Care Home: Peat Lane House

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What the care home does well The induction and admission process is good enabling a person considering moving into the home to make an informed decision. The management team work closely with family and other professionals to make sure a full needs assessment is completed and the home is suitable for them. People are supported with decision making in their lives with staff encouraging and supporting an independent lifestyle. There was evidence of independent advocates being used to support people through the decision making process. Regular consultation is taking place on both an individual basis and with regular meetings in each flat. The expert by experience noted, "Staff are also trying to find new ways of communicating with people to make suretheir voice is heard", which is good practice. Personal and confidential information is securely stored at all times with staff aware of their responsibilities in relation to handling and sharing such information.A good range of activities are being provided that meet the varied and very different needs of the people living in Peat Lane. People are getting individualised support to pursue their hobbies and interests including sailing, Jazz exercise class, going to the gym, swimming, drama group and attending a social club. Each flat is staffed independently according to individual needs and abilities. Based on our discussions with and feedback from people living in the home, their relatives and staff there were sufficient staff on duty to provide a good quality of care and support as the following comments reflect. "Staff are enthusiastic and the people who live there seem happy". "We have good staff I like them". "The staff are thoughtful and have a good understanding about what people need". "There are more staff now to help people who want to go out".Visitors and families are made welcome inthe home and people are supported and encouraged by staff to maintain contact and visit their friends and relatives when they choose. Clear policies and procedures are in place that make sure people are aware of how to raise a concern or complaint and that it will be dealt with appropriately. Sound recruitment procedures are in place in line with good practice guidelines making sure staff are safe and suitable for their role. Staff training is taking place on a regular basis to make sure staff have the appropriate skills and knowledge. Supervisors provide regular supervision and support to the care staff with 1-1 meetings and staff meetings being used to share information and review their practice including annual appraisals. Annual quality reviews are taking place with questionnaires being used to gain feedback from people living in the home, staff, relatives and other professionals. Based on this feedback an annual development plan and business plan for the home is published ensuring the home is run in people`s best interests. What has improved since the last inspection? The introduction of more person centred care plans make sure staff have a better understanding about what is important to people in their lives and how they want to live their lives.Staffing levels have improved with all vacant posts now filled making sure people are getting the support they require to lead an independent and fulfilling lifestyle.How personal care and health care information is recorded is improving and is in a more accessible format making it easier for people to understand. Safeguarding procedures and records have improved making sure people are protected from abuse or harm. Communication systems have been reviewed and different ways of communicating with people are used to try and make sure people are given relevant information in a timely manner. What the care home could do better: Care plan reviews should take place at least annually or sooner if the need arises with the management team monitoring them to make sure they are taking place at appropriate times.All strategies and risk assessments should be signed and dated when they are agreed to ensure they are reviewed and updated on a regular basis.More detailed records should be in place to guide staff in supporting people with known medical conditions or specific aspects of their health care that need regular input, to make sure they receive a consistent and appropriate level of support.The decor of the home should be closely monitored by the manager to make sure it remains in a good state of repair whilst awaiting the planned moves to alternative accommodation. The way window opening cords have been tied up provides a risk of entanglement. To remove this hazard the point where the cords are secured should be raised. Key inspection report Care homes for adults (18-65 years) Name: Address: Peat Lane House Peat Lane House Sandylands Kendal Cumbria LA9 6LA 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: Ray Mowat Date: 1 9 1 0 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 © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Information about the care home Name of care home: Address: Peat Lane House Peat Lane House Sandylands Kendal Cumbria LA9 6LA 01539773073 01539773073 peat.lane@cumbriacc.gov.uk www.cumbriacare.org.uk Cumbria Care care home 19 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 19 0 learning disability Additional conditions: 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 The maximum number of service users who can be accommodated is: 19 Date of last inspection A bit about the care home Peat Lane House is registered as a Care Home for 19 people with learning disabilities of whom five may also have a physical disability. The registered provider is Cumbria Care, who are the Local Authority provider. The living accommodation is arranged into six separate flats accommodating between two and four people. Each flat had its own sitting room, fitted kitchen, bedrooms and bathroom facilities. The larger flats also have a separate dining room. A central laundry was available for some flats that do not have their own laundry facilities. The flats are linked by communal corridors and accessed via a shared entrance door and entrance hall, off which are staff offices. There is a staff sleep-in room situated upstairs. The Home also has a large separate communal lounge, which can be used by any of the people living in the home. One of the flats is a respite facility that accommodates up to three people. Each flat has its own dedicated staff team who offer support, supervision and personal care. The current scale for charging is £501.81, and the level of contribution is determined through a financial assessment carried out by a social worker. This covers board, amenity bills, council tax and staffing costs. Additional charges include transport, personal items, toiletries, clothes and social activities. A Handbook is available for people thinking of moving into the home and the latest Commission for Social Care Inspection report is made available on request. 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 How we did our inspection: This is what the inspector did when they were at the care home. The quality rating for this service is 2 stars. This means the people who use the service experience good quality outcomes. This inspection visit took place over one day and included a visit by an, expert by experience, as well as the lead inspector. An expert by experience is a person who, because of their shared experience of using services, and or ways of communicating, visits a service with an inspector to help them get a picture of what it is like to live in or use the service. During the visit we (The Care Quality Commission) met with people living in the home, and visiting relatives and spent time with the manager and supervisory staff on duty. We also met with care staff individually and talked to them as they went about their duties. The manager completed a self assessment questionnaire called an Annual Quality Assurance Assessment (AQAA) and sent it to us before the inspection visit. This provided us with information about how the home is run and the managers views on what the home does well, where they have improved and plans for the future. There is also information about the people who live in the home and the staff working there. Surveys were sent out as part of this inspection to people living in the home, staff and other professionals with their views being used to formulate the judgements in this report. We also examined records relating to the running of the home that are required by legislation, which included care plan files that guide staff in supporting people to achieve their goals and lead independent lives. We examined staff files and records relating to the maintenance and safety of the home. The last inspection on this service was completed on 6th September 2007. What the care home does well The induction and admission process is good enabling a person considering moving into the home to make an informed decision. The management team work closely with family and other professionals to make sure a full needs assessment is completed and the home is suitable for them. People are supported with decision making in their lives with staff encouraging and supporting an independent lifestyle. There was evidence of independent advocates being used to support people through the decision making process. Regular consultation is taking place on both an individual basis and with regular meetings in each flat. The expert by experience noted, Staff are also trying to find new ways of communicating with people to make sure their voice is heard, which is good practice. Personal and confidential information is securely stored at all times with staff aware of their responsibilities in relation to handling and sharing such information. A good range of activities are being provided that meet the varied and very different needs of the people living in Peat Lane. People are getting individualised support to pursue their hobbies and interests including sailing, Jazz exercise class, going to the gym, swimming, drama group and attending a social club. Each flat is staffed independently according to individual needs and abilities. Based on our discussions with and feedback from people living in the home, their relatives and staff there were sufficient staff on duty to provide a good quality of care and support as the following comments reflect. Staff are enthusiastic and the people who live there seem happy. We have good staff I like them. The staff are thoughtful and have a good understanding about what people need. There are more staff now to help people who want to go out. Visitors and families are made welcome in the home and people are supported and encouraged by staff to maintain contact and visit their friends and relatives when they choose. Clear policies and procedures are in place that make sure people are aware of how to raise a concern or complaint and that it will be dealt with appropriately. Sound recruitment procedures are in place in line with good practice guidelines making sure staff are safe and suitable for their role. Staff training is taking place on a regular basis to make sure staff have the appropriate skills and knowledge. Supervisors provide regular supervision and support to the care staff with 1-1 meetings and staff meetings being used to share information and review their practice including annual appraisals. Annual quality reviews are taking place with questionnaires being used to gain feedback from people living in the home, staff, relatives and other professionals. Based on this feedback an annual development plan and business plan for the home is published ensuring the home is run in peoples best interests. What has got better from the last inspection The introduction of more person centred care plans make sure staff have a better understanding about what is important to people in their lives and how they want to live their lives. Staffing levels have improved with all vacant posts now filled making sure people are getting the support they require to lead an independent and fulfilling lifestyle. How personal care and health care information is recorded is improving and is in a more accessible format making it easier for people to understand. Safeguarding procedures and records have improved making sure people are protected from abuse or harm. Communication systems have been reviewed and different ways of communicating with people are used to try and make sure people are given relevant information in a timely manner. What the care home could do better Care plan reviews should take place at least annually or sooner if the need arises with the management team monitoring them to make sure they are taking place at appropriate times. All strategies and risk assessments should be signed and dated when they are agreed to ensure they are reviewed and updated on a regular basis. More detailed records should be in place to guide staff in supporting people with known medical conditions or specific aspects of their health care that need regular input, to make sure they receive a consistent and appropriate level of support. The decor of the home should be closely monitored by the manager to make sure it remains in a good state of repair whilst awaiting the planned moves to alternative accommodation. The way window opening cords have been tied up provides a risk of entanglement. To remove this hazard the point where the cords are secured should be raised. 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 Ray Mowat Care Quality Commission Inspection North West Citygate Gallowgate Newcastle Upon Tyne NE1 4PA Tel: 03000616161 Fax: 03000616171 Email: enquiries.northwest@cqc.org.uk mailbox businessservices @cqc.org.uk 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. The homes admission procedure ensures peoples needs are assessed and that the home is suitable and has sufficient resources to support them. Evidence: In addition to a social work assessment of need and any other specialist assessments, one of the supervisory team will also complete their own pre admission assessment. This enables them to identify individual personal care and health care needs to make sure the home is suitable and has the skills and resources to meet their needs. During this process people are encouraged to visit the home and have a trial stay, which enables a more accurate assessment to be completed and helps the person to make an informed decision about the suitability of the home. Staff work closely with the individual, their family or representative and other professionals throughout the assessment and admission procedure. This results in a detailed assessment being completed that gathers valuable information for the development of a person centred care plan. This plan identifies individual needs and personal preferences about how a person likes to live their life and what is important to them. A key aspect of this is communication needs, which are recorded in detail and helps staff to promote a persons independence and support them to make choices and decisions in their daily lives. The assessment of need is an ongoing process that should be monitored through the regular care plan reviews as well as the day to day monitoring and information sharing among the staff team and the other agencies involved. The manager gave examples of referrals being made to the community health team for advice and guidance and to make sure the right levels of support were in place, when a persons needs were changing. 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 health and personal care needs were being met by staff that respect their rights and promote an independent lifestyle. Evidence: Staff are in the process of developing more person centred care plans for each person that reflect their individual preferences and aspirations and goals for the future. They also provide a lot of valuable background information about a persons life experiences, relationships and significant events and things that are important to them in their lives. Everyone living in the home has a support plan in place that records personal care and health care needs, which is a more practical guide for staff in the day to day care and support people require. We examined three peoples support/care plans in detail. They each had a named carer and supervisor who take responsibility for collating this information and keeping it under review. It was evident from the files we examined there is a lot of detailed information that helps staff to provide a personalised service that supports people to achieve their goals. This included information about personal care, how people communicate and make their needs known, daily living skills, daily and weekly routines that are important to a person and records of likes, dislikes and what is a good or bad day for them. Where there is this detailed level of information it helps staff to provide a consistent and personalised service. However one of the plans we examined was last reviewed in July 08 so was now overdue for review. It included a good range of risk assessments also dated July 08 in addition to a list of needs and actions. These were agreed at the last review but the outcomes were not recorded making it difficult to measure progress in achieving their planned goals. Also in the same file a falls risk assessment and procedure for walking had been developed but neither were signed or dated again making it difficult to know if they were up to date and accurate and had been Evidence: reviewed. It is recommended reviews take place at least annually or sooner if the need arises and these are monitored to make sure they are taking place. A daily report book is completed for each person at the end of each shift that records the care and support provided and activities people have been involved with. It also records a diary of appointments and the support arrangements required. Staff support people with decision making on a day to day basis encouraging their independence as much as possible but also liaising with family members and significant others as needed. The manager gave examples where they had accessed the services of an IMCA (Independent Mental Capacity Act Advocate) who got involved to ensure peoples views were heard and their choices respected for major life decisions they were making. Staff we met had a good insight to the importance of taking on an enabling role with people, encouraging independence and decision making in their lives. Each of the six flats operate independently of each other with a named supervisor taking a lead role in the day to day management of each one. They have regular meetings with the people living there and the staff team that support them to make sure the flat operates in their best interests. As mentioned previously there is a good range of risk assessments in place that support people to enjoy an independent lifestyle both at home and in the community. All the records we examined were securely stored in line with data protection good practice guidelines. Electronic records are password protected on the computer system and all personal and confidential paper records are kept in locked filing cabinets. Staff are aware of their responsibilities in maintaining confidentiality and only sharing information on a need to know basis. 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. People are receiving appropriate support from staff to pursue their interests and hobbies both in the home and in the local community. Evidence: Since the last inspection staffing levels have improved ensuring there are appropriate numbers of staff on duty to support people with pursuing their individual hobbies and interests. All the people living in the home attend some form of day service five days each week. Some people attend vocational work placements including a horticultural project and an office skills and administration project. They value this opportunity which is giving them meaningful occupation and a positive role in the local community, whilst developing important life skills. Alternatively some people require more intensive support focused on their individual needs. This includes day service staff working with them from home and accessing suitable activities in the local community or attending structured day service activities on a sessional basis. This gives them a lot of autonomy when deciding how to spend their day ensuring it is meeting their individual needs. Some of the people living in the home have the finances to fund cars through motorbility, which enables them to access community activities and events more easily. Risk assessments are in place that support people to move around the community with minimal staff support, which is promoting their independence whilst making sure they are safe. Routes are planned with people and safeguards and assessments agreed to make sure hazards are minimised and people have the skills and knowledge they require. Some people are able to use public transport whilst others prefer to walk. People are involved in a good range of both vocational and leisure activities in the home Evidence: environment and in the local community. These include a music and dance group, horse riding, sailing, visits to the local pubs and the town centre shops and amenities. Some people have joined a local gymnasium based at a hotel where they go for a regular workout or relaxing gym and swim session. People are supported with their cultural and religious needs with some people attending local churches of their choice and also enjoying the friendship of regular church social clubs and meetings. Peoples preferred daily routines are recorded within the individual care plans identifying what they feel is a good day or a bad day and also what they like and dislike. This helps staff to make sure they are respecting peoples choices about how they want to live their lives and what is important to them. People are free to have visitors to the home and there were examples of family members visiting on a regular basis, in addition to people going out to visit both family and friends when they choose. Each of the separate flats operate independently of each other with menus agreed and planned with the people living there. They are then supported by staff to shop for the food and prepare the meals. There is a lot of flexibility with meals and mealtimes depending on what activities people have planned. Each of the flats have a kitchen/dining area or separate dining room where people can enjoy a communal meal. 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. On the whole personal and healthcare records were up to date providing staff with relevant information to meet individual needs. Evidence: In addition to the more person centred care plans staff are completing a new health care record and action plan for each person. These are easier for people to understand with pictures and symbols used to explain the information they record. Once complete they will provide staff with a comprehensive record of each individuals personal care and health care needs. They are also developing a hospital passport, which records essential information about each individual that hospital staff would need to know to care for them in a hospital setting. We looked at the medication records held in the home. This included a record of all medication coming into and leaving the home ensuring all medication held is accounted for. We checked a selection of medication stock held against individual records and found these to be up to date and accurate. Medication record sheets (MAR charts) were in place for each person recording all regular medication including creams. For as and when required medication (PRN medication) protocols had been agreed and signed by relevant professionals about what the medication is and how and when it should be administered. Risk assessments were also in place for people who self administered their medication, which were also agreed and signed. One of the care plans we examined although it referred to the fact a person required Catheter care and bag changes were recorded on the medical record, it did not make clear the level and type of care would be provided and what the staff responsibilities were in supporting this individual. This lack of detail in the care plan could lead to an inconsistent service being provided that did not meet the persons needs. The other records we examined were more detailed providing vital information and guidance for staff to enable them to provide a personalised service. Peoples preferred Evidence: daily routines were well documented helping staff to prompt and encourage independence 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. The homes policies, procedures and practice make sure people are safe and their views are respected. Evidence: The home has a new complaints policy and procedure that is clearly written, and is easy for people to understand. It can be made available on request in a number of different formats to enable anyone associated with the service to complain or make suggestions for improvement. The complaints procedure is made available to people living and working in the home, which was confirmed by people we met and from survey responses and was seen to be displayed in the foyer. People said they understand how to make a complaint and they are clear of what can be expected to happen if a complaint is made and how and when to expect it to be responded to. Since the last inspection visit there has been evidence of the home working closely with the local authority and other agencies in identifying and referring safeguarding concerns. The manager and staff are aware of the services and local authority safeguarding policies and procedures and their responsibilities in identifying and reporting concerns. Staff receive training in their induction about how to safeguard residents from abuse and harm, and this is followed up by a rolling programme of further training to ensure that staff are up-to-date on these issues. A new recording system has been introduced to ensure any unexplained bruising or injuries are appropriately documented and reported. The manager has completed training in relation to the Mental Capacity Act and Deprivation of Liberty and has obtained easy read versions to be made available to people living in the home. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Although there have been some improvements to the environment, it remains adequate with the limitations of some parts of the home and continued problems with repairs and renewals. Evidence: The layout, design and institutional nature of the building continues to present problems, which have been well documented in previous reports. One flat in particular is too small for its purpose and is of a poor design for anyone with mobility or behavioural issues. A local implementation group has been formed which includes representatives from relevant parties including people living in the home and parent carers who are looking at alternative housing solutions for all the people currently living in the home. The property is owned by Impact housing association who are reluctant to invest capital expenditure into the home due to the plans for alternative accommodation. As a registered care home Cumbria Care remain responsible under the Care Home Regulations to ensure the premises to be used as a care home are of sound construction and kept in a good state of repair externally and internally and all parts of the home are kept clean and reasonably decorated. It was evident parts of the home are looking worn and in need of decoration, which were discussed with the manager. She showed us minutes of a meeting with the housing association that identified that flaking paint would be addressed and mouldy grouting and sealant would be replaced. The manager and staff also described how they had been completing minor repairs and some decorating, which is not an ideal situation. It is recommended the decor of the home is closely monitored by the manager to make sure it remains in a good state of repair whilst awaiting the planned moves to come to fruition. Each flat has had a telephone installed to improve communications, for people living in the flat their relatives and staff. One flat has chosen to have a private number that they take responsibility for. Three flats now have their own washing machines enabling people to take responsibility for their own laundering of clothes, which is helping them to develop daily living skills and promotes their independence and control. Access into the garden has been an ongoing issue and consequently this area is under used. This Evidence: has been commented upon by people who live in the home and their relatives who do not have free access to safe outside space. No progress has been made on this issue at the time of this visit. On the top of the stairs to the rear of the building there were two long cords hanging down that operate the opening mechanism on two roof windows. The way the cords have been tied up provides a risk of entanglement. To remove this hazard the point where the cords are secured should be raised. People have access to a communal lounge on the ground floor which is used for social occasions and also has a television and computer with internet access. There is also a multi sensory light room that people can access, which can be used for relaxation or educational purposes. 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. The home now has a full compliment of staff who receive regular training and supervision enabling them to provide very personalised and consistent care and support. Evidence: All the vacant positions that were causing staff shortages at the last visit have now been filled. The home also have access to relief staff with many of the part time staff willing to work extra hours when required to cover absences, which provides a good continuity of care. Each flat is staffed independently according to individual needs and abilities. Based on our discussions with and feedback from people living in the home, their relatives and staff there were sufficient staff on duty to provide a good quality of care and support as the following comments reflect. Staff are enthusiastic and the people who live there seem happy. We have good staff I like them. The staff are thoughtful and have a good understanding about what people need. There are more staff now to help people who want to go out. Staff receive regular training including induction training in core subject areas as well as specialised training such as dementia training, epilepsy management and behaviour management. The home follow County Council recruitment policies and procedures which are in line with current good practice and employment legislation. We looked at a selection of staff personnel files of people who have been recruited since our last visit to the home. All necessary checks and references were in place prior to staff starting their contract. Job descriptions and contracts of employment including shift patterns had been agreed and a copy retained on file. The manager described how they are involving people who live in the home in the recruitment process which is good practice. Based on survey responses from staff and discussions we had with them during this visit they confirmed that there are good support networks available to them. Regular monthly team meetings are held for the staff from each flat. This gives people the opportunity to share good practice and relevant information about the people they Evidence: support, review key policies and procedures and for the supervisory team to deliver briefings from senior management. In addition everyone meets with their named supervisor for formal supervision every six to eight weeks as well as an annual appraisal of their performance. This involves people reflecting on their practice, roles and responsibilities and to identify training and development needs. The manager works closely with the organisations training department to ensure all new staff complete a thorough induction programme and receive regular training to maintain their skills and knowledge. The organisation has a commitment to ensure continuous professional development for all staff. Over 50 of the staff have achieved or are working toward their National Vocational Qualification (NVQ) at level 2 or 3. Staff we met confirmed this giving examples of training being provided regularly and specialist courses being arranged when required. Based on our own observations and from our discussions with relatives and other professionals staff have a good understanding of individual needs and Staff have a good rapport with the people they support. 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 being managed more efficiently and effectively and in the best interests of the people living there. Evidence: The manager works closely with the supervisory team to ensure the home is run in the best interests of the people living there. In addition to regular 1-1 supervision with each supervisor she holds supervisor team meetings every two weeks and regular staff team meetings either fortnightly or monthly for each flat. This enables her to communicate effectively with the teams and give a clear sense of direction as well as supporting them in their roles. Relatives of people living in the home and other professionals we contacted confirmed that communication has improved. People talked about regular updates and being informed of changes and difficulties people experience. There was evidence of the management team making appropriate referrals to other agencies when the need is recognised. During this visit we discussed with the manager deprivation of liberty issues relating to locked doors and locks on a fridge. Although risk assessments were in place in relation to these issues we have asked for a response from the manager in relation to the use of deprivation of liberty safeguards in such instances. Regular meetings are held with the people in each flat in addition to support staff meeting with people individually to make sure their views are heard and responded to. An annual customer satisfaction survey is completed with people who live in the home, their relatives and other professionals involved with the home. Based on these responses the manager compiles an improvement plan and action plan in response to the issues raised. This is made available to all interested parties and the information is used to develop the homes business plan. Staff surveys we received as part of this inspection visit reflected that people are happy in the home and there are now more staff available to support people. Some of their comments included, it is a safe and homely environment in the Evidence: flat. People decide how they want to live their lives. We support the needs of individuals through positive risk taking. The manager described improvements that have been made to communication systems particularly with parents and relatives. Telephones have been installed in all the flats enabling more direct access. Email is also being used with some people as their preferred method of communication. A newsletter is also being produced to keep people up to date with progress on projects and a three monthly meeting is held with the housing association regarding the relocation plans. Also when people stay in the home for short respite periods a record book has been introduced to improve communication with parent/carers. The parent/carers we had contact with confirmed that communication was, much better and easier. The records we examined during this visit were securely stored in line with good practice guidelines and on the whole were up to date and accurate. There are suitable systems in place to safeguard the people living and working in the home. County Council policies and procedures are in place with support and guidance available from the organisations Health and Safety department. Servicing and repairs of equipment and aids are taking place regularly and regular checks are completed to ensure a safe environment is maintained at all times. 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 6 Care plan reviews should take place at least annually or sooner if the need arises with the management team monitoring them to make sure they are taking place at appropriate times. All strategies and risk assessments should be signed and dated when they are agreed to ensure they are reviewed and updated on a regular basis. More detailed records should be in place to guide staff in supporting people with known medical conditions or specific aspects of their health care that need regular input, to make sure they receive consistent and an appropriate level of support. The decor of the home should be closely monitored by the manager to make sure it remains in a good state of repair whilst awaiting the planned moves to alternative accommodation. 2 9 3 19 4 24 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 5 24 The way window opening cords have been tied up provides a risk of entanglement. To remove this hazard the point where the cords are secured should be raised. 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 © (2009) Care Quality Commission (CQC). 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