Care Home: Meadow Lodge

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What the care home does well People thinking of using the home were invited to spend `tea visits` there. One person staying at the home remembered doing this and thought it was very helpful. Some younger people were using the home as part of their plans to be more independent. For example, people might want to attend a specialist college or to live in a supported living house. Respite times helped them learn to be away from home, practice skills and live alongside others. People staying were helped to unpack and re-pack their things. A list helped make sure they returned home with the things they had brought. Support plans that we looked at had a lot of useful information. People had agreed what was in their plans. The service was developing `person-centred` ways to do support planning. Support staff kept clear notes of what happened in the home. We saw that a relief support worker, who had not worked at the home before, had enough time to read support plans and handover notes. Risk assessments were very well written. They showed clearly that they were worked out with the people they were about. A member of staff said the home was ‘like a youth hostel`, because people came for their own reasons but they also took part in the daily life of the group of people they were with. We found that everyonestaying had `made themselves at home`. People seemed happy to help with preparing or clearing away the evening meal. Each bedroom had a television, and there was a large TV with DVD in the sitting room. This was a cosy room, where people relaxed. The dining room and kitchen were also homely and felt `lived in`. There were two main shopping days per week. People staying at the home often helped with the shopping. Enough items were kept in stock so that plenty of different meals could be provided. There was a homely feeling around the meal table. Staff joined in with the meal. People made their packed lunches for the following day, choosing what to put in. People told us they always enjoyed their meals when staying at the home. When people are not well they are helped to get the help they need from people like nurses and doctors. Staff know how to give people their medicines. They have training in how to support people with epilepsy. There were very good systems for making sure that people who took medicines had the right ones with them. The home was kept very clean. There was a weekly job sheet for staff, to make sure all parts of the home were cleaned regularly. When there were not enough of the home’s staff to come in, relief staff came from Wiltshire Council`s own relief staff bank. Many of the bank staff worked oftenat Meadow Lodge. There was always at least one of the permanent staff on duty. People could not start working in the home until their background had been checked. The staff had lots of training so they know different ways of supporting people. Most of the staff have got NVQ certificates. They get regular one-to-one supervision. What has improved since the last inspection? A lot of work had been done on improving assessments. There was better information for people. `Courtesy calls` were made to the families of all people after each stay at the home, to check if people were happy with the arrangements. This gave people a chance to suggest ways things might be changed the next time they came. We made sure that when people had made complaints about the home [two since March 2009], the proper complaints procedures had been followed. This meant that people who were not happy about something could be sure their concern was taken seriously. The home was now keeping proper information about the people that work there. Fire safety had been made much better. They had taken advice from the Fire Service. The staff now had regular fire safety instruction. They had started a weekly evacuation practice. One memberof staff was the fire officer for the home. What the care home could do better: We found that many parts of the home needed repainting. A net curtain had been put up in the upstairs bathroom after our last inspection. It did not make the room warmer or more private. We would still like to see proper curtains or a blind fitted. People could be invited to decorate their support plans or add photos, if they wished. Support plans could make it more clear what people`s main reasons were in staying at the home. Then staff could write how each stay helped people to work towards their goals. The home hopes to help people to use community resources more and to learn skills. We think the staff should receive special training so they can be most useful to people. To support people to take medicines safely and in private, there could be a special medicine cabinet in each bedroom. Every year people are asked what they think of what the home does for them. This helps the managers to plan for the future. They should let people know what kinds of answers they get, and what they are going to do as a result. Key inspection report Care homes for adults (18-65 years) Name: Address: Meadow Lodge Sadlers Mead Monkton Park Chippenham Wiltshire SN15 3PE two star good service The quality rating for this care home is: A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Roy Gregory Date: 1 0 1 2 2 0 0 9 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should:  Be safe  Have the right outcomes, including clinical outcomes  Be a good experience for the people that use it  Help prevent illness, and promote healthy, independent living  Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home:  3 stars – excellent  2 stars – good  1 star – adequate  0 star – poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area Outcome area (for example: Choice of home) These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by:  Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice  Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983   Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2010) 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 Information about the care home Name of care home: Address: Meadow Lodge Sadlers Mead Monkton Park Chippenham Wiltshire SN15 3PE 01249656136 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) : Wiltshire Council care home 4 Number of places (if applicable): Under 65 Over 65 4 0 learning disability Additional conditions: The maximum number of service users who can be accommodated is 4. The registered person may provide the following category of care only: 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 disabilityCode LD Date of last inspection 2 6 0 3 2 0 0 9 A bit about the care home Meadow Lodge is in a quiet area of Chippenham. The home provides respite places for up to four people with a learning disability. People take part in activities and attend college or other day resources, as if they were at their usual home. The service is provided by Wiltshire Council. There is 24-hour staff cover to provide support for people staying there. Meadow Lodge has a sitting room, dining room and kitchen. There are four single bedrooms. One bedroom is on the ground floor and has its own toilet. There is a large, private garden area behind the house. It is possible to walk to the railway station, and into Chippenham town centre, where there are good bus services to other towns. There is plenty of parking space at the home. 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 Good Good Good Good Good Good Good Good How we did our inspection: This is what the inspector did when they were at the care home We visited Meadow Lodge on Thursday 10th December 2009 between 1:00 p.m. and 8:00 p.m. We were able to talk with all four people that were staying there at the time. We also spent time with a senior support worker, and a relief worker. The manager, Tanya Andrews, was able to join us for about half of the time that we were there. We accepted an invitation to join everyone in the home at the evening meal. Two people showed us the bedrooms they were using during their stay. We also saw all the shared rooms of the home bathrooms, kitchen, utility, sitting room and dining room. We looked at the paperwork in the home, that explained what support people needed and how staff worked to keep people safe. We could also read about activities people did. We saw how medicines were kept. Other records showed how staff received training and supervision. We looked at ways the home is supported by Wiltshire Council, and how they get the views of people that stay at the home, to help them run it how people want. After our last inspection in March 2009, we asked the home to provide us with a plan of how they were going to make the improvements we had asked for. We received their plan before this inspection visit. We also received their Annual Quality Assurance Assessment [AQAA], which all services send to us each year. What the care home does well People thinking of using the home were invited to spend tea visits there. One person staying at the home remembered doing this and thought it was very helpful. Some younger people were using the home as part of their plans to be more independent. For example, people might want to attend a specialist college or to live in a supported living house. Respite times helped them learn to be away from home, practice skills and live alongside others. People staying were helped to unpack and re-pack their things. A list helped make sure they returned home with the things they had brought. Support plans that we looked at had a lot of useful information. People had agreed what was in their plans. The service was developing person-centred ways to do support planning. Support staff kept clear notes of what happened in the home. We saw that a relief support worker, who had not worked at the home before, had enough time to read support plans and handover notes. Risk assessments were very well written. They showed clearly that they were worked out with the people they were about. A member of staff said the home was ‘like a youth hostel, because people came for their own reasons but they also took part in the daily life of the group of people they were with. We found that everyone staying had made themselves at home. People seemed happy to help with preparing or clearing away the evening meal. Each bedroom had a television, and there was a large TV with DVD in the sitting room. This was a cosy room, where people relaxed. The dining room and kitchen were also homely and felt lived in. There were two main shopping days per week. People staying at the home often helped with the shopping. Enough items were kept in stock so that plenty of different meals could be provided. There was a homely feeling around the meal table. Staff joined in with the meal. People made their packed lunches for the following day, choosing what to put in. People told us they always enjoyed their meals when staying at the home. When people are not well they are helped to get the help they need from people like nurses and doctors. Staff know how to give people their medicines. They have training in how to support people with epilepsy. There were very good systems for making sure that people who took medicines had the right ones with them. The home was kept very clean. There was a weekly job sheet for staff, to make sure all parts of the home were cleaned regularly. When there were not enough of the home’s staff to come in, relief staff came from Wiltshire Councils own relief staff bank. Many of the bank staff worked often at Meadow Lodge. There was always at least one of the permanent staff on duty. People could not start working in the home until their background had been checked. The staff had lots of training so they know different ways of supporting people. Most of the staff have got NVQ certificates. They get regular one-to-one supervision. What has got better from the last inspection A lot of work had been done on improving assessments. There was better information for people. Courtesy calls were made to the families of all people after each stay at the home, to check if people were happy with the arrangements. This gave people a chance to suggest ways things might be changed the next time they came. We made sure that when people had made complaints about the home [two since March 2009], the proper complaints procedures had been followed. This meant that people who were not happy about something could be sure their concern was taken seriously. The home was now keeping proper information about the people that work there. Fire safety had been made much better. They had taken advice from the Fire Service. The staff now had regular fire safety instruction. They had started a weekly evacuation practice. One member of staff was the fire officer for the home. What the care home could do better We found that many parts of the home needed repainting. A net curtain had been put up in the upstairs bathroom after our last inspection. It did not make the room warmer or more private. We would still like to see proper curtains or a blind fitted. People could be invited to decorate their support plans or add photos, if they wished. Support plans could make it more clear what peoples main reasons were in staying at the home. Then staff could write how each stay helped people to work towards their goals. The home hopes to help people to use community resources more and to learn skills. We think the staff should receive special training so they can be most useful to people. To support people to take medicines safely and in private, there could be a special medicine cabinet in each bedroom. Every year people are asked what they think of what the home does for them. This helps the managers to plan for the future. They should let people know what kinds of answers they get, and what they are going to do as a result. If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Roy Gregory Colston 33 33 Colston Avenue Bristol Avon BS1 4UA 01179307110 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website http:/www.cqc.org.uk/. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line - 0870 240 7535. Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People interested in using the home receive information to help their decision about receiving respite care, and are assessed to be sure the home can meet their needs. Evidence: Considerable work had been done on improving the assessment process and the provision of information, since our previous inspection visit in March 2009. Courtesy calls were being made to the families of all people after each stay at the home, in order to ascertain satisfaction with the arrangements. This gave people a chance to suggest ways in which their next use of the home might be changed, to meet changing needs or aspirations. A record was kept of these calls. We suggested the outcome of courtesy calls should be repeated in peoples individual care records, to demonstrate that any required changes would be clearly known to support staff at the start of each persons stay. If there were a prolonged time since a persons previous stay, it would be worth conducting a further call to the family prior to the persons arrival, to take account of any significant changes that had occurred. Tanya Andrews indicated in the homes Annual Quality Assurance Assessment [AQAA] that this is intended to become usual practice for all people staying. For people considering use of the facility for the first time, as a minimum the home required referring social workers to provide a current community care assessment and an epilepsy profile. Other than in emergency situations, people thinking of using the home were invited to spend time there by way of tea visits, often with a familiar informal carer or social care worker. We saw that observational records of such visits were kept in the same way as care records for people that stayed at the home. Two of the people staying at the home told us that they recalled their first visits there and had felt helped to settle in, one of them having visited twice before their first overnight stay. We were told that a Evidence: 17-year-old had recently made a short visit, to fit with planning for their support needs after they would attain age 18. The home had its own assessment form. We saw that this was used to ensure that information in a persons community care assessment was checked and added to, as well as drawing on the experience of trial visits. Most people were repeat users of the home. A log was kept to show when peoples community care assessments were due for review. Increasingly, younger people were using the respite facility as an element in planning for greater independence, rather than primarily to give respite time for their usual informal carers. For example, one of the people we met in the home was planning to attend a specialist college. Respite periods in Meadow Lodge supported them in learning to be away from home and to develop skills in independent living and living alongside others. These aims were clearly shown in the assessment information gathered by the home. Some people who stayed at the home were aiming to live ultimately in supported living environments. Some people who had stayed at Meadow Lodge in the past had been re-assessed as in need of greater levels of support, and were now using the sister home, which catered for higher and more complex support needs. Following a requirement made at the previous inspection, the services statement of purpose and service user guide had been updated. The information was presented in a good pictorial format. We were told that it was given to all users of the service, and their family carers, and they were to be asked if they would like a copy sent to them annually. We suggested that copies could be placed in a holder in each bedroom, on a par with practice in commercial guest accommodation. 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. Peoples support and developmental needs are assessed and reviewed through a planning system that promotes recognition of rights and abilities to make choices. Risks are recognised and minimised to enable participation in every day life experiences. Evidence: Support plans that we looked at were detailed, and there was good evidence that people were directly involved in agreeing what was in their plans. Information provided to us before the inspection showed that the service was developing ways of incorporating person-centred thinking and practice in how support plans are formulated. This could be taken further, by inviting people to add photos or to decorate their plans, if they wished. We also considered the comprehensive nature of the support plans made them fairly dense, so identifying the most important information was not easy. It would be helpful to staff if the primary aims of a persons plan in using the respite facility were clearly highlighted as part of the one page profile in each plan. This would enable them to concentrate, in their records of a persons stay, on those aspects of the stay that related to the persons aims. Our previous recommendation about this is restated; however, record keeping by support staff was clear and objective. We saw that a relief support worker, who was not familiar with the home, was able to devote sufficient time to reading support plans, care records and handover notes, and to ask related questions of the permanent member of staff. Risk assessments were particularly well written, showing clearly that they were devised with the direct involvement of the people they concerned. They began with asking the question, what do you want to do, then identified potential hazards in the activity, based on individual perceptions and skills. The next question was what can we agree to make it Evidence: less dangerous? The assessments showed a creative approach to facilitating rather than denying participation in a range of activities within and outside the home. They were signed jointly by the person using the service and the member of staff devising the assessment. Support plans and risk assessments were subject to regular reviews. Plans included guidance on peoples communication needs, and how people made choices. We saw that people made constant choices about use of different parts of the home and how they passed their time. They told us they went to bed and took baths when they wished. We saw that staff encouraged people to engage in conversation and household tasks with each other and with staff, whilst respecting where individuals sought privacy. Staff were clearly aware of support plan guidance and risk assessments about the needs and wishes of the people staying in the home. Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Varied activities give people opportunities to maintain leisure interests, to develop skills and to access the community. Relationships with families and friends are supported. People participate in everyday tasks as they wish and their rights are respected. A healthy diet is offered, and mealtimes are conducted as people wish. Evidence: A member of staff described the home as rather like a youth hostel, in that people came for their own reasons but also took part in the daily life of the group of people they were with. When we visited, there were four people staying. Two were relatively young and had begun using the home within the past year, and two were older, with an established friendship. All four got on together extremely well. Each had made themselves at home. People seemed to see it as natural that they would help with preparation or clearing of the evening meal. All chose to eat together at the table, but staff said people could equally have a meal on a tray elsewhere if they wished. Efforts were made to find out about peoples every day routines at home, so that they could be sustained whilst staying at Meadow Lodge. Each bedroom was provided with a television, whilst there was a large TV with DVD in the sitting room. This was a cosy room, in which people readily relaxed. We saw a person making a choice of DVD to watch, whilst another person chose a colouring activity that they had brought with them. For each person there was a log kept of activities that they engaged in. Recently, for example, one person had made their packed lunches, sewn a glove puppet and been to the cinema. There was a brief evaluation of each activity, which helped establish the things people responded to or found difficult. Evidence: An activity co-ordinator post had been created, to work in both Meadow Lodge and its sister respite home. This was partly in recognition that customary reliance on external formalised day activities was set to become much less the norm for the people using the home. Therefore, community resources were being researched more. It would be worth seeking specific training opportunities for the specialist activities worker. They would also benefit from attending local learning disability self-advocacy groups, perhaps with one or two of the people that use the respite services. The services annual quality assurance assessment [AQAA] stated an intention to develop more structured activities within the home to develop skills, and to plan more activities in advance of a persons stay. There were occasional service user meetings in the home, which helped generate ideas about possible activities, but these were limited by not being representative of the large number of people that stay at different times. One member of staff said a meeting away from the home, comprising any regular users that wanted to attend, might be more productive. Otherwise, the evening meal time represented an engaging and informal way of helping people to share ideas with staff and with each other. Contact between people and their families during their stay could be as much or as little as they required. The courtesy call system had served to increase families opportunities to feel involved in how respite was provided. The staff team were about to undertake training regarding sexuality and relationships. Support plans included information on food likes and dislikes, and allergies. There were two main shopping days per week, with additional items bought in between as needs arose. People staying at the home were often included in shopping. Sufficient items were kept in stock so that a variety of meals could be provided. Pictorial menu cards were used, to help people choose from different ways of using ingredients. We were told that it was not unusual to prepare different meals for different people. At our visit, all people sat down to a substantial meal of freshly cooked fish pie. People enjoyed their meal, and told us they always did so. There was a homely atmosphere around the meal table, staff joining in with the meal. Later in the evening we saw people preparing their packed lunches for the following day, making choices as to what to put in. There was a good variety of breakfast foods available. We saw that people were able to help themselves to hot and cold drinks as they wished, supported according to individual risk assessments. 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 are supported to meet their preferred personal needs. Peoples health needs are known and monitored, with good liaison with health professionals as necessary. People are protected by the services policies and procedures for handling medicines. Evidence: Generally, people staying at the home have few needs in respect of direct support to personal care. Where prompts were necessary, the needs were explained in support plans. At the previous inspection, we made a recommendation that more attention needed to be paid to the gender balance of support workers at any time, to ensure there was no conflict with the needs of the people staying. As a result, there was guidance on planning the staff rotas and making requests for relief staff support, to ensure an imbalance did not arise. Whenever all people staying in the home were female, no male support workers were used during that time. Notifications of events that we have received from the home have demonstrated that staff are alert to medical needs arising, and prompt to obtain and act on health care advice. Where a person has an ongoing medical condition, this is shown clearly in records. Staff of the service, and staff supplied by the Wiltshire County relief bank, are all required to have training in working with people with epilepsy, and in administration of rescue medications. There was a chart to be used for recording all seizures, and for some people, additional monitoring information was recorded at the request of medical practitioners. We were told that some training in working with autism was being sought. Some staff had been trained in PEG feeding, to meet an individual need. Staff did not receive specific training about diabetes or food allergies. Staff were trained in safe handling of medicines and their competency was checked annually, by testing and observing practice. One member of staff was to register for train the trainer in handling medicines, in January 2010. The home notified us of three Evidence: medication errors since our previous inspection. These were each followed up by formal interview by the manager and individual action plans. We suggested that added security, and also privacy for people staying at the home, could be provided for by installing lockable medicine cabinets in each of the bedrooms. There were very good systems in place for ensuring that people who took prescribed medicines had the right ones with them. For each person that used the service, there was a record of correspondence and telephone contact with their GP surgeries, which ascertained individual medication regimes immediately prior to admission or readmission. Peoples medicines were checked in by staff, ensuring that labelling, printed Medication Administration Record and repeat prescription details agreed with each other. The terms of use of as needed medicines were checked through this process. Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are appropriate procedures, including staff training, to protect people from harm, and to receive and act on complaints. Evidence: The courtesy calls system was effective in giving people the opportunity to air any level of concern at an early stage, so matters could be addressed without assuming the status of a complaint. Two matters had been recorded as complaints, within the homes complaints record, since our previous inspection visit. In each case, the complainants had been offered the formal Wiltshire Council complaints procedure, but had been satisfied with local resolution. We confirmed that an earlier requirement, to ensure the written complaints procedure is followed, had been met. Information given to all potential users of the service included a copy of the complaints procedure. As part of a council-wide initiative, all staff had undertaken on-line training about recognising and responding to suspected abuse of vulnerable people. This was based on the No Secretspublished guidance to locally agreed inter-agency safeguarding procedures. There was provision in place for in-house annual refresher training in this field. We recommend development of a member of staff to take a lead on safeguarding practice within the service. Where a person staying at the home has an identified issue of presenting behaviours that can cause difficulties for others, a positive behaviour management plan can be put in place on an individual basis. However, management of behaviour issues is not a part of the service offered, and Tanya Andrews said in practice, behaviour that challenges others would tend to be assessed as a reason not to offer a respite placement. There was a list of known incompatibilities between service users, so that two people known to find it difficult to relate to each other would not be offered placements at the same time. If issues arose in the home, causing staff to be unsure how to address them, the home shared in Wiltshire Councils duty manager on-call system, so authoritative advice could be accessed any time. Where any person staying at the home wished for support in Evidence: management of their personal monies, individual written arrangements were made on an individual basis and recorded in their care plan. This could include safe-keeping by the home, for which there were appropriate recording systems to show transactions were genuine. Cash balances were frequently checked against records for accuracy. People staying were assisted to unpack and re-pack their belongings, with a list taken to ensure they returned home with the things they had brought. 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 home provides a home-from-home environment, which is kept clean to a good standard. Evidence: As at our previous inspection visit, we found that many parts of the home would benefit from repainting. We were told that a refurbishment programme had been devised and was ready to be taken to Property Services to be progressed. There was said to be no budget allowance for replacement of a badly worn carpet in the downstairs bedroom, which instead was to receive a professional deep clean. A net curtain had been put up in the upstairs bathroom following our observations there previously, but it was a makeshift solution to the need for enhanced privacy and comfort there and we would still like to see substantial curtains or a blind fitted. Despite the cosmetic shortcomings, the home provided a very homely environment in which people were clearly at ease. One person staying told us he had a favourite bedroom, but was happy to use whichever was available. He had been supported to produce a picture, with his name, which he put on his bedroom door each time he stayed. All the other people staying said they were happy with the bedrooms and the rest of the house. The sitting room, dining room and kitchen were homely and felt lived in. The home was kept clean to a high standard. A weekly day-by-day task sheet, backed by routine monitoring, ensured all parts of the home received regular cleaning, including the utility area, office and staff sleep-in room as well as all personal and shared accommodation used by people staying at the home. Monthly tasks, such as de-scaling of shower heads, were signed for to show they had been completed. One member of staff had delegated responsibility for overseeing infection control standards. There was a good supply of protective gloves and aprons for use by staff and people staying, as needed. Laundry provision was sufficient to provide for bed changes and the needs of people whilst they were staying. Evidence: There was a book for staff to note maintenance needs as they arose, which showed they were addressed efficiently. Tanya Andrews said a handyman from another Wiltshire Council establishment was due to undertake some of the identified repainting work. 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 are supported by competent, trained staff, whose work is regularly supervised. Recruitment practices ensure people are protected from being cared for by unsuitable staff. Evidence: Staffing for the home has been shared with a sister home, the two being operated as Chippenham Respite Service. However, from January 2010 this staff group of 17 was to be split into teams specific to each home, albeit some covering of vacant shifts between the two homes was still likely. Otherwise, shortfalls in staff availability were always made up from Wiltshire Councils own staff bank. Many of the bank staff worked regularly at Meadow Lodge and one was seconded there, which helped to provide a consistent service. An advantage of the County bank staff was that they shared a common training background with permanent staff at the home. There was a policy of always having at least one of the permanent staff team on duty, again to provide for consistency. There were always two staff on duty when the home was occupied, including at night and throughout the weekend, and one member of staff was provided during times that no service users were in. This meant some tasks could be undertaken with minimum disruption to the lives of people staying at the home, and also someone was at home if a person needed to arrive at an unplanned time. Staff we spoke to thought the establishment of a staff team just for Meadow Lodge would make key work more regular and therefore meaningful. The people staying in the home when we visited conversed easily with the staff on duty, one of whom was supplied by the bank and had not previously worked at the home. Both staff showed a competent balance between making themselves available, offering choices of participation and allowing people personal space. Tanya Andrews told us ways were being sought to increase staff availability to undertake one-to-one work with people during the day. One possibility was to reduce staff sleep-in cover to one staff member. Evidence: As employees of Wiltshire Council, staff at the home [and bank staff] have been subject to robust recruitment procedures, which we have inspected on many occasions. These ensure no person can commence working with vulnerable people until all vetting procedures and take-up of references have been completed. However, at our previous inspection we found that staff records kept in the home itself did not provide sufficient evidence of this process and we made a requirement about this. We saw that in response, a staff record system has been devised, which meets the relevant regulations. Tanya Andrews was appropriately engaging staff individually in collating the information needed, so putting the system into operation was not yet complete. Training records were kept for individual staff members and for the team as a whole. These were easy to access and track. They showed staff were kept up to date with mandatory training, with training planned through the year. The home has the benefit of access to training organised by Wiltshire Council. We could also see there was an emphasis on staff working towards NVQ [National Vocational Qualification] in care. Over half the permanent staff had achieved NVQ to at least level 2, and others were working towards this. A supervision plan in the office showed that team leaders supervised support workers, whilst Tanya Andrews line manager supervised her and the team leaders. All supervisory staff had received training in supervision skills. We saw that peoples individual supervision times were planned into staffing rotas, with a minimum expectation of eight one-to-one supervision meetings per year for each member of staff. 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. There are effective management systems to organise and monitor the running of the home. They seek peoples views on the quality of service provided. There are systems in place to identify and promote the health and safety needs of people that stay at the home, and staff. Evidence: Tanya Andrews was appointed in July 2009 as manager of both Meadow Lodge and its sister home, and it was intended this arrangement would continue after the respective staff groups were separated. She was conscientious about dividing her time reasonably equally between the two homes. Tanya Andrews had commenced the process of application to the Commission for registration as manager. She was nearing completion of NVQ in care to level 4, after which arrangements had been made for her to begin a Qualification in Leadership and Management. She and the team leaders had monthly management meetings. We also saw from minutes that there were regular meetings for the whole staff group. A member of staff said these were well attended and covered both operational matters and specific issues concerning people that stayed at the home. At our last inspection we made a number of requirements and recommendations, to ensure the home met regulations and developed good practice. We asked them to produce an improvement plan, which they did. This received the attention not only of Tanya Andrews, but also her line manager and other management personnel from Wiltshire Councils learning disabilities services. The plan was positively used by the home to bring about the improvements we had asked for. The manager of another service provided by Wiltshire Council carried out monthly unannounced audit visits on behalf of the Council, covering matters such as staff training, quality of care planning and daily records, and provision for health and safety. The reports of these visits, which have been Evidence: regularly supplied to us, showed they are done thoroughly. An action plan was completed by the manager on receipt of each report and the following visit would seek evidence that actions had been completed. The service carried out an annual quality assurance exercise to gain feedback from people who use it. A form for use by people who stayed at the home was pictorial and welcoming. It asked people to say what they thought were the best and worst things about staying at Meadow Lodge. It asked, Is there anything we can do to make your stay more enjoyable? The 2009 survey was in hand and due to be completed by the end of January 2010. We looked at the evaluation of the 2008 exercise. Its value was limited by a wide range of replies having been grouped together as other; it would have been helpful to see the detail of issues people identified, and also whether and how this translated into an action plan to inform the development of the home. Users of the service would probably value feedback on the outcomes of surveys. There was an internal action plan for health and safety management, based on a detailed internal audit conducted in October 2009. Fire safety arrangements, including recording of fire drills, had been much improved, in line with current Fire Service guidance. There was evidence to show that the home had met a requirement we had made, for staff to have regular instruction in fire safety. A weekly evacuation practice, including all people staying at the time, had been started. One member of staff had a delegated responsibility as fire officer. We saw evidence of in-date gas, electrical and boiler safety checks. Training records showed all staff had current certification for training in health and safety, food hygiene and manual handling. Wiltshire Council provided generic risk assessments and Tanya Andrews carried out specific risk assessments that were individual to the home. Are there any outstanding requirements from the last inspection? Yes  No  Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No Standard Regulation Requirement Timescale for action Requirements and recommendations from this inspection Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No Standard Regulation Description Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set No Standard Regulation Description Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 1 2 Consider providing basic information for people staying in the home in each bedroom. Aim to make courtesy calls to people who use the service, and their carers, prior to each stay, and record the outcomes of such calls as part of the individuals care record. You should ensure that peoples hopes and aspirations are further expanded upon and monitored within care planning documentation. Invite people to personalise their support plans with pictures or writing, if they wish. Seek specialist training and community involvement opportunities for staff who take a lead on development of activities and social engagement. Consider installing indivdual medicine cabinets in each bedroom, to promote personalised administration of medicines and reduce risk of errors. 3 6 4 5 6 13 6 20 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 7 8 23 24 Consider delegating a lead role in safeguarding to a senior support worker. A permanent solution should be put in place to enhance privacy and comfort with regard to the identified bathroom window. Analysis of quality assurance surveys should show they value all comments received. People should be given feedback on the results of surveys and how they have influenced developmental planning. 9 39 Helpline: Telephone: 03000 616161 or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2010) 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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