Care Home: Lufton Manor College Of FE

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What the care home does well The students we spoke with, and those who wrote to us, said they are treated well by staff, who listen to them and act on what they say. They know who to speak to if they are unhappy and know how to complain should they wish to. They were seen to be supported in a confident and respectful way by staff; staff had a good rapport with students. Students are able to make decisions and choices in daily life. They are actively involved in the day to day running of the college through meetings, Student Council and they continue to take part in staff selection. There are positive comments from students included in this report. Students, and people close to them, are actively involved in planning their care. Care plans identified what students can do independently, and contained good, detailed information for staff on how to offer support. The college offers students pathways to independence, employment and community living and work; a wide range of activities are available both in the college and the community. Students are encouraged to be independent wherever possible and continue to be encouraged and supported by staff. The college has a comprehensive assessment procedure; information from the prospective student, and from people close to them, is obtained and students are able to visit the college and stay for three days for assessment. This benefits the student as they can make sure they are happy with the college and that their needs can be met. The staff members we spoke with, and those who who wrote to us, said they are provided with up to date information about the care needs of students. They are provided with appropriate training and feel well supported in their roles; there were positive comments from staff which are contained in this report. Students have a good choice of accommodation which best suits their needs; they are encouraged to personalise their homes. There are effective systems in place which allows the college to review the quality of the care and support they provide; the views of students, and people close to them, are central to this process. The quality of the record keeping at the college is very good; there are effective systems in place to ensure students records are kept confidential. What has improved since the last inspection? The college is currently working with us to review its service provision and procedures to ensure that the appropriate registration is in place and all students are placed in suitable accommodation to meet their needs. This process still needs to be completed. The college now ensures that clear procedures are in place and care plans are followed by staff. This ensures students` changing health needs are met and protects students` health and wellbeing.The date that students` complaints are responded to are now recorded; this shows the college is responding to complaints in a timely manner and that students are listened to. The college now has a risk assessment in relation to the use of shared towels to document how they are managing the risk of spread of infection. This promotes the health and welfare of students. There has been a greater focus upon the social care offered to students; this helps to ensure their needs are met and that there is a more balanced approach to the support offered to students. The safeguarding procedures have been thoroughly reviewed; this promotes the welfare and safety of students and provides better support for staff. What the care home could do better: The Registered Person must ensure care plans for students who may present difficult or aggressive behaviour are improved so that they clearly describe the type of behaviour and exactly how staff are to respond. This will ensure students are responded to in a planned, consistent and safe way. The Registered Person must ensure risks to students who may present difficult or aggressive behaviour are thoroughly assessed and included within their plan of care. This will ensure students are supported by staff in the most safe and least restrictive way. The Registered Person must ensure all staff are supervised on a regular basis; they may also wish to review how they record supervisions and other discussions with staff. This will ensure staff are provided with appropriate support to enable them to provide a good service to students and that the record keeping reflects the levels of support they are providing. The Registered Person must ensure that the services provided by the college are registered in the correct way. This will ensure that all students are provided with a safe and accountable service. Key inspection report Care homes for adults (18-65 years) Name: Address: Lufton Manor College Of FE Lufton Manor College Of FE Lufton Yeovil Somerset BA22 8ST     The quality rating for this care home is:   two star good 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: David Smith     Date: 0 4 1 2 2 0 0 9 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 34 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) 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. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 34 Information about the care home Name of care home: Address: Lufton Manor College Of FE Lufton Manor College Of FE Lufton Yeovil Somerset BA22 8ST 01935403120 01935403126 tess.baber@mencap.org.uk www.mencap.org.uk Royal Mencap Society care home 74 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) : Number of places (if applicable): Under 65 learning disability Additional conditions: Date of last inspection Brief description of the care home Lufton College of Further Education is one of three specialist colleges that together form Mencap National College. Lufton offers full-time residential and day education for students aged 16-25 with learning disabilities. The College is currently registered for 74 residential students. It is located on two rural sites on the outskirts of Yeovil at Lufton Manor and at Manor Farm. The college provides a range of residential provision on both sites. Accommodation is tailored to meet students developing independence skills, and provide various levels of support. A third of students live away from the main site in semi-independent settings. The aim of the college is to prepare students for the next stage in their lives (Mencap). Students are on Progression Pathways which were introduced at the college in September; there is a Pathway to Independence, a Pathway to Employment and a Pathway to Community Living and Work; courses are usually three years long. Care Homes for Adults (18-65 years) Page 4 of 34 Over 65 0 74 0 9 1 2 2 0 0 8 Brief description of the care home We inspect the service using the National Minimum Standards which apply to residential services for younger adults (Care Homes for Adults 18-65). However, as an educational establishment Lufton is also inspected by Ofsted. Our reports should therefore be read in conjunction with the Ofsted reports to gain a comprehensive overview of the service provided. Care Homes for Adults (18-65 years) Page 5 of 34 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced visit to the college to enable us to complete a Key Inspection. We visited the college over three separate days and spent approximately 14 hours carrying out this inspection. The inspection was carried out by one inspector, but the term we is used in this report. This is because the report, and the judgements within it, are on behalf of the Care Quality Commission. The pre-inspection planning involved reviewing the report of the last Key Inspection completed in December 2008. We also looked at the service history, which details all other contact with, or about, the college. We looked at the colleges Annual Quality Assurance Assessment (known as an AQAA); this is a self assessment which describes how well outcomes are being met for students Care Homes for Adults (18-65 years) Page 6 of 34 at the college. The AQAA was completed in some detail and gave us all the information we needed. We provided a number of surveys for students and staff members before we visited; nineteen were completed and returned. The views of each person who wrote to us have been included in this report. We gathered additional information by speaking with the Principal, the College Learning Manager and the three managers who are applying for registration. We spoke to a number of staff privately; we also spoke informally to other staff during our visits to various types of accommodation and we observed staff speaking with and supporting students. We looked at a number of records such as students care records, risk assessments, medication administration, staff records, complaints and compliments and some health and safety procedures. During our visits we spent time at the main college site, at the Manor Farm site and visited one site in the community. The preferred term for the home is college. The preferred term at the college for people who live at the home is student. These are used throughout the report. Care Homes for Adults (18-65 years) Page 7 of 34 What the care home does well: What has improved since the last inspection? The college is currently working with us to review its service provision and procedures to ensure that the appropriate registration is in place and all students are placed in suitable accommodation to meet their needs. This process still needs to be completed. The college now ensures that clear procedures are in place and care plans are followed by staff. This ensures students changing health needs are met and protects students health and wellbeing. Care Homes for Adults (18-65 years) Page 8 of 34 The date that students complaints are responded to are now recorded; this shows the college is responding to complaints in a timely manner and that students are listened to. The college now has a risk assessment in relation to the use of shared towels to document how they are managing the risk of spread of infection. This promotes the health and welfare of students. There has been a greater focus upon the social care offered to students; this helps to ensure their needs are met and that there is a more balanced approach to the support offered to students. The safeguarding procedures have been thoroughly reviewed; this promotes the welfare and safety of students and provides better support for staff. 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. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 34 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 34 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Students can decide whether the college can meet their support and accommodation needs; this is because they, and people close to them, can visit the college and are provided with full, clear, accurate and up to date information. The college has a comprehensive system in place to ensure that they are able to assess and meet prospective students individual aspirations and needs. Evidence: The college has an up to date Statement of Purpose and a detailed Prospectus which describe the aims of the college and how they are able to support students. Documents that are given to students are all written in an easy read format using symbols. The college has an intake of new students every September. Prospective students and their families are invited to visit the college during open days; one such visit took place during the first day of our inspection. Care Homes for Adults (18-65 years) Page 11 of 34 Evidence: If the prospective student wishes to make an application, the college will give them an application form at the end of the visit; this form has been improved since our last visit and now asks for more detailed information. We viewed care plans that contained an application form completed by students, and information obtained from people close to them, such as their parents, carers and Connexions. Once a successful application has been made, the college invites students to stay at the college for three days; an initial assessment is then carried out to ensure that the students needs can be met appropriately, and to give the student the opportunity to sample life at the college to ensure that they are happy. At the start of term, the college undertakes a six week baseline assessment. Students are able to take part in taster sessions so that they can find out what interests them and identify what they might like to do. Each student has a personal tutor and keyworker who can give information, answer questions and help to make students feel comfortable at the college. Each student we spoke with, and who wrote to us, said they did visit the college and that they did receive enough information to decide if this college was suitable for them. One student said before I chose to come here I came for a visit with my Mum and Dad; I enjoy it here, the people are nice. Care Homes for Adults (18-65 years) Page 12 of 34 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Students needs and goals are met and each person has a plan that they, and people close to them, have been involved in making. Students are supported to make decisions about their lives and to take risks to enable them to live as independently as possible. They are asked about, and are involved in, all aspects of life at the college. Evidence: We looked at the care records of seven students; plans were clear, person centred and contained a good level of detail. They explained what students can do independently, and contained information for staff on how to assist and support the student where necessary. Each plan contained detailed communication profiles and interaction profiles with behaviour management support plans. Should students have any particular cultural needs, these are included in their plan. Students and people close to them are involved in developing and then reviewing their Care Homes for Adults (18-65 years) Page 13 of 34 Evidence: care plans; when students first arrive their initial plan of care is written using information from the assessment process. This is developed after the 6 week baseline assessment and is then kept under constant review. Students have a dedicated personal tutor and keyworker, one of whom they see on a daily basis; they also have more formal meetings to ensure they are able to express their views and update their care plan if this is necessary. Each person now has a Journey File. This contains a copy of their care plan; staff sign to say they have read each persons plan and their support guidelines. Staff complete records to ensure students care and support is monitored; this ensures that if people are progressing, their needs change or they require additional support, this will be noted by staff and acted upon. The college had individual transition plans for students who meet with a college transition officer to discuss their own personal development; where they are now; where they want to go; how to get there; who will help; and by when. The staff members we spoke with, and those who wrote to us, said they are always provided with up to date information about the support needs of students. Comments from staff included we have a good balance between education and care and we evidence more now, it all goes into each persons portfolio and helps them gain qualifications which suits their abilities. There are many ways students are able to express their views; they have weekly accommodation meetings, personal tutorials, Student Council Meetings (students are able to speak to a student council representative if they have any problems or there is anything they would like the Student Council to talk about) by using the colleges complaints procedure and at their own review. Students are represented on some of the colleges committees, are involved in the interviews for new staff and they complete a survey each year, together with parents and carers. The students we spoke with, and those who wrote to us, said they do make decisions about what to do each day and they are able to do the things they wish during the evenings and at weekends. Staff members told us they support and encourage students to make their own decisions. One staff member said we give students choices and opportunities and they have regular meetings where they can voice their opinions and another staff member told us we have confident students who are free to be themselves. Through observation and discussions, it was evident that staff continue to encourage Care Homes for Adults (18-65 years) Page 14 of 34 Evidence: students to take responsible risks. We viewed individual risk assessments relating to independent living skills and self medication. These assessments were clear and detailed. Care Homes for Adults (18-65 years) Page 15 of 34 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Each student is treated as a individual and has opportunities and appropriate support for personal and emotional development. People have access to a range of activities and maintain links with the local community. Students rights are respected; they are able to keep in touch with families and friends. Students have healthy, well presented meals which they choose. Evidence: Students are now on Progression Pathways which were introduced at the college in September; there is a Pathway to Independence, a Pathway to Employment and a Pathway to Community Living and Work. These new pathways are much more based on each individuals needs and wishes. Care Homes for Adults (18-65 years) Page 16 of 34 Evidence: The students we spoke with, and those who wrote to us said they are able to do the things they wish; the records we looked at show that students are involved in a wide range of courses and other activities such as drama, swimming, cycling, bowling, army cadets, film club, discos and having meals out. The college has a number of specialist volunteers who coach students in different types of sports. One student said we do tutorials, work preparation and other sessions. Im really happy, love living here and all the people are nice. Other comments included: everybody is helpful and works hard, I like the activities, we have interesting lessons and Im happy at college. There is a strong focus on the rights of students; they have a number of ways for them to express their views, described earlier in this report. A number of students hold a key to their accommodation; during our visits staff were seen to knock on doors before entering bedrooms to respect students privacy. Students we spoke with and those who wrote to us said they feel that their privacy is respected and staff are helpful. In all accommodation, students had devised their own set of house rules. These had been agreed by the students in each accommodation and signed up to. This is good practice as it ensures that students rights are respected. One student told us we say what we want to do, everyone takes turns doing the things that need to be done; we all agree to it. The staff we spoke with, and those who wrote to us, said that students are treated and valued as individuals; they feel there is a good balance between the educational and social aspects at the college. One member of staff said there is a good range of activities both on site and out in the community; it is student led. Other comments were the new pathways are a good, positive move as students time tables can be adjusted to suit their needs and the learning experience here is very good; it allows students to experience the real world. Students are supported to keep in touch with their families and friends; some have regular visits from family members. Staff make regular telephone calls to students families to ensure they are kept up to date and the college provides internet facilities so that students may use e-mail. They have also recently introduced the use of Skype which allows students to make telephone calls over the internet; if students use a web cam, they can also see the person they are speaking to and this appears to be extremely popular. Students confirmed that they enjoy their meals at the college; menus show that a Care Homes for Adults (18-65 years) Page 17 of 34 Evidence: wide choice of meals are available, including a vegetarian option. Should students have a particular diet, for health or cultural reasons, these are catered for. The main dining room at the college is bright and airy with patio doors leading onto the pleasant decked area. During our visit to one part of the college away from the main site, we saw students being supported at lunchtime. People ate lunch in the dining room and were encouraged to choose their meals; staff were present to offer support and there was a relaxed, informal atmosphere. When we visited one home in the community students were planning their weekly menu and the wrote their shopping list. One student told us we always plan the weekly menu and write the shopping list and another said I am a good cook, the staff help me if I need it. Care Homes for Adults (18-65 years) Page 18 of 34 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Students receive personal support from staff in the way they prefer and want; their physical and emotional needs are met. If they take medicine, they manage it themselves if they can. If they cannot manage their medicines, they are supported with them in a safe way. Evidence: The care plans we looked at clearly described the support students need in relation to their personal care; they have access to health care professionals through the local GP service, chiropodist, local hospital and pharmacy. The College has a Day Care Officer provision, which supports individuals with all medical appointments. Students have a designated key worker to support them with their personal care needs, where required; they confirmed that they have choice in what time they get up and go to bed and what they wear. The college provides good therapeutic support by employing speech and language therapists, an occupational therapist and a music therapist; students also have access to psychologists. Care Homes for Adults (18-65 years) Page 19 of 34 Evidence: During our last visit we saw that for one student the college had not followed the individuals care plan to ensure their changing needs were met appropriately. This issue has been taken very seriously by the college and both care planning and reviewing in relation to health and personal care has been focused upon and improved wherever possible. Students care and support is monitored; this ensures that if needs change or they require additional support, this will be noted by staff and acted upon. Students are supported to manage their own medicines, where this is possible. The risks to each student are assessed and they are provided with high levels of support. If students make a mistake with their medication, this process is reviewed but does not necessarily mean they can no longer be responsible; one person who had made an error was given extra support and guidance which supported them to continue to manage their medicines. If staff support students with their medicines, they are provided with appropriate training. Medicines are stored securely; the records we looked at in one home were well kept. Medicines are usually provided in blister packs by the pharmacy; where this is not possible, they are stored in separate, named containers. Each student had a medication profile and there were manufacturers notes on all prescribed medicines, which staff can refer to. When students take their medicines away from the college, such as when they stay with their parents, clear records are now kept of the medicines which leave the college and how many are returned. Care Homes for Adults (18-65 years) Page 20 of 34 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. If students 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 college generally safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. Evidence: The college has a formal Complaints Policy, a policy to protect vulnerable people (known as safeguarding) and a Whistle Blowing Policy, which staff can use in confidence to raise any issue or concern they have regarding poor practice or suspected abuse. Two complaints books are maintained; one for students and the other for relatives. We viewed the complaints that had been received since the last inspection. The college had recorded the action taken and outcome; the date the complaint was responded to is also now recorded. A record is kept of compliments received by the college; there have been 22 received this year. All of the students who wrote to us confirmed that they knew who to speak to if they were unhappy. Some students also mentioned filling in a Jonathan Card; these cards trigger an investigation and are available throughout the college. One student we spoke with said if I had a problem I would talk to the staff; they would help me and Care Homes for Adults (18-65 years) Page 21 of 34 Evidence: another said if I was unhappy I would tell staff and they would help me. Staff members we spoke with and those who wrote to us said they do know who to speak to if they have any concerns regarding the care and support provided at the college; they feel their views would be listened to and taken seriously. Staff also said they felt students would speak out if they were unhappy; one member of staff said if they are not happy Im sure students would say; they would always get a fair hearing. It was clear from speaking with staff, that safeguarding now has a much higher profile within the college. Staff are provided with training and there is now a safeguarding team within the college which consists of the Principal, Assistant principal, College Learning Manager, the Heads of Care, Training Manager and Day Care Officers. The AQAA states this team ensures procedures are followed robustly including follow up actions to support students and staff. The college supports students who may display behaviours which may be perceived as challenging the service; behaviours may include students becoming withdrawn, being verbally aggressive or occasionally physically aggressive, although staff told us this was very rare. Should students need support with their behaviours, clear guidance should be included in care plans and risk assessments should be written if these are appropriate. One care plan we looked at was not clear; information provided by this students previous care provider did explain they could exhibit some challenging behaviour including pushing people, walking out of class, banging objects. They need clear boundaries. The initial care plan was not clear on what behaviours this person may exhibit and did not describe how staff should offer support. This student then presented some known behaviours, such as walking out of college, and others such as pushing and kicking other students. It was clear that staff members did all they could to support this student, and those they were being aggressive towards, but they were not following any clear plan and there were no risk assessments in place in relation to interventions staff were using. This was discussed at the end of the inspection; staff acknowledged this area of care planning needs improvement and the new application form, which asks for more detailed information, should help this process. Staff are provided with training to help ensure students safety; the records we looked Care Homes for Adults (18-65 years) Page 22 of 34 Evidence: at show they have had training in safeguarding, managing violence and aggression, challenging behaviour, positive interaction and health and safety. Clear records are kept of each accident and incident and the college has a very thorough process of auditing each form; this audit is carried out by a senior manager. We are always informed of any significant event which occurs within the college. Care Homes for Adults (18-65 years) Page 23 of 34 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The college provides a wide range of clean, comfortable and homely environments; students personalise their own accommodation. Evidence: Lufton Manor is located on two rural sites on the outskirts of Yeovil at Lufton Manor and at Manor Farm; it is set within several acres of grounds and there are car parking spaces available for visitors. The college provides a variety of accommodation for students; these are tailored to meet their developing independence skills and provide varying levels of support. There are houses on the main college site, other accommodation at Manor Farm (a short walk from the main site) and several semi-independent settings in the community. We spent time at the main site, visited Manor Farm and one house in the community. All of the accommodation we viewed was clean, homely and comfortable. Bedrooms were personalised by each student and reflected their individual tastes; students had many personal item, photographs and pictures. All accommodation has been made more homely as information which had been displayed on notice boards or fixed to walls has now been placed in a small folder; this Care Homes for Adults (18-65 years) Page 24 of 34 Evidence: helps to make the environment more like a home. The students we spoke with, and those who wrote to us, said their home is always kept fresh and clean. Some students said they help to keep their home clean; one said we do the washing up, cleaning, clean the bathroom, hoovering, use the washing machine; everyone takes turns we all agree to do it and another student said I help to keep my house clean, I do the hoovering, washing up and my own washing. One student was very keen to show us around their home. They had asked for a mirror to be put up in their bathroom and this had been done; they were very happy about this and told us this was their choice. All of the bathrooms had liquid soap available. Students have their own individual towels for bathing; most bathrooms had one towel for students to dry their hands. The towel is changed daily to minimise the spread of any infection and an appropriate risk assessment is now in place to support this practice. The AQAA says that the college has an action plan to deliver best practice in the prevention and control of infection. Staff are provided with infection control training and gloves and aprons are available should they need them. We viewed lots of signage with symbols throughout the accommodations. These encourage independence by informing students and prompting them to do things themselves. The AQAA confirms the College has a cyclical maintenance plan which includes decoration and re-carpeting of individual accommodation areas: they also wish to further develop accessible signage across the college. Care Homes for Adults (18-65 years) Page 25 of 34 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Students have safe and appropriate support as there are enough competent, qualified staff on duty at all times; they have confidence in staff because checks have been done to make sure that they are suitable to work at the college. Students needs are met and they are supported because staff generally get the right training, supervision and support they need from their managers. Evidence: The college has a large staff team to support students; every student has a named key worker who helps to co-ordinate the support they receive. The students we spoke with, and those who wrote to us, said they are treated well by staff who listen to them and act on what they say. Comments from students included; we always have the same staff, I really like them, the staff are nice, my keyworker really helps me, I always know the staff who are working, I talk to them and they always listen to me and staff are fine, they are nice. The staff we spoke with, and those who wrote to us, said they are happy working at the college; they are always given up to date information about the people they support. They feel there is generally a relaxed atmosphere, they feel listened to and Care Homes for Adults (18-65 years) Page 26 of 34 Evidence: that their views are taken seriously and acted upon wherever possible. Comments from staff include; most of the time its very good working here, the college supports staff in their job role and provides various training opportunities, staff do care for the students and advocate for them, I really enjoy working here especially when you see a student achieve and it is a wonderful place, people like working here. When asked what the college could do better, there were very few comments from staff. One person said communication could be better, but it is difficult due to the size of the site and another staff member said staffing is usually fine but we do struggle at times when people are sick. It was evident that staff were happy and confident in their roles and they did not have any concerns. We saw staff supporting and interacting with students at various times during our visits. It was clear that staff have a good understanding of students needs and how to communicate effectively with them. Staff have a very good rapport with individuals and always had time for them; there was a very relaxed, homely atmosphere throughout the college. The college has a thorough recruitment process; the staff we spoke with and those who wrote to us said that all necessary checks were carried out before they were allowed to start work. Students continue to be involved in the recruitment of new staff; this is good practice. We looked at the records for two staff who have recently joined the staff team; these contained a copy of their application form, documents proving their identity and eligibility to work in the UK, two satisfactory references (one of which is verified over the telephone) and an Enhanced CRB. New staff complete a thorough induction training programme; all staff are then provided with mandatory courses such as first aid, food hygiene, how to move and handle people safely, health and safety and infection control. Staff are also given training in specific areas such as medication administration, how to manage difficult or aggressive behaviour, how to recognise and respond to abuse (known as safeguarding) and on specific conditions such as epilepsy, Autism, Downs Syndrome, diabetes and Learning Difficulties. The college have 20 planned training days each year; a Training Officer is employed to oversee staff training and they also deliver some training courses. Staff are supported to gain a National Vocational Qualification (known as an NVQ) and staff told us their are opportunities for promotion within the college. The staff we Care Homes for Adults (18-65 years) Page 27 of 34 Evidence: spoke with and those who wrote to us are happy with the level of training they receive. They are provided with training they feel helps them understand and meet students needs, keeps them up to date on new ways of working and gives them enough knowledge about healthcare and medication. The staff meet regularly within their own specific teams; these meetings are held every month. In addition to this, senior members of the teams meet with their line manager every week. The staff we spoke with felt there were many opportunities to meet and share information. Staff are provided with supervision; this is a 1:1 meeting with their named supervisor. The college wish to supervise staff at least six times per year and appraise staff annually. The records we looked at show that many staff have not had supervision in the last three months and others had not had an appraisal in the last year. Staff told us that as the size of staff teams had increased, the number of supervisors had not. One person who supervises staff said I now have 10 staff to supervise, its too many really and another staff member told us supervisors feel a little overloaded with supervisions. The staff we spoke with said they were well supported; staff who wrote to us confirmed that they meet with their manager for support and to discuss their work. The college needs to improve the frequency of supervision and may also wish to review how staff supervisions and other support meetings are recorded to ensure they clearly show the levels of support being provided to the staff team. Care Homes for Adults (18-65 years) Page 28 of 34 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Students have confidence in the college because it is run and managed appropriately; their opinions are central to how the college is run and how it is developed. The environment is safe for people and staff because health and safety practices are carried out. Evidence: The college has improved the management structure since our last visit. The College Learning Manager is now supported by three managers who are individually responsible for the main college site, the Manor Farm site and the community houses. We met with all four of these managers during our inspection visits and discussed their roles with them. We have been in discussions with senior managers and other Mencap staff regarding the registration of this service to ensure the community housing provision is appropriately registered. Discussions on how best to achieve this are still ongoing but registration should be completed shortly. Care Homes for Adults (18-65 years) Page 29 of 34 Evidence: The students we spoke with, and those who wrote to us, and discussions with staff members and managers show that there is an open and inclusive management style. People said they are happy to discuss any issues, they feel they are always listened to; people said communication and management support is generally very good. Comments from staff included; we do get good support, I feel I can always approach my line manager, the management is very supportive, they have an open door policy and both staff and the managers are very supportive towards each other. The college gains the views of students, and those who are close to them, in a variety of ways. The AQAA explains that students have their own voice within the College via a student elected body, who have representatives at all the College management meetings; Student Council meet weekly and minutes are produced and fed back to the College Principal. All students have a Jonathan Card to use if they have a grievance; these cards trigger an investigation and response to the student within 72 hours, with measured outcomes. There are weekly student accommodation meetings, which are minuted and copies of which go to the Head of Care, who ensures that any actions required are followed through. Students complete a survey each year along with parents and carers. The record keeping at the college is of a good standard. Files and other documents are very well organised, easy to access and stored securely. Lufton Manor has a number of policies and procedures, which are designed to ensure that both the students and the staff team are safe, the service complies with the law and remains aware of best practice or new ways of working. Staff understand these policies as they are asked to read them and they sign to say they have done so. Regular monitoring visits are carried out on the accommodation provided for students; we spoke with the manager who carries out these visits. They told us they look at records, such as care plans, and the environment. They also arrange joint visits with the colleges health and safety manager to ensure staff are completing checks and reporting any health and safety issues. There are good health and safety measures in place. Regular checks are maintained in each student accommodation; records are kept of fridge and freezer temperatures and any risk assessments which apply. The college has a health and safety manager who ensures the college is a safe place for students and staff. Care Homes for Adults (18-65 years) Page 30 of 34 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 31 of 34 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 23 13 The Registered Person must ensure care plans for students who may present difficult or aggressive behaviour are improved so that they clearly describe the type of behaviour and exactly how staff are to respond. This will ensure students are responded to in a consistent and safe way. 04/03/2010 2 23 13 The Registered Person must 04/03/2010 ensure risks to students who may present difficult or aggressive behaviour are thoroughly assessed and included within their plan of care. This will ensure students are supported by staff in the safest and least restrictive way. Care Homes for Adults (18-65 years) Page 32 of 34 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 3 36 18 The Registered Person must ensure all staff are supervised on a regular basis. This will ensure staff are provided with appropriate support to enable them to provide a good service to students. The Registered Person must ensure that the services provided by the college are registered in the correct way. This will ensure that all students are provided with a safe and accountable service. 04/03/2010 4 38 12 04/03/2010 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 36 The Registered Person should review how they record supervisions and other discussions with staff. This would help to ensure that the record keeping reflects the levels of support they are providing. Care Homes for Adults (18-65 years) Page 33 of 34 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. 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