were being implemented, these included a recent photograph of the person on their medication record and samples of staff signatures. The medication policy has been reviewed and was seen to be in line with guidance from the Royal Pharmaceutical Society and our guidance. 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. There is an accessible complaints policy. Care is taken to make sure that individuals are able to express any concerns openly. People are protected from harm by safeguarding procedures. Staff make sure that decisions are made independently by the person, with appropriate support. Evidence: We were told If people who use our service has concerns or complaints, they have people close to them, so they know how to complain. Their concerns are looked into and action is taken to put things right. [AQAA 2010] Lucerne plans to: Have regular meeting to see if service users are being honest with their concerns. and to Continue to listen to service users and deal with any complaints in the most professional way.[AQAA] We have not received any complaints and neither has the home. One person has raised concerns to us regarding a persons right to chose. During our site visit we discuss this with the manager and reviewed the individuals records. We found that there were no issues with care and support given. The general practitioner had confirmed that the individual did not have the capacity to make an informed decision. This was as the result of an assessment of capacity. There have been no safeguarding alerts. Care has been taken to make sure that any incidents or accidents are recorded accurately. This makes sure that people are protected and suitable supervision is in place. 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. Individuals live in a home that meets their needs. People are able to personalise their rooms. Evidence: The AQAA states: People stay in a safe and well maintained home that is homely, clean, comfortable , pleasant and hygienic. During our site visit we had a look around the premises and were able to confirm this. The house was clean and tidy. Individuals had their own personal possessions such as books and DVDs. Bedrooms had been decorated according to the persons wishes. Repairs and refurbishments to the bathrooms had been achieved, as required at the previous inspection. The carpeting on the stairs had recently been replaced. 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. Training provided for staff makes sure that people are supported by a qualified and competent team. The manager is aware of the need to make sure that appropriate checks are carried out prior to someone commencing employment. Evidence: The home considers in its AQAA that staff are competent, qualified and [there are]enough staff on duty at all times. Staff understand and accept what is expected of them. Lucerne considers that it could do better by: employ[ing] staff so we can help with one of the service users language barrier. On our site visit we were told by the manager that no one new has been employed since the last inspection. When we talked with some members of staff they confirmed that they now had a job description on file, as required previously. We found that training had been given in the following areas, person centred care planning, safeguarding, incident and accident reporting. Training on risk assessments had been planned for May 2010. We noted that staff had used the local authorities e-learning module for Safeguarding, this makes sure that information is current. We will do more checks on the recruitment process during our regulatory activity, when new members of staff have been employed. There were sufficient staff available to support people during our visit. 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. People can be sure that Lucerne is run in their best interests. An evidence framework is now in place to support the positive outcomes that individuals experience. The home is maintained to a satisfactory level and there were no health and safety issues identified. Evidence: Lucernes AQAA told us: People in the home have confidence that the care home is being managed appropriately. and they plan to improve by meeting all expectations on action plan. When we did our site visit we found that all the requirements from the previous inspection had either been achieved or work had progressed to make sure they would be met soon. The staff have worked well with the Care Home Support Team and have made the changes recommended by the team. We found that all the homes policies and procedures had been reviewed and updated if needed. Documentation and information that we asked for to do our inspection was readily available. Individuals finances are managed well. Each person has a record and receipts are kept for all purchases. People can be confident that maintenance and routine testing of equipment makes sure they are kept safe. Electrical wiring testing has been done, also included were checks on switches, sockets and the fire alarm system. Evidence: The manager told us that they will be implementing a formal Quality Assurance System in the next twelve months, but they are making sure that peoples views are heard. The AQAA was completed well and contained more details of how the service is operating and when it plans to improve. 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 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 20 It is recommended that the amount of medications received and any allergies are written on the record sheet. This will make sure that there is a clear audit trail. Helpline: Telephone: 03000 616161 or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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