Care Home: Mere Lodge

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What the care home does well People can make choices about their lives. Staff support people to do the things they like doing, such as going shopping, going swimming and going on holiday.Staff support people to maintain their religion and cultureStaff receive lots of training so that they know how to do their jobThe people who live at the home and their relatives are asked what they think about the quality of the care and support. What has improved since the last inspection? The home has been redecorated and several rooms have new furniture.The bathrooms have been improved There is now a separate laundry room on the first floor and a larger office on the ground floorStaff have done lots of trainingMore information has been put in people`s support plans What the care home could do better: Old information needs removing from support plans so that plans are easier to understand Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Mere Lodge 93 Mere Road Leicester LE5 5GQ 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: Ruth Wood Date: 0 6 0 7 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area Outcome area (for example: Choice of home) These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to:  Put the people who use social care first  Improve services and stamp out bad practice  Be an expert voice on social care  Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Reader Information Document Purpose Author Inspection report CSCI Page 2 of 29 Care Homes for Adults (18-65 years) Audience Further copies from Copyright 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 29 Information about the care home Name of care home: Address: Mere Lodge 93 Mere Road Leicester LE5 5GQ 01162517441 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) : Mere Lodge Healthcare Ltd care home 4 Number of places (if applicable): Under 65 Over 65 4 0 learning disability Additional conditions: Care Homes for Adults (18-65 years) Page 4 of 29 Date of last inspection A bit about the care home Mere Lodge is a terraced house in the Highfields area of Leicester. It provides a service for four people with learning disabilities. It is opposite Spinney Hill Park and close to lots of shops, places of worship and other facilities. On the ground floor there are two lounges, one with a dining area, a kitchen, and a bathroom with a bath and a shower. Upstairs there are four bedrooms, a toilet with a shower enclosure, and the laundry room. At the back of the house there is a small paved area. The fees to live at the home are between £ 878 and £1,730 per week. The latest CQC report is available from the manager and the service users guide gives full information about Page 5 of 29 the home. Care Homes for Adults (18-65 years) Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home Care Homes for Adults (18-65 years) Page 6 of 29 How we did our inspection: This is what the inspector did when they were at the care home Before we visited the home, we looked at the information that the manager had sent us about how the home is run and the kind of people who live and work there. We looked at information sent to us about things that had happened in the home since our last inspection on 15th July 2008. We visited the home on 6th July 2009 in the afternoon, between 1:30 pm and 6:30 pm We looked at all of the rooms in the house We spoke to the three people who were living in the house on that day Care Homes for Adults (18-65 years) Page 7 of 29 We looked at peoples support plans and how their needs are met We spoke to the manager about how they manage the home We spoke to staff about how they supported people and about the training they had done. We looked at staff records. These told us about the checks that had been done to make sure staff had the right skills and were safe to work in the home. What the care home does well Care Homes for Adults (18-65 years) Page 8 of 29 People can make choices about their lives. Staff support people to do the things they like doing, such as going shopping, going swimming and going on holiday. Staff support people to maintain their religion and culture Staff receive lots of training so that they know how to do their job The people who live at the home and their relatives are asked what they think about the quality of the care and support. Care Homes for Adults (18-65 years) Page 9 of 29 What has got better from the last inspection The home has been redecorated and several rooms have new furniture. The bathrooms have been improved There is now a separate laundry room on the first floor and a larger office on the ground floor Staff have done lots of training Care Homes for Adults (18-65 years) Page 10 of 29 More information has been put in peoples support plans What the care home could do better If you want to read the full report of our inspection please ask the person in charge of the care home Care Homes for Adults (18-65 years) Page 11 of 29 If you want to speak to the inspector please contact Ruth Wood CQC East Midlands Citygate Gallowgate Newcastle upon Tyne NE1 4PA Phone 03000616161 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 12 of 29 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 13 of 29 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 have access to good information about the service so that they can make an informed decision. Good assessment procedures ensure that the service can meet peoples needs. Evidence: We looked at both the standard and easy read version of the service user guide. Both give accurate and up-to-date information about the service. The three people who responded to the Commissions survey said that they had been asked if they wanted to move into the home and they had received enough information about the home; some had made visits before they moved in; I was told of my bedroom, I had visits before. We discussed in detail the admission of one person to the service with the acting manager and the organisations project manager. The person was visited several times at their existing placement and an assessment of their needs was completed. The manager consulted with and worked alongside the persons existing carers and their Independent Mental Capacity Advocate (IMCA). Because of the persons particular needs it was felt to be inappropriate for them to make visits prior to their move but Care Homes for Adults (18-65 years) Page 14 of 29 Evidence: photographs of the home were taken to their existing placement and their IMCA visited and evaluated the service before the person moved in. Assessment documents were in place for the two people whose care that we looked at in detail. Care Homes for Adults (18-65 years) Page 15 of 29 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People are supported to make choices and support plans reflect their needs and how they should be met. Evidence: We looked at two peoples support plans. It is clear that the current manager has done a great deal of work to improve the quality of the information, and peoples needs and how they should be met are outlined. All four staff members who responded to the Commissions survey said that they are given up to date information about the needs of the people they support. Some further consolidation is required to ensure that old information is removed from current files and appropriately archived. This should avoid confusion as to which is the current support plan. Some information is also duplicated and again a process of consolidation would make support plans more accessible to the people who live and work in the home. Risk assessments and behavioural contracts form part of peoples support plans and Care Homes for Adults (18-65 years) Page 16 of 29 Evidence: these set parameters within which people are enabled to take reasonable risks and make choices about their lives. All three people who responded to our survey said that they make decisions about what to do each day, I live the life I want. People do have a daily routine outlined but there are sufficient staff on duty to enable people to choose to do something different and still be appropriately supported. People make choices about the kinds of activities they do, the clothes that they wear and the food that they eat. Care Homes for Adults (18-65 years) Page 17 of 29 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 . Peoples leisure, vocational and cultural needs are met Evidence: Each person has a daily routine but staffing levels are sufficient to allow deviations from this should they wish to do something different. One person said that they liked to go out with staff and will help with the shopping for the home. Another person has a programme of physical exercise, which includes regular swimming; this is helping to improve the persons fitness and manage a long term health condition. One person has taken part in college courses and another is looking to move into employment. The acting manager said that considerable work had taken place in trying to build links with the local community. Wherever possible the home tries to buy food from local suppliers; this is particularly important for one person living in the home who must have Halal food because of their religious and cultural beliefs. Comment cards received by the home indicate that this persons family is fully satisfied with the arrangements Care Homes for Adults (18-65 years) Page 18 of 29 Evidence: in place to meet their relatives cultural needs. People living and working in the home have been invited to celebrations and events within the local community and one person living at the home is a member of the local football team. Considerable work has also been done to ensure that people retain regular contact with their families and people receive and make visits with staff support. Arrangements are currently being made for people to go on holiday. Care Homes for Adults (18-65 years) Page 19 of 29 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 . Peoples health and medication needs are met Evidence: How people like their personal care needs met is outlined in their support plans and includes the level of support that they need. Staff spoken with were also able to give information about how they supported different people to maintain their personal care. Each person has a Health Action Plan but the quality of the information that they contain is varied. If these documents are to be used it is important that the information within them is detailed and regularly reviewed to ensure that it is up to date and accurate. Records demonstrate that people have regular access to medical services such as opticians, dentists, chiropodists and GPs and staff regularly monitor peoples blood pressure and weight and refer any concerns to the GP. People also have regular access to mental health professionals where appropriate. Appropriate storage is in place for medication, including controlled medication. Medication records examined were completed accurately and staff receive training and ongoing supervision in administering medication. Information about which homely remedies each person may be given has been outlined by the GP and protocols are in Care Homes for Adults (18-65 years) Page 20 of 29 Evidence: place that give information to staff about when as required medication should be given. Some of the protocols required modification to more clearly define the triggers before medication is given; this has now been completed by the acting manager. Care Homes for Adults (18-65 years) Page 21 of 29 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 . Peoples concerns are listened to and current practice in the home ensures that they are protected. Evidence: The three people who responded to our survey all said that they knew who to speak to if they werent happy and confirmed this when we spoke with them directly during the inspection visit, I speak to the staff, or my keyworker or the manager. The complaints procedure is being updated so that it is presented in an easy read format. All staff have received training in safeguarding vulnerable adults and the four staff who responded to our survey said that they knew what to do if someone had concerns about the home. The two staff members we spoke with during the inspection visit demonstrated a good understanding of their responsibilities under safeguarding and whistle blowing procedures. We asked the acting manager to clarify the response made by the local authority to a safeguarding referral made earlier in the year. The manager is investigating this. Although all staff, including the manager, have received appropriate training in safeguarding we recommend that the manager and senior staff members undertake the alerters course in this area presented by the Local Authority. We looked at the arrangements in place for safeguarding peoples financial interests. Each person now has their own bank account and support plans guide staff as to the support required in this area by each person. Records are kept of all transactions and the manager regularly audits these. Care Homes for Adults (18-65 years) Page 22 of 29 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 clean and comfortable home that meets their needs. Evidence: Improvements have been made to the homes environment since the previous key inspection. The washing machine and tumble dryer have been moved from the kitchen to a designated laundry room on the first floor and the office has been moved to the ground floor, adjacent to the kitchen. The bathrooms on the ground and first floors have been refurbished and peoples bedrooms have been redecorated and new flooring has been fitted. People have been involved in choosing their colour schemes. Communal areas have also been redecorated including both lounges and the hall, stairs and landing. New furniture has also been purchased for the lounge and dining areas and is appropriate for the specific needs of the people living in the home. Recommendations made by the health and safety inspector, including the replacement of the existing boiler have been acted upon. At the time of the inspection the home was fresh and clean throughout and the three people who responded to our survey all said that the home was always fresh and clean. Certificates were in place to evidence that all staff have received training in infection control. Care Homes for Adults (18-65 years) Page 23 of 29 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 staff who have received training appropriate to their role. Evidence: The four staff who responded to our survey said that recruitment checks, such as Criminal Records Bureau (CRB) checks had been completed before they started working in the home. We looked at the recruitment records of the last three people who started work in the home. Two written references, employment histories and CRBs were in place for all three and their names had been checked against the vulnerable adults register to ensure that they were safe to work at Mere Lodge. Certificates confirm that staff have received a lot of training over the last six months. This has included managing challenging behaviour, risk assessment, communication, record keeping and an introduction to mental health. The Project Manager David Bailey said that he intended to enroll six staff on the new Learning Disability Qualification in September. Discussion with two staff members confirmed that they had received training appropriate to their job role. Care Homes for Adults (18-65 years) Page 24 of 29 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The home is well managed in the interests of the people who live there. Evidence: The acting manager has worked in the home since August 2008 and is currently in the process of applying for registration with the Commission. He is a qualified learning disability nurse and has experience of working with people with challenging behaviour. All four staff members who responded to our survey said that the manager met with them regularly to discuss their work and this was confirmed in our discussions with staff members during the inspection visit. Staff said that they felt well supported by the manager and had seen many positive changes in the way the home was managed. This view is reiterated by comments from relatives and professionals made on the homes quality monitoring surveys. These form part of the homes quality monitoring process. People living in the home complete a survey monthly and professionals and families approximately every six months. Responses have led to changes in the home such as the fitting of net curtains. Regular staff and resident meetings are held and records of both meetings show that these are well attended. Care Homes for Adults (18-65 years) Page 25 of 29 Evidence: Following the Local Authoritys health and safety inspection, health and safety policy has been reviewed and risk assessments for safe working practice have been updated. All staff have received training in infection control, first aid, health and safety, fire safety and food hygiene. Fire evacuation routes are checked on a daily basis, fire systems on a weekly basis and the fire risk assessment was update on 09/04/09. Care Homes for Adults (18-65 years) Page 26 of 29 Are there any outstanding requirements from the last inspection? Yes  No  Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 27 of 29 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 6 Information in support plans should be consolidated to ensure that it is more easily accessible to the person being supported and the staff that support them. The acting manager and senior staff should attend the alerters safeguarding training given by the Local Authority. 2 23 Care Homes for Adults (18-65 years) Page 28 of 29 Helpline: Telephone: 03000 616161 or Textphone : or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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