Care Home: Luma Care Ltd

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What the care home does well The service encourages people to try new things and to develop their independence. This is a done in a well planned way, which is based on people`s own interests and ideas. People who use the service are asked about their needs and personal goals. Comprehensive and detailed plans are then completed with each person, which helps staff to provide support in a consistent way. The plans are kept up to date, so that they reflect people`s progress and any changes in their lives. People told us about things that they had been able to achieve with support, such as getting jobs and completing college courses. Staff also help people to have social lives that reflect their interests as young adults. People have joined clubs and do a range of sports. Within the home, people like to use the internet and they do different things `on-line`. One person who uses the service commented about staff `they help me plan my life, so I have time for everything I want to do each day, which is a huge help as I am so disorganised`. Another person told us `I can do pretty much anything I want to do. The staff are very helpful in supporting this`. The staff team receive training and guidance which helps them to understand the needs of the people who use the service. People`s health issues are responded to by staff in a sensitive way. One person commented `I never feel embarrassed or uncomfortable talking to them about any painful, personal problems`. People who use the service are not made to feel different from their peers. One person mentioned that when out with a support worker, the support worker was careful not to behave `like care staff`. The home is well placed for people to be able to get to their different activities in and around the city. It gives people experience of living in an ordinary type house. People are involved in the domestic routines and are given responsibilities within the home at a level that they feel comfortable with. People who use the service have the opportunity to express their views about the running of the home. Each week they can meet with the managers and staff to talk about things together. We were present at a meeting which had been arranged for the afternoon of our visit. There was a discussion about the deployment of staff, and how this could be matched to the times when people wanted one to one support with activities. Staff members showed a willingness to work in a way which would provide the flexibility that the people who use the service wanted. Overall, the people who use the service benefit from the management approach in the home, which is inclusive and promotes their rights. What has improved since the last inspection? The last inspection took place about six months after the home opened. We reported at the time that people were being well supported with settling into the home and making links with the local community. This support has continued and the people who use the service have well established routines. Some changes have been made, as people have had new ideas about the type of work they want to do, and how they want to spend their time. One person is working towards getting a place at university. We were told in the AQAA that one person was taking driving lessons. When we visited the home we heard that they had passed their test. They had received a lot of cards congratulating them on this achievement. This success had also opened up other possibilities for employment. We heard that the person was looking at the possibility of being a fork lift truck operator. People are receiving support, so that they can learn to do more things independently. People prepare some of their own meals and are learning how to plan menus and manage their money. One person is now taking some responsibility for managing their prescribed medication. The process of self-administration is being carried out in a planned way. A risk assessment has been undertaken and there is a strategy for how the outcome will be achieved. At the last inspection we talked about the need for better presentation and a more `joined up` approach to the completion of people`s different plans and records. This aspect has much improved. It was now much clearer to see the progress that people were making with their goals, and what they had achieved. Other records have been developed and are being used, so that there is better information about what is happening in the home. Staff training and development has progressed, so that people who use the service benefit from a competent staff team. 80% of the staff team have now achieved a National Vocational Qualification (NVQ) at level 3. This means that the home has met a target that was set in its training plan for 2007 - 2008. One staff member commented `I have completed my NVQ 3 in health and social care with excellent support from my manager, and that is something that I never thought I would be able to do. I am so much more reflective in my practice of the needs of the residents`. What the care home could do better: We were told in the AQAA that the key worker role would be developed and there would be further flexibility in the working patterns, to support people`s changing needs. Other improvements were being planned, including developments in relation to staff training, and maintaining the property. As mentioned above, one person was learning how to manage their own medication. We talked to Mr Ferris about how the recording needed to be changed, so that there could be no misunderstandings about who was taking responsibility. We have recommended that the format of the reports made under Regulation 26 of the Care Homes Regulations 2001 is reviewed. This is to ensure that the reports are informative and reflect the views of the people who use the service. We also confirmed with Mr Ferris that all staff records must be kept in the home. A policy for quality assurance has been produced. There were several parts to the home`s quality assurance system. These will need to receive attention in the coming year, to ensure that the policy is fully implemented. Some other new policies have been produced, but they need to be dated and have review dates identified. This is to ensure that their content is reviewed on a regular basis, and amended, for example in the light of any changes in guidance and legislation. While at the home we saw that two communal doors were in regular use and they were being held open to facilitate this. These were fire doors, which therefore needed to be kept closed when not in use. We recommended to Mr Ferris that he obtains advice about approved devices that could be fitted to the doors, so that they can safely be kept open. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Luma Care Ltd 42 Rollestone Street Salisbury Wiltshire SP1 1ED     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: Malcolm Kippax     Date: 1 2 0 5 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. 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. 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 38 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) 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. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 38 Information about the care home Name of care home: Address: Luma Care Ltd 42 Rollestone Street Salisbury Wiltshire SP1 1ED 01722341031 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) : davidferris@lumacare.co.uk Luma Care Ltd care home 3 Number of places (if applicable): Under 65 Over 65 0 learning disability Additional conditions: 3 The maximum number of service users who can be accommodated is 3. The registered person may provide the following category of service: Care home providing personal care - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: Learning disability (Code LD) Date of last inspection Brief description of the care home Luma Care was registered as a new care home in November 2007. The services Statement of Purpose states that Luma Care supports people from 16 to 25 years old, who have a diagnosis of Asperger Syndrome, Attention Deficit Hyperactivity Disorder, Tourettes Syndrome and other associated difficulties falling within the autism spectrum. The home is an ordinary terraced property which is close to the centre of Salisbury. The communal space consists of an open plan lounge and dining area. There is a kitchen, which leads on to an enclosed, courtyard type garden. One bedroom is on the first floor, and the loft has been converted to provide two other bedrooms. The bedrooms do not have en-suite facilities and there is a bathroom and a shower room that people can use on the first floor. There is also an office on the first floor for staff to use. People who use the service receive support from the homes manager, a Care Homes for Adults (18-65 years) Page 4 of 38 Brief description of the care home therapeutic manager and a team of support workers. Inspection reports and information about the homes fee structure are available from Luma Care. There is a fee for Basic Care, and the fee increases if Vocational Support, and/or Educational Support, are also provided. Copies of inspection reports can also be seen on the Commissions website at www.cqc.org.uk Care Homes for Adults (18-65 years) Page 5 of 38 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: 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: Before visiting the home, we asked Luma Care to complete an Annual Quality Assurance Assessment known as the AQAA. This was their own assessment of how they were performing. It told us about what has happened during the last year and about their plans for the future. We sent surveys to the home so that these could be given out to the people who use the service and to staff members. We had surveys back from two people who use the service, and from five staff members. We looked at all the information that we have received about the home since the last inspection. This helped us to decide what we should focus on during an unannounced visit to the home, which took place on 12th May 2009. Care Homes for Adults (18-65 years) Page 6 of 38 There were two people using the service at the time of our visit. We talked to them about the home and the things that they did. We spoke to the registered manager, Mr D. Ferris, and met with the homes therapeutic manager and with three staff members. We went around the accommodation and looked at some of the homes records. The judgements contained in this report have been made from all the evidence gathered during the inspection, including the visit. This was the second inspection of Luma Care since the home opened. The previous inspection took place on 13th May 2008. What the care home does well: What has improved since the last inspection? Care Homes for Adults (18-65 years) Page 8 of 38 The last inspection took place about six months after the home opened. We reported at the time that people were being well supported with settling into the home and making links with the local community. This support has continued and the people who use the service have well established routines. Some changes have been made, as people have had new ideas about the type of work they want to do, and how they want to spend their time. One person is working towards getting a place at university. We were told in the AQAA that one person was taking driving lessons. When we visited the home we heard that they had passed their test. They had received a lot of cards congratulating them on this achievement. This success had also opened up other possibilities for employment. We heard that the person was looking at the possibility of being a fork lift truck operator. People are receiving support, so that they can learn to do more things independently. People prepare some of their own meals and are learning how to plan menus and manage their money. One person is now taking some responsibility for managing their prescribed medication. The process of self-administration is being carried out in a planned way. A risk assessment has been undertaken and there is a strategy for how the outcome will be achieved. At the last inspection we talked about the need for better presentation and a more joined up approach to the completion of peoples different plans and records. This aspect has much improved. It was now much clearer to see the progress that people were making with their goals, and what they had achieved. Other records have been developed and are being used, so that there is better information about what is happening in the home. Staff training and development has progressed, so that people who use the service benefit from a competent staff team. 80 of the staff team have now achieved a National Vocational Qualification (NVQ) at level 3. This means that the home has met a target that was set in its training plan for 2007 - 2008. One staff member commented I have completed my NVQ 3 in health and social care with excellent support from my manager, and that is something that I never thought I would be able to do. I am so much more reflective in my practice of the needs of the residents. What they could do better: We were told in the AQAA that the key worker role would be developed and there would be further flexibility in the working patterns, to support peoples changing needs. Other improvements were being planned, including developments in relation to staff training, and maintaining the property. As mentioned above, one person was learning how to manage their own medication. We talked to Mr Ferris about how the recording needed to be changed, so that there could be no misunderstandings about who was taking responsibility. We have recommended that the format of the reports made under Regulation 26 of the Care Homes Regulations 2001 is reviewed. This is to ensure that the reports are Care Homes for Adults (18-65 years) Page 9 of 38 informative and reflect the views of the people who use the service. We also confirmed with Mr Ferris that all staff records must be kept in the home. A policy for quality assurance has been produced. There were several parts to the homes quality assurance system. These will need to receive attention in the coming year, to ensure that the policy is fully implemented. Some other new policies have been produced, but they need to be dated and have review dates identified. This is to ensure that their content is reviewed on a regular basis, and amended, for example in the light of any changes in guidance and legislation. While at the home we saw that two communal doors were in regular use and they were being held open to facilitate this. These were fire doors, which therefore needed to be kept closed when not in use. We recommended to Mr Ferris that he obtains advice about approved devices that could be fitted to the doors, so that they can safely be kept open. 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 10 of 38 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 11 of 38 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are provided with sufficient information about the home to decide whether it will be suitable for them. The home has procedures in place, so that it can obtain enough information about the needs of a prospective user of the service. Evidence: The home had its first inspection in May 2008. There were two people using the service at that time. These people were already known to the homes manager, Mr Ferris, before they moved in, as he had worked with them in another setting. We reported at the last inspection that their needs had been assessed, and information had also been received from peoples families. The two people had visited the home before moving in. We did not look at the assessment arrangements again during this inspection, as nobody else had moved into the home during the last year. However we were told in Care Homes for Adults (18-65 years) Page 12 of 38 Evidence: the AQAA that the assessment process had been reviewed and the forms had been made more person centred and comprehensive. We were told in the AQAA that the homes prospectus and Service Users guide had been updated. During our visit, we were given a copy of Luma Cares Statement of Purpose, which had been reviewed since the last inspection. This included some more details about the home and had been updated to show the change of regulator which took place in April 2009. The two people who use the service told us that they had settled in well. They had got to know the local area and had done a number of new things in the last year. Peoples needs had been kept under review since they moved in. One person had attended a review meeting in March 2009. Mr Ferris said that a review meeting for the other person had been arranged for June 2009. People also met with staff regularly, so that they could talk about their day to day needs. Care Homes for Adults (18-65 years) Page 13 of 38 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have individual plans, which provide comprehensive and detailed information about their needs and goals. People can make decisions about their lives. They make informed choices and are supported to take risks so that they can develop their independence. People can participate in the day to day running of the home and are closely involved in the daily routines. Evidence: Each person had a personal file which included a range of individual plans, assessment forms and other written information. One of the key documents was a Person Centred Placement (PCP) Plan. People had been asked whether they wished to write or type the plans themselves, or if they Care Homes for Adults (18-65 years) Page 14 of 38 Evidence: would like staff to do this. People had signed their plans. The plans were up to date; one of them had been produced in March 2009 and the other in April 2009. The PCP plans set out the main areas of support that people needed, and what they wanted to achieve in the future. They linked to Individual Social (IS) Plans, which provided further details about peoples goals and targets. There was information about strategies that had been agreed with people, and the resources that would be needed. This helped to ensure that staff supported people in a planned and consistent way. The IS plans were being reviewed every three months, so they reflected the progress that people were making and any changes in their circumstances. People told us about their goals and plans for the future. These were consistent with the information that had been recorded in their individual plans. People were working on different tasks, such as gaining employment, getting a place at college, and being more involved in menu planning and cooking. We talked to one of the people about their plans for finding a new job. It was recorded in their individual plans that they had written a CV and then taken this to an employment agency. In their surveys, the people who use the service confirmed that they could make decisions about what to do each day. Risk assessments had been undertaken in connection with various activities that were linked to peoples goals and targets. People had goals which meant that they spent a lot of time outside the home. We saw records of risk assessments in relation to road safety, cycling unsupervised and travelling alone. The assessments had been reviewed during the last year. Peoples risk assessment records included Activity Planning sheets. Staff members were using these sheets to record when a risk assessed activity had been undertaken, and what the outcome was for the person. This looked like a very good way of monitoring peoples competence and safety when taking part in new activities that involved a degree of risk. Overall, there was a lot of information being recorded about peoples needs and how they wanted to be supported. At the last inspection we had talked about the need for better presentation and a more joined up approach to the completion of peoples different plans and records. This aspect has much improved. It was now much clearer to see the progress that people were making with their goals, and what they had achieved. We asked staff in their surveys whether they were given up to date information (for Care Homes for Adults (18-65 years) Page 15 of 38 Evidence: example in the care plans) about the needs of the people they supported. Staff members all responded Always to this question and made positive comments about the levels of communication between people in the home. One staff member commented We have weekly meetings which include the residents to discuss care plans and support which include individual targets. Also in my supervisions I am given information, I have never been so involved in the residents development, it is a great learning environment. The people who use the service told us that they met with staff, usually weekly, for a one to one discussion. Information about these meetings was recorded in detail on Key Worker Record forms. The meetings were a way in which people could discuss their day to day progress and give feedback about things that were affecting them. People told us that they could get up and go to bed when they wished. We heard staff talking to people about their plans for the day, and then making arrangements to help ensure that these ran smoothly. People had keys to the front door, so that they could come and go as they wished. We saw people using the kitchen during the day and one person prepared their own meal in the evening. We spoke to one person about the support that they received with looking after their personal money. They were able to manage this themselves, without the need for staff members to be involved. We were invited to be present at a meeting in the home, which had been arranged for the afternoon of our visit. This meeting was for the people who use the service, and for the staff who supported them during the day. Mr Ferris told us that separate staff meetings were not being held, as it was the aim to involve the people who use the service as much as possible in the day to day business. We saw that people could add their items to the meeting agenda, and contribute to the discussions on an equal basis. There was discussion about a number of issues. The people who use the service were being listened to, and their views helped in the decision making process. One discussion was about the deployment of staff, and how this could be matched to the times when people wanted one to one support with activities. Staff members showed a willingness to work in a way which would provide the flexibility that the people who use the service wanted. There was also a discussion about food waste, the need for recycling and saving energy. This helped people to understand their responsibilities as citizens and how they could reduce bills. Care Homes for Adults (18-65 years) Page 16 of 38 Evidence: Minutes were being kept, so that it was clear what had been decided and who would be taking responsibility for following things up. Care Homes for Adults (18-65 years) Page 17 of 38 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are part of their local community and can take part in activities that are appropriate to their age and culture. Peoples rights are being respected and the home supports people to have appropriate relationships. People are encouraged to be as independent as they can be in their daily lives. This includes making choices about what to eat and helping to prepare the meals. Evidence: People spoke to us very positively about the support that they received with finding things to do outside the home. They told us about their jobs, and about the different work placements and college courses they had attended. People had gained experience Care Homes for Adults (18-65 years) Page 18 of 38 Evidence: of working in a kitchen, in shops, a night club and in a cafe. One person had tried a number of different activities during the last year. This was helping them to decide about the type of work that they wanted to do in the future. Hairdressing was one possibility being looked into. The other person had some part-time work and combined this with social activities and college courses. One of their goals was to gain a place at university and they were working through the steps they needed to take in order to achieve this. We read in the homes records about the support that people received, which would help them with their job and college applications. This had included interview coaching, referral to local employment services, and accompanying people on open days. The home was well placed for people to be able to get to their different activities in and around the city. People walked to many of their regular activities, but were also gaining experience of using public transport. We were told in the AQAA that one person was taking driving lessons. When we visited the home we heard that they had passed their test. They had received a lot of cards congratulating them on this achievement. This success had also opened up other possibilities for employment. We heard for example that the person might like to look at the possibility of being a fork lift truck operator. People told us about the social networks that they had established after moving into the home. One person had joined a tennis club and liked to do other sports. They were very keen on photography and examples of their work were displayed in the home. The person had a computer in their room and they went on the internet to get their photographs printed on-line. They said that they also did banking on-line. The other person who uses the service was also busy during the day and worked in the evenings at a local club. They were interested in drama and had been supported with attending auditions. Both people who use the service had activities and were developing social lives which reflected their interests as young people. It was evident from our conversations with people that they felt that their cultural and faith needs were being met. One person said that they had the opportunity to go to a church and knew that this was a choice they could make. Peoples diverse needs were reflected in their goals, but we thought that they could be highlighted better in their assessment and personal information records. For example, Care Homes for Adults (18-65 years) Page 19 of 38 Evidence: Religion was included in a list of personal details, rather than there being a separate section which covered a persons cultural and faith needs. Details were recorded in peoples individual files about their family backgrounds and important contacts. This helped to ensure that staff had the information they needed to support people with their relationships. People told us that they kept in touch through phone calls, emails and letters. People also visited relatives who lived some distance away. Within the home it was expected that people would participate in the daily routines and household tasks. People helped with the food shopping and with preparing meals. They did their own laundry. Some of peoples goals were geared to developing skills such as cooking and menu planning. At the time of our visit, one person was purchasing and preparing all their own meals as part of an agreed programme of life skills. This experience would help prepare them for a move to a more independent type of accommodation. The other person also prepared some of their own meals regularly and kept a weekly food budget. Meals were eaten in homely surroundings and the accommodation as a whole was furnished and decorated as an ordinary domestic type environment. Care Homes for Adults (18-65 years) Page 20 of 38 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People receive personal support from staff in the way that they need and prefer. Their health needs are met and people receive support which helps them to manage their own health care and medication. Evidence: We were told in the AQAA that support through verbal prompting was offered to people on a daily basis. This included advice about personal hygiene and healthcare. It was reported in the AQAA that people were mostly independent in these areas, but on a few occasions reminders were needed to keep people on task. People told us about the things that they managed themselves, which included their personal care. They did not have any physical care needs. We were told that people managed their own nail cutting, but that staff were aware of the need to monitor how well this was being done. People had the privacy of their own rooms. They chose what to wear and appeared to be confident about their personal appearance. Care Homes for Adults (18-65 years) Page 21 of 38 Evidence: People also told us in their surveys and during the visit about the support that they received from staff, and how this was helping them. One person who uses the service commented they help me plan my life, so I have time for everything I want to do each day, which is a huge help as I am so disorganised. People also told us about the specific areas in which they received support. One person said I have learned to budget and save my money. They also mentioned that they had been supported with activities which had developed their confidence and social skills. The other person who uses the service commented I can do pretty much anything I want to do. The staff are very helpful in supporting this. People had mobile phones on which they could be contacted by staff when out of the home. We were told that any advice or messages from staff were usually sent by text. People preferred this method because it was more discreet and private when they were with their friends. One person mentioned that when out with a support worker, the support worker was careful not to behave like care staff in front of their peer group. The people who use the service had their own keys to the front door. We were told that on occasions, people returned to the home and then spent some time on their own without staff on the premises. We confirmed with Mr Ferris that the safety of this arrangement should be formally assessed through the risk assessment process. Information about peoples contact with GPs and other health professionals was recorded in their personal files. People were registered with local GPs and had access to a dentist and optician. People raised personal issues about their health and welfare when meeting with their key workers each week. People liked to make some of their own appointments and the meetings were an opportunity to share information about these. Details of health related issues were recorded on the Key Worker Record forms. Significant Event records were also being kept. These records ensured that there was good information about the matters that people had raised, how these were followed up, and their outcome. The Person Centred Placement Plans included a Health Action Plan section, which helped to highlight peoples health priorities. One persons plan showed the need for them to be advised about keeping fit and having medication reviews. Peoples Individual Social (IS) Plans also included matters in relation to personal and Care Homes for Adults (18-65 years) Page 22 of 38 Evidence: healthcare support. People had talked about specific needs and agreed how these would be followed up. We read in one persons IS plan that they would be attending a session with a consultant psychiatrist, which would include a review of their medication. It was reported in the AQAA that people chose whether to access certain services. We were told about an example of this when a person declined the offer of seeing a bereavement counsellor directly. However the staff team sought their advice, and were provided with strategies, which would help them to support the person. We read in the AQAA that Healthy Eating was being promoted. We saw evidence of this in the arrangements that were being made to support a person with their own menu planning and meal preparation. We read in the AQAA that one of the ways that the home had improved during the last year was by offering more indepth guidance about healthy living and relationships. This included the subjects of substance abuse, sexual health and sexual education. The staff team included male and female support workers from different backgrounds. We were told in the AQAA that this offered a variety of support options, and people who used the service could choose who they wished to support them with a specific matter. One person who uses the service commented about staff I never feel embarrassed or uncomfortable talking to them about any painful, personal problems. We asked staff in their survey whether they felt that they had the right support, experience and knowledge to meet the different needs of people who use services. They all responded Always to this question. One staff member commented As a staff team we are all experienced in different ways and from different backgrounds, when helps give the residents a lot more opportunities. We were told in the AQAA that another development during the last year had been the support given to one person with managing their own medication. We looked at the medication arrangements during our visit. There was a written policy on medication and a procedure for its administration. Information about peoples medication was included in their individual plans. One person did not have medication prescribed. As reported in the AQAA, one person was taking some responsibility for managing their prescribed medication. The process of self-administration was being carried out in a planned way. A risk assessment had been undertaken and there was a strategy for how the outcome would be achieved. Care Homes for Adults (18-65 years) Page 23 of 38 Evidence: The person was currently at a stage when they asked staff for their medication without prompting. They then took the medication from a dosette box / compliance aid which had been prepared by staff with a weeks supply. This was a stage prior to the person looking after the medication themselves. We looked at the medication records. The preparation of the dosette box / compliance aid was not being recorded. The person who uses the service, and the staff member involved, were both signing a record to confirm when the medication had been administered on each occasion. We talked to Mr Ferris about the preparation of the weekly dosette box and the need to record who was involved in this, and was taking responsibility for the contents. In normal circumstances, staff must only administer medication from the original packs that have been supplied by the dispensing pharmacy. If the person who uses the service is primarily involved in filling the dossete box as a stage towards managing and looking after their own medication, then a record needs to be kept as confirmation that they are taking responsibility. There were no controlled drugs being prescribed, and no prescribed medication that was for use on a PRN (as required) basis. There was a suitable cabinet in place for peoples current medication. Mr Ferris said that he had contacted peoples GPs about gaining approval for a list of homely remedies. However he had not yet heard back from them and needed to follow this up. Care Homes for Adults (18-65 years) Page 24 of 38 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are listened to and they know what to do if they have any concerns. Procedures are in place which help to protect people. Evidence: Luma Care had produced a written complaints procedure. This had been given to the people who use the service. The procedure was included in the information about the home that is available to outside agencies. It was reported in the AQAA that the home had not received any formal complaints during the last year. We were also told in the AQAA that people were given opportunities to voice their opinions, and when issues were raised these had been recorded and addressed at the time. People told us that they knew how to make a complaint, and who to speak to if not happy with something. One person commented I can talk to any staff member about any complaints I have, and they will write them down and pass them to the manager. I can also make complaints, which are not private, at our weekly meeting with all the staff and the other resident. The other person said that they could talk to the staff or to the manager. They also mentioned somebody who was independent of the service, and that they could fill in a Care Homes for Adults (18-65 years) Page 25 of 38 Evidence: form which is available when I want it. Staff members confirmed in their surveys that they know what to do if somebody had concerns about the home. One staff member commented If there is a concern I initially will see if I might be able to help. If not I will pass it onto my manager who would be able to deal with the issue and this would be recorded and dealt with by them in confidence, or they can contact our independent person for Luma Care, the director or even CSCI. Another staff member told us There is a complaints procedure in place which we are always reminded of. Luma Care Ltd had produced written polices, which covered topics such as managing behaviour, physical intervention restraint, protecting people from abuse, and whistle blowing. It was reported in the AQAA that there had been no incidents during the last year when restraint was used. There had also been no incidents referred to the local authority under the safeguarding adults procedures. It was reported in the AQAA that the home gave a high priority to dealing with concerns and advising people about their rights. The people who use the service commented very positively about the way in which they were being treated by staff. One person told us that they had a great relationship with staff, and that the staff always listened to their needs. We were told in the AQAA that staff received in-house training in protecting people from abuse, and that some staff had also attended a local training course. The staff members we met during our visit confirmed that they had received training about abuse, and had been given written guidance about the protection of children and vulnerable adults. Some staff had completed training in adult protection when undertaking their National Vocational Qualification. Care Homes for Adults (18-65 years) Page 26 of 38 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a homely environment which is kept clean and is meeting their needs. Evidence: The property is an ordinary terraced house and does not stand out as being a care home. At the back of the house there was a small courtyard type garden with patio chairs and a table. A lack of parking outside the home was one drawback for visitors and staff, although there were some public car parks nearby. The home was well placed for people to be able to get to many of their planned activities. People told us about the different places and shops that they could walk to by themselves. Nobody was reported to have any physical disabilities. The home had not been adapted for people with physical disabilities and the first and second floors could only be reached by stairs. The communal space consisted of an open plan lounge and dining area. These were furnished and decorated in a modern and co-ordinated style. The overall appearance was one of a well maintained interior. Care Homes for Adults (18-65 years) Page 27 of 38 Evidence: The accommodation looked clean and tidy. In their surveys, we asked the people who use the service whether the home was kept fresh and clean. They responded Always to this question. One person told us it helps us feel better about ourselves when our room is tidy and the house is clean, and prepares us for how our house should be kept when we are living independently. The other person commented the home is cleaned everyday by the staff or sometimes myself. There was a domestic type kitchen, which the people who live at the home were free to use. Laundry was carried out in an area beyond the kitchen. There was a procedure to follow for the movement of washing, to avoid the risk of cross-infection. There were one-use soap and paper towel dispensers in the bathroom, which also helped to reduce the risk of cross-infection. The home had received a visit from an environmental health officer in May 2008. Mr Ferris told us that this had gone very well. We read the report of their inspection and saw that no requirements or recommendations had been made. During our visit people, were using the communal and domestic areas, as well as their own rooms. One person showed us their room, which they said they were happy with. They had chosen the colours and the room looked light and airy. People had been provided with small safes where they could lock things away. The homes Statement of Purpose included some information about the accommodation, but did not have details about the sizes of rooms. This information still needs to be added. The bedrooms did not have en-suite facilities. It had been decided at the time of registration that as a small, family type home, en-suite facilities would not be a requirement. There was a bathroom and a shower room that people could use on the first floor. We were told that at the last inspection that there were plans to fit new double windows. This work was not carried out as originally planned, although Mr Ferris said it was to be done in the next 12 months. Care Homes for Adults (18-65 years) Page 28 of 38 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are supported by competent staff, who are obtaining relevant qualifications. People are protected by the homes recruitment practices. However not all the required records were available in the home. Evidence: We were told in the AQAA that there was a staff team of nine, which included support workers and a senior support worker. The deployment of staff was being planned in advance and rotas kept. A minimum of two staff were deployed during the day and there was one person on waking duty overnight. Agency staff were not being used. The staffing levels meant that people could receive a lot of one to one support. The comments from the people who use the service showed that they are happy with the level of support they received. For example, they commented the staff are always very flexible about whatever I would like to do, and I am able to suggest any activity of my choosing, and staff always accommodate my needs. Care Homes for Adults (18-65 years) Page 29 of 38 Evidence: Mr Ferris told us that the homes induction programme had been developed during the last year, as they had learnt more about the needs of the client group and the staff team. Staff told us in their surveys, that their induction had covered everything very well. They said that they had a lot of training, and been given information about the running of the home and the people who use the service. One staff member commented I found all this very useful when I first started and have since received refresher training to update myself. I was also shown the policies and procedures of the home which I can access at the time to refresh my working practice. Staff also confirmed in the surveys that they were being given training which was relevant to their role, helped them to understand and meet peoples individual needs, and kept them up to date with new ways of working. We were told in the AQAA that all staff had received training in food handling. The staff we met during the visit also confirmed this. Staff members comments included the training I receive has certainly helped me within my position in the house. Another staff member told us I have had a large amount of training, in-house here at Luma Care, on training courses outside of Luma Care and recently completed my NVQ level 3 with the local training centre. Three staff members mentioned in their surveys that they had recently completed a National Vocational Qualification (NVQ) at level 3. One staff member commented I have completed my NVQ3 in health and social care with excellent support from my manager, and that is something that I never thought I would be able to do. I am so much more reflective in my practice of the needs of the residents. We were told in the AQAA that 80 of the staff team had now achieved an NVQ at level 3. This meant that the home had met a target that was set in its training plan for 2007 - 2008. There was a new training plan and programme for the year ahead. This was a costed programme. There was also information about how the training plan would be put into practice, and how it supported Luma Cares objectives. The training plan included such topics as Protecting from abuse, Fire Safety, Medication, Health and Safety, Clients needs, and the Key worker role. We were told about other subjects that would be covered with staff, although these were not included in the plan. The home had developed a training package called Valuing People, which focused on equality and diversity issues, and how people who use services can be discriminated against. Care Homes for Adults (18-65 years) Page 30 of 38 Evidence: Some of the paperwork in relation to staff training and development was not being fully used at the time of the last inspection. This was being addressed and we were told that each staff member now had a personal development plan. The recruitment documentation was also being improved. A new application form, health declaration form, and recruitment checklist had been produced. We were told that one staff member had been recruited since the last inspection. Other members of the staff team had been appointed before the home opened, or shortly afterwards. We looked at their recruitment records at the last inspection and saw their CRB (Criminal Record Bureau) disclosures. Mr Ferris said that it was the intention to apply for new CRB disclosures every three years for the existing staff. We talked to Mr Ferris about the new staff members employment record, as their file was not available at the home at the time of our visit. There was a record confirming that a CRB disclosure had been received. We confirmed with Mr Ferris that all records relating to recruitment and employment need to be kept in the home. We were sent information on the following day which showed the recruitment checks that been completed, and the information that had been received in relation to the new staff member. This included references and documents confirming proof of identity. The POVA (Protection of Vulnerable Adults) list had been checked, and the CRB disclosure received before the person had started working at the home. In their surveys, and during our visit, the staff members commented very positively about the support that they received from their manager. Staff confirmed that they had one to one meetings with their manager for supervision. The meetings were being planned in advance and minutes kept. As reported in the section Individual Needs and Choices, weekly meetings were being held involving the people who use the service and the staff who support them during the day. We asked about the involvement in meetings of those staff who worked overnight in the home. Mr Ferris said that they were not involved in the meetings, but did see the minutes and had the opportunity to pass on their comments. Care Homes for Adults (18-65 years) Page 31 of 38 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from the management approach in the home, which is inclusive and promotes the rights of the people who use the service. Policies and procedures in the home are being developed to ensure that they are comprehensive and safeguard peoples interests. Evidence: Mr Ferris was registered as manager when the home opened in November 2007. As part of the registration process, the applicant is required to show that they are a fit person to manage the home. Fitness refers to a number of personal attributes, such as having integrity and being of good character. The applicant will also have demonstrated that they have the qualifications, skills and experience that are necessary for managing the care home. Details of Mr Ferris qualifications and experience, and those of the therapeutic manager, were provided in the homes Statement of Purpose. We were told in the Care Homes for Adults (18-65 years) Page 32 of 38 Evidence: AQAA that Mr Ferris attended updates and training for further development. At the last inspection we received feedback about how well the people who use the service had settled into the home. We received further comments at this inspection from the people who use the service, which confirmed that they were very happy with the service they received and how they were being supported. Staff members were also very positive about the home and how it was being managed. One staff member commented the service gets the young person ready to go it alone in the big wide world. Other staff members comments included very good development of residents, open communication, and the residents are always involved in decision making, its very person centred. Information had been included in the AQAA about the homes plans for the next 12 months and what could be done better in most areas. This showed that Luma Care was able to identify ways in which the home could improve. The people who use the service had the opportunity to express their views on a regular basis, and these were being acted on. A more formal system of quality assurance was being developed, and a policy and procedure for quality assurance has been produced. Part of this, including a management audit of standards, has been implemented during the last year. An annual development plan has been produced. We were told that the full implementation of the quality assurance system would involve regular surveys to stakeholders and outside agencies. It was reported in the AQAA that Luma Care was also assessing whether an external system such as Investors in People was needed. From the evidence of this inspection we thought that the homes strengths were in the way that it focused on peoples individual needs, and in a management and staff approach, which was inclusive and promoted the rights of the people who use the service. The home was still developing its policies and procedures to ensure that these covered all relevant areas. Some new policies have been produced, but they had not all been dated or had a review date identified. A director from Luma Care was visiting the home each month and writing a report in accordance with Regulation 26 of the Care Homes Regulations 2001. There was a checklist format to the reports and the reports did not include feedback from the people who use the service. There were headings in the checklist such as Wakefulness of staff and Wakefulness of residents, when it was not clear what was being checked. Care Homes for Adults (18-65 years) Page 33 of 38 Evidence: There was a policy on health and safety. Other policies had been produced for specific areas such as the control of substances hazardous to health (COSHH), fire safety and infection control. Risk assessments were being undertaken in connection with the environment and facilities, as well as concerning peoples individual activities. Some regular safety checks were being carried out, including the testing of the fire precaution systems. A fire risk assessment had been undertaken in September 2008. While at the home we saw that two communal doors were in regular use and they were being held open to facilitate this. These were fire doors, which therefore needed to be kept closed when not in use. We recommended to Mr Ferris that he obtains advice about approved devices that could be fitted to the doors, so that they could safely be kept open. Care Homes for Adults (18-65 years) Page 34 of 38 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 35 of 38 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation 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 20 13 A record must be kept which 30/06/2009 shows who is taking responsibility for the preparation of a dosette box / compliance aid. In normal circumstances medication must only be administered from the original packs that have been supplied by the dispensing pharmacy. This is to ensure that there can be no misunderstandings about the circumstances in which the dosette box compliance is being used, and that its use is in the best interests of the person who uses the service. 2 34 17 Staff records must be kept in the home and available for inspection. This is to ensure that there is the evidence that we need to show that the recruitment procedures are robust and 30/06/2009 Care Homes for Adults (18-65 years) Page 36 of 38 the appropriate documentation has been obtained. 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 11 That peoples diverse needs, for example in relation to faith and culture, are more fully described in their assessment and personal records. This will help to ensure that these needs are always paramount when decisions are being made about the services that people require. A cupboard that meets the current storage regulations for controlled drugs, the Misuse of Drugs (Safe custody) (Amendment) Regulations 2007 should be installed. This is so that any controlled drugs can be stored safely if they need to be kept in the home in the future. That there is a discussion with the dispensing pharmacist about the use of the dosette box / compliance aid and whether this can be replaced with a pharmacist prepared monitored dosage system. That consideration is given to ways in which the night staff can be directly involved in the homes weekly meetings. This is so that they have the opportunity to contribute on an equal basis as other staff. That the homes training plan includes information about all the subjects that are to be covered with staff. This is to ensure that it gives a full and accurate picture of the training that staff are to receive. That the format of the reports made under Regulation 26 of the Care Homes Regulations 2001 is reviewed. This is to ensure that the reports are informative and reflect the views of the people who use the service. That the policies and procedures are dated to show when they were produced, and that dates for reviews are also identified. This is to ensure that their contents are reviewed on a regular basis, and amended in the light of changes in guidance and legislation. That advice is obtained about suitable devices that can be fitted to doors, so that they can safely be kept open when needed (non-approved devices must not be used). 2 20 3 20 4 33 5 35 6 39 7 40 8 42 Care Homes for Adults (18-65 years) Page 37 of 38 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. 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