Care Home: Palmers Lodge

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What the care home does well There were detailed assessments of the needs of residents. The home has worked with the resident advocates and other professionals to review their care. Admissions to the home are not made until a full assessment had been carried out of the potential resident`s needs. The acting manager was able to show that he has updated and improved both residents care plans. We found that care plans were person centred. The care plans covered all the needs of the two residents. Detailed risk assessments have been carried out and where being regularly reviewed. People`s needs are met in ways that promote their independence and safety. Both residents had confirmed in their surveys that they knew how to make a complaint. We found that a complaints policy is available for residents. The home support residents to express their views and concerns in a safe and understanding environment. There has been a general improvement in the decoration of the home. Residents bedroomed were personalise. The home make sure that the environment is developed to reflects the individual needs of residents. Staff spoken to understood their responsibilities. We observed that they knew how to work with the two residents currently living at home. Staff could explain how they met the needs of residents. Training records showed that all training was up-to-date. Training has been provided on working with people with a learning disability and challenging behaviour. The home has made sure that staff are receiving relevant training so that they can focus on delivering improved outcomes for residents. What has improved since the last inspection? At the last key inspection thirteen areas for improvement had been identified. Since the last inspection the acting manager is updated the statement of purpose so that it includes all the current details of the service. People are provided with detailed and accurate information about the home. When we looked at residents care plans we found that they were all up-to-date. Recommendations and actions from reviews have been included in care plans. Recommendations and actions from reviews are included in care plans so that the needs of residents are met. Both residents risk assessments were up-to-date. Since the last inspection both of residents risk assessments had been review and contained detailed information on how to support them safely. Risks to residents are access to promote their safety and wellbeing. Daily notes and discussions with staff showed that residents now have access to more community-based activities. Residents are supported to participate in activities in their local community.The acting manager was able to show us that he has introduced more effective systems for monitoring residents personal finances. Both residents are receiving the correct benefits as this has been reviewed by their placing authorities. Residents are protected from financial abuse. We walked around the home and found that the resident`s bedrooms have all been redecorated and items of new furniture had been purchased. One residents bedroom now has new furniture as the broken items have been replaced. Residents are provided with bedrooms that meets their needs. We found that the tumble dryer is now in working order. Regular maintainance checks are carried out. We found by looking at records that repairs are now being carried out in a timely manner. The homes environment support resident to live as they choose. Staff meeting minutes and discussions with staff confirmed that regular staff meetings are now taking place. The acting manager has contacted the Home Office to establish the immigration employment status of staff. Staff receive the suport they need to care for residents. The acting manager told us that he`s supervision gives him a chance to identify and discuss his performance and personal development needs. He showed us notes from his one-to-one supervision, these recorded activities related to his continued personal development. The acting manager is supported to improve his skills to benifit residents. Since the last inspection the acting manager has worked more closely with the day centre. The day centre had made a number of recommendations as to how the home could improve the way in which it met the residents needs. Discussions with the acting manager and care plans showed that these have been implemented. The home works with other professionals to improve the care of residents. The registered providers had provided the Commission with a copy of the most recently audited accounts. These confirmed the financial viability of the company. Financial resources are used to meet the needs and provide a good outcomes residents. What the care home could do better: Four areas for improvement have been identified at this inspection. Residents need to have an annual holiday. Residents are allowed to access a holiday that reflects their aspirations are lifestyle. The menu was found not to be available in an accessible format for residents to access. This needs to be put in place so that residents are supported to choose the meals that they would like. One of the medication prescribed for a resident was found to have been discontinued by the consultant psychiatrist. However, the medication`s Administration record showed that this medication was still available on as required basis. The acting manager was asked to clarify this to ensure the safety of the resident. The acting manager explained that he has yet to carry out a quality assurance survey of residents, their advocates, and professionals to establish their views on how the home could be improved. The acting manager agreed to carry out this survey. Residents, their advocates and professionals should be consulted about how the home can improve the quality of care it provides. Key inspection report Care homes for adults (18-65 years) Name: Address: Palmers Lodge 36 Sidney Avenue London N13 4UY     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Tony Brennan     Date: 0 9 0 4 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 32 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 32 Information about the care home Name of care home: Address: Palmers Lodge 36 Sidney Avenue London N13 4UY 02088896231 02088896231 manager.palmtree@aermid.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Aermid Health Care (UK) Ltd Name of registered manager (if applicable) Manager Post Vacant Type of registration: Number of places registered: care home 6 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is 6 The registered person may provide the following category/ies of service only: Care home only: Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Learning disability - Code LD Date of last inspection Brief description of the care home Palmers Lodge is registered to provide care for six adults with learning disability. Currently, there are two residents living at the home. A company called Aermid Health Care Properties Ltd owns the home. This company runs a number of similar care homes. The home is a semi-detached house located in a residential area. The home is built on three floors. The bedrooms are located on all the floors. Communal areas in the home include a lounge, dining room, kitchen, bathrooms, toilets and a sensory area. The home aims to support people with learning disabilities, challenging behaviour and autistic disorders to live more independently . Care Homes for Adults (18-65 years) Page 4 of 32 Over 65 0 6 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: The quality rating of this service is two star. This means the people who use the service experience good quality outcomes. This unannounced key inspection was undertaken as part of the annual inspection programme. we sought to confirm that the home had addressed the areas for improvement identified at the last key inspection. Prior to the inspection the home had completed its annual quality assurance assessment. The annual quality assurance assessment provided us with information about the home and how it was seeking to improve outcomes for residents. We also looked at other information we have received about the home since the last key inspection. This included any information regarding incidents that the home had told us about. The inspection took place over one day we were assisted by the acting manager, Mebs Care Homes for Adults (18-65 years) Page 5 of 32 Rahman, with the inspection. Comment cards were received from the two residents and eight staff. We spoke with professionals. As part of the inspection visit we spoke with two staff and observed the care of the two residents. We toured the building and examined a number of records relating to the care, health, safety and management of the home. At the end of the inspection feedback was given to the acting manager, and areas for improvement were discussed. We would like to thank the staff were assisted us by asking questions about the running of the home. Would also like to thank two residents who allowed us to observe how staff worked with them. Care Homes for Adults (18-65 years) Page 6 of 32 What the care home does well: What has improved since the last inspection? At the last key inspection thirteen areas for improvement had been identified. Since the last inspection the acting manager is updated the statement of purpose so that it includes all the current details of the service. People are provided with detailed and accurate information about the home. When we looked at residents care plans we found that they were all up-to-date. Recommendations and actions from reviews have been included in care plans. Recommendations and actions from reviews are included in care plans so that the needs of residents are met. Both residents risk assessments were up-to-date. Since the last inspection both of residents risk assessments had been review and contained detailed information on how to support them safely. Risks to residents are access to promote their safety and wellbeing. Daily notes and discussions with staff showed that residents now have access to more community-based activities. Residents are supported to participate in activities in their local community. Care Homes for Adults (18-65 years) Page 7 of 32 The acting manager was able to show us that he has introduced more effective systems for monitoring residents personal finances. Both residents are receiving the correct benefits as this has been reviewed by their placing authorities. Residents are protected from financial abuse. We walked around the home and found that the residents bedrooms have all been redecorated and items of new furniture had been purchased. One residents bedroom now has new furniture as the broken items have been replaced. Residents are provided with bedrooms that meets their needs. We found that the tumble dryer is now in working order. Regular maintainance checks are carried out. We found by looking at records that repairs are now being carried out in a timely manner. The homes environment support resident to live as they choose. Staff meeting minutes and discussions with staff confirmed that regular staff meetings are now taking place. The acting manager has contacted the Home Office to establish the immigration employment status of staff. Staff receive the suport they need to care for residents. The acting manager told us that hes supervision gives him a chance to identify and discuss his performance and personal development needs. He showed us notes from his one-to-one supervision, these recorded activities related to his continued personal development. The acting manager is supported to improve his skills to benifit residents. Since the last inspection the acting manager has worked more closely with the day centre. The day centre had made a number of recommendations as to how the home could improve the way in which it met the residents needs. Discussions with the acting manager and care plans showed that these have been implemented. The home works with other professionals to improve the care of residents. The registered providers had provided the Commission with a copy of the most recently audited accounts. These confirmed the financial viability of the company. Financial resources are used to meet the needs and provide a good outcomes residents. What they could do better: Four areas for improvement have been identified at this inspection. Residents need to have an annual holiday. Residents are allowed to access a holiday that reflects their aspirations are lifestyle. The menu was found not to be available in an accessible format for residents to access. This needs to be put in place so that residents are supported to choose the meals that they would like. One of the medication prescribed for a resident was found to have been discontinued by the consultant psychiatrist. However, the medications Administration record showed that this medication was still available on as required basis. The acting manager was asked to clarify this to ensure the safety of the resident. The acting manager explained that he has yet to carry out a quality assurance survey Care Homes for Adults (18-65 years) Page 8 of 32 of residents, their advocates, and professionals to establish their views on how the home could be improved. The acting manager agreed to carry out this survey. Residents, their advocates and professionals should be consulted about how the home can improve the quality of care it provides. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 32 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 32 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. The statement of purpose is an accurate description of the service provided to residents. Staff understand how to meet the changing needs of residents. Evidence: The acting manager explained that the statement of purpose had been revised so that it provided up-to-date information about the home. Since the last key inspection the statement of purpose had been revised so that it provided a more details picture of the service. Also it has been recently updated to include the details of the acting manager,s experience and qualifications. We found that the needs of the two residents who we case track were within a range of those specified in the statement of purpose. The statement of purpose identified the skills and staffing resources that are available to meet the needs of residents. The home provides the statement of purpose that provides an accurate description of the service showing how it will meet the needs of residents. There are two residents living at the home. They have been at Palmers Lodge for a number of years. The annual quality assurence assessment highlighted that, We Care Homes for Adults (18-65 years) Page 11 of 32 Evidence: have detailed community assessments and other relevant information about residents admission to the home. Residents files contained detailed assessment information from their placing authorities. There are currently three vacancies. The annual quality assurence assessment confirmed that, For new admissions we will obtain detailed community care assessments. If we feel we can meet the residents needs we will carry out our own comprehensive preadmission assessments. We spoke with the acting manager who explained that he would make sure that staff with the appropriate skills were available to meet the needs of new residents. Any new admissions would staggered to make sure that the existing residents had time to adjust. Prospective residents can feel confident that their needs will be assessed to ensure their wellbeing. We found that residents needs had been reviewed regularly by their place in authorities. At the last key inspection it had been found that actions and changes from these reviews had not been included in residents care plans and actioned. The acting manager told us that he had made sure that any actions from reviews had been included in residents care plans. Staff spoken to told us that the acting manager tells them about any changes in the needs of residents. We observed that staff knew how to communicate with residents. Residents can be confident that staff understand how to respond to their changing needs. Care Homes for Adults (18-65 years) Page 12 of 32 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. Residents can be confident that their needs are planned for and personal goals reflected in their individualised care plans. Residents are supported to make decisions about how they wish to live. Risks to residents are assessed to make sure they are supported to maintain their independence. Evidence: The annual quality assurance assessment stated that, All service users have an individual care plan which is reviewed monthly. As far as possible service users are involved in their individual care planning and their reviews. The acting manager explained that he has introduced more person centered care planning. We found that the care plans for the two residents were detailed and person centered. This meant that the care plans were based on how they wished to be supported by staff. Care plans were personalise and referred to the cultural needs of residents. The acting manager explained that he had involved the residents, their family members, staff and professionals in preparing care plans. We could see from looking Care Homes for Adults (18-65 years) Page 13 of 32 Evidence: at care plans that they had been developed with the involvement of the individual residents. A relative had told us that she had been consulted about the needs of the resident. Both residents had completed surveys in which they confirmed that they were getting the care they needed. We observed that staff took time to understand residents and do things in a way that they would like. Surveys from staff confirmed that they had information about the needs of residents. One member of staff commented, Residents needs are put first. The home involves individuals in the planing care that affects their lifestyle and quality of life. Details of residents behaviour that might be challenging to service were identified in the risk assessments and care plans. Action to address and manage these behaviours were outlined in detail this included giving guidance on how to respond to specific behaviours. Staff spoken to understood the specific needs of residents with regard to supporting them to manage their behaviour. Records showed that the the home had consulted relevant professionals (consultant psychiatrists) regarding how to address the behaviour of residents. Behaviour that may challenge the service is addressed sensitively to support and maintain residents well being. Risk assessments were found to cover all areas that affect residents daily life. The annual quality assurance assessment stated that, Comprehensive risk assessments have been carried out, and individual needs provided for. Any activity which carries a risk would have a comprehensive risk assessment. These are reviewed at regular intervals. At the last inspection it was highlighted that one of the residents risk assessments had not been updated. We spoke with the acting manager who explained that the risk assessments for both residents had been fully updated. We found that residents risk assessments were detailed identified all the specific risks facing the residents. Risk assessments were based on the history of previous risk-taking on the part of residents. The risk assessments for each resident provided staff with clear guidance on how to minimise risks to them. These were reflected in care plans. Risk assessments had been reviewed. Changes to the level of risk have been recorded and addressed to make sure that residents were safe. Staff were able to describe how they prevented risk to make sure that residents were safe and supported to exercise control over how their lives. Risks relating to behavioural issues were identified. We observed that staff engaged with residents in an appropriately adult way. Staff spoken to could explain how they worked with individual residents to maintain their safety. A member of staff said, We encourage residents to express their choices and personal tastes. Comprehensive risk assessments that are reviewed regularly are in place to ensure the safety and independence of residents. Care Homes for Adults (18-65 years) Page 14 of 32 Evidence: Care Homes for Adults (18-65 years) Page 15 of 32 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. Residents are supported to engage in a range of activities that meet their needs. Residents have community contacts and are supported to maintain personal relationships. Residents are supported to have a balanced diet that reflects their personal choices. Evidence: At the last inspection it was recommended that residents should be supported to be involved in more community activities. The annual quality assurance assessment highlighted that residents had been involved in more activities in the local community. We spoke with the acting manager who explained that he had been working with the day centre.He had done this so that residents were offered a greater range of activities. Records showed that both residents were attending the day centre throughout the week. Both residents had a detailed activities plan. Their daily notes, and discussions with staff showed that these were being implemented. Surveys from Care Homes for Adults (18-65 years) Page 16 of 32 Evidence: both residents confirmed that they were able to choose how they would like to spend their time. A member of staff commented in their survey that there had been an, Improvement to residents activities. Staff confirmed that they regularly assist residents to participate in activities in the community. Residents daily notes and Care plans showed us that they were regularly involved in activities both in and outside of the home. This included household tasks such as shopping and general cleaning. Residents are involved in meaningful activities of their own choice, and according to their individual interests and capabilities. At last inspection it was recommended that residents should have an annual Holiday. The acting manager explained that this still needed to be provided for residents. The annual quality assurance assessment highlighted that, Residents need passports to implement a holiday. Residents should be supported to choose a holiday. The annual quality assurance assessment confirmed that residents were supported to develop contacts in the local community. Their daily records showed that residents were supported to maintain contacts with family and friends. The acting manager explained that he is speaking to both residents relatives on a weekly basis. He also told us that one of the residents regularly spends weekends with their family. These activities were highlighted in the residents care plans and daily notes. Residents have an opportunity to develop and maintain family relationships. A member of staff commented that, in Meals times are flexible and residents are involved in preparing the menu and shopping. The acting manager explained that he has encouraged residents to go on weekly shopping trips to buy food. Minutes from regular meetings with residents showed that they were involved in choosing the food they would like. We found that the menu was varied and reflected the choices and dietary needs of residents. We observed that residents were able to have a drink when they wished. Although the menu reflected the choices of residents it was not available in accessible format for residents. This was discussed with the acting manager who agreed to review the menu to make sure it was accessible to residents. A variety of meals are provided that reflect the individual preferences of residents. Care Homes for Adults (18-65 years) Page 17 of 32 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. Residents are supported with their personal care needs to maintain their independence. residents are able to choose the medical care they need. residents are protected by safe procedures for the handling of medication. Evidence: In their annual quality assurance assessment the home had highlighted that personal care needs were identified in residents care plans. We found that care plans outlined the support residents required to maintain their independence when being assisted personal care. We observed that residents were dressed appropriately for their culture and age. Care plans also outlined whether residents needed support from same gender staff. Staff were able to explain how they help residents when supporting them with their personal care. Personal care is responsive to the individual needs and preferences of residents. The annual quality assurence assessment confirmed that all residents were registered with a General Practictioner and they had access to other medical services. The two residents had their medical needs identified in their care plans and risk assessments. Daily notes showed that residents had been a supporter to access opticians, dentists Care Homes for Adults (18-65 years) Page 18 of 32 Evidence: and chiropodists. Medical needs have been reviewed. Reviews from social workers confirmed that they were happy with the medical support available to both residents. Both residents had recently been reviewed by their consultant psychiatrist. Care plans and discussions with staff showed that any changes to their needs had been responded to. Residents health needs are addressed to ensure their continued health and well-being. The annual quality assurance assessment highlighted that the home, Is working with professionals regarding the best interest meetings relating to medical needs. We spoke with the acting manager who explained that he had been consulting health and social work professionals about the capacity of both residents to refuse medical care. We found that these meetings were being planned. The home make sure that residents have access to the healthcare they need. We found that records the administration of medication complete. Each resident had a medication profile outlining their individual medication and the reasons for the medicines they were taking. We checked and found the two residents were receiving all the medication that they had been prescribed by their doctors. The home has developed an effective medication policy to make sure that medicines are administered safely. There is a clear guidance on the use of medication or managing residents challenging behaviour. This outlined when it is appropriate to use this medication. Both residents medication needs had been reviewed, either as part of their social work reviews or by their psychiatrist. It was shown on one residents medication profile that their consultant psychiatrist had discontinued a medication. However, their medication administration record showed that this medication had been supplied and was to be administered on an as required basis. We discussed this with acting manager who said that while the medication had been discontinued the psychiatrist felt that it should be available when required. We ask that this issue should be clarified with the psychiatrist so that it is clear whether this medication is still needed. The annual quality assurance assessment highlighted that staff had received training in the safe administration of medicines. Training records and discussions with staff confirmed that they had training on the safe administration medicines. Staff are trained to administer medication safely. Care Homes for Adults (18-65 years) Page 19 of 32 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. Residents can be confident that their complaints will be listened to and acted upon. Adult protection procedures protect residents from abuse. Evidence: The annual quality assurance assessment confirmed that a complaints procedure was in place. It also highlighted that there had been no complaints for the last six months. We spoke with the acting manager who explained that he has weekly discussions with the families and advocates of the two residents. This allows him to address any issues that may arise promptly. Feedback from professionals confirmed that they could discuss the issues with the acting manager. Residents had access to the complaints procedure in an appropriate format to make sure that it was accessible. Both residents surveys confirmed that they knew how to make a complaint. We saw minutes from the weekly residents meetings that the acting manager has introduced over the last months. These showed that staff were attempting to listen to the views of the residents. The complaint records showed that there had been no complaints in the last six months. Issues prior to this had been addressed. staff spoken to understood the importance of taking any concerns raised by residents seriously. They were able to explain how they knew when residents were not happy. The home has a culture that allows residents to express their views and concerns in a safe and understanding environment. Care Homes for Adults (18-65 years) Page 20 of 32 Evidence: At the last inspection a requirement was made that residents monies were managed properly and that they received the correct benefits. This would protect them from potential financial abuse. We spoke with the acting manager who told us that he had, in coloration with the two residents placing authorities, made sure that they were receiving the right benefits. We checked the financial records for both residents. These showed that they receive in regular amounts of money on a monthly basis. All expenditure had been receipted. We saw that money had been spent on personal items, such as clothing. Residents monies are managed in a way that makes sure that they are protected from financial abuse. The acting manager explained that he has carried out refresher training with all staff regarding safeguarding residents. Staff spoken to understood how to recognise and respond to safeguarding allegations. Training records showed that they had received training on adult protection. There was one safeguarding issue since the last inspection this is currently still being investigated. The acting manager explained to us how he was working with the professionals involved. He showed us he was open and wanted to make sure the issues was resolved. Residents feel safe and well supported by an organisation that has the protection and safety as a priority. Care Homes for Adults (18-65 years) Page 21 of 32 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. Residents are provided with a safe and homely environment that is personalised to meet their needs. The home is clean and hygienic to promote residents safety. Evidence: The annual quality assurance assessments stated that Regular maintainance checks are carried out. The maintainance record showed that there were no outstanding maintainence issues. We found that the tumble drier which at the last inspection had not been fixed, was now working. Staff spoken to said that to maintain its issues were being addressed promptly. The home is well maintained provides a comfortable and safe environment for residents. We looked at residents bedrooms and found that they were personalised. The acting manager explained that residents bedrooms have recently been redecorated. This had been done and the involvement of the residents and their advocates. Both bedrooms are furnished and decorated differently reflecting the individual preferences. We observed that each bedroom had its own colour scheme. The items are broken furniture (highlighted at the last inspection) in one residents bedroom had been replaced. Residents are supported to personalise their bedrooms. Appropriate measures are in place to prevent cross infection. The home has detailed Care Homes for Adults (18-65 years) Page 22 of 32 Evidence: policies on the prevention of cross infection. The annual quality assurance assessment stated that staff had training in infection control. We found that training records confirmed this. Staff spoken to understood how to work to minimise the possibility of cross infection. Staff confirmed that they had access disposable gloves and aprons. We observed that liquid soap and paper towels were available throughout a home. A proactive infection control policy makes sure that the risk of infection to residents is minimised. Care Homes for Adults (18-65 years) Page 23 of 32 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. Sufficient staff, with the necessary skills and support are available to meet the needs of residents. People are fully protected by the homes recruitment procedures. Evidence: Both staff and residents confirmed in their surveys that sufficient staff were available at all times. We found that the rota showed that a consistent staffing level was maintained. The acting manager explained that two staff are on duty throughout the day and one night. The rota showed that staff are available to support residents to attend community activities and appointments. Staff spoke to told us that they felt sufficient staff were available to support residents needs. We saw sufficient staff are provided at busy times of the day, and to meet the changing needs of residents. The service has enough staff available at the necessary times to support the needs, activities and aspirations of residents. The annual quality assurance assessment highlighted that all areas of training had been carried out. It also pointed out that, Have introduced E learning and learning disability training. Staff records showed that new staff were given a formal induction. All areas mandatory training had been provided. Discussions with staff showed that they had a detailed knowledge of the needs of residents and how to meet them. A training plan is in place. This showed that all areas of training necessary to make sure Care Homes for Adults (18-65 years) Page 24 of 32 Evidence: staff would meet the needs of residents would be provided. Training records showed that training has been provided on the management of behaviour that may challenge the home and the Mental Capacity Act. Residents are supported by staff that have the necessary skills to understand and meet their needs. Training records show that over 50 of staff had either a level two or three in the national vocational qualification in care. As part of this training staff had covered equal opportunity and diversity issues. Professionals and advocates confirmed that they felt staff have the skills to meet the needs of the two residents. A member of staff commented that there was, Good up-to-date training available throughout the year. The acting manager told us that he will be planning further training to enable staff to further meet the needs of residents. The home make sure that all staff receives relevant training that is focused on the delivering of improved outcomes residents. At the last inspection it was found that it was not clear from records that one member of staff could work at the home due to their immigration status. The acting manager showed us information from the Home Office which clearly outlined how and when this member of staff was allowed to work in the home. The acting manager had also checked the immigration and employment status of all other staff who might be affected by this. We saw relevant documentation and a record which clearly show the immigration status of those staff. We looked at the files of two members of staff who had started work at since the last inspection. These were found to contain all the relevant documentation. Two references and CRB check. These had been obtained prior to them starting work at the home. This showed that the home followed a clear recruitment procedure that make sure that residents are safe. Robust recruitment procedures are followed to ensure the safety and well-being of residents. The acting manager explained that he has been carrying out regular supervision with staff. We saw records of supervision that showed it covered key areas of practice and individual development issues. Staff spoken to confirmed that they were well supported by the acting manager. They said they had regular one-to-one supervision with the acting manager. Staff supported to develop their skills and understanding in order to meet the needs of residents. At the last inspection it was highlighted that the managers supervision did not address their individual development needs. We spoke with the acting manager who confirmed that he was receiving regular supervision. He showed us records of this that confirmed his personal development needs were being addressed through the process Care Homes for Adults (18-65 years) Page 25 of 32 Evidence: of one-to-one supervision. The acting manager is supported in this role to further develop the skills to the benefit of residents. Care Homes for Adults (18-65 years) Page 26 of 32 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. Effective management systems are in place to make sure that people well being and safety as promoted. Residents and their representives need to be consulted about the development of the home. Residents and staffs health and safety is always promoted. Evidence: The acting manager has worked at the home of the last four months. In that time he was able to show us that he had introduced a number of improvements to how the home support residents. Staff spoken to confirmed that they felt supported by the acting manager. They understood what was expected of them. The acting manager explained to us that he has experience working people with learning disabilities. He has a particular experience of challenging behaviour and how this can be managed. The acting manager is in the process of applying to the Commission to become the registered manager for Palmers Lodge. He is currently registered as the manager of another home which is rated good. Staff spoken to say that the manager was available and regularly working at the home. The registered manager explained that he will consider whether he will manage both homes or become the manager for palmers Lodge alone. The acting manager has the necessary qualifications and experience to Care Homes for Adults (18-65 years) Page 27 of 32 Evidence: manage palmers Lodge so that the residents receive good care outcomes. At the last inspection it was highlighted that a number of recommendations had been made by the day centre that both residents attain to improve the quality of their care. By looking at care plans and talking to staff we were able to confirm that these had been acted upon. The home has responded to the day centres suggested for improvement to improve outcomes for residents. There is a system in place for monitoring the quality of the service provided by the home. However, no the survey has been carried out of the views of residents and their representatives. Residents and their relatives must be consulted and involved in the development of the home. The annual quality assurance assessment told us about changes to the acting manager had already made to improve outcomes for residents. From looking at records and talking to staff we were able to establish that these had been put in place. The acting manager has started to consult residents and hold meetings with them on a weekly basis. He has also had regular contact with their representatives, both relatives and professionals. There is an emphasis on trying to involve residents in the running of the home. The acting manager has made sure that the safety risks to residents and staff are identified. Measures are put in place to provide a safe living and working environment. Staff spoken to understood how to work safely. Records showed that fire equipment was regularly tested and maintained. Fire drills were taking place regularly. The fire risk assessment provides details of potential risks of fire. All health and safety policies were available. Certificates were available to show that since the last inspection that portable electrical appliances and fire extinguishers had been serviced. COSHH guidance is in place and chemicals was stored safely. Accidents were being recorded and monitored by the acting manager. Residents can be confident that the home will maintain their safety. At the last inspection the home was asked to provide audited accounts to demonstrate the continued financial viability of the company. The provider had done this. The accounts showed that financial resources were available to provide the necessary resources to meet the needs of residents. The acting manager explained that he has been given greater freedom to purchase items for the home. The necessary resources are available to manage the home in the best interests of residents. Care Homes for Adults (18-65 years) Page 28 of 32 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 29 of 32 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 39 28 The registered person should make sure that a survey is carried out on the use of residents and their representatives of the quality of service provided by the home. Residents and their representatives views must form part of the monitoring and development of the home. 07/06/2010 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 14 The registered persons should make sure that residents have an annual holiday. Residents need to be supported to have an appropriate lifestyle. The registered persons should make sure that the menu is available in formats that residents can access and understand. Residents need to be supported to choose the food they would like. 2 17 Care Homes for Adults (18-65 years) Page 30 of 32 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 3 20 The registered persons should make sure that there are clear instructions on what medicines residents should be receiving. Care Homes for Adults (18-65 years) Page 31 of 32 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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