Care Home: Penfold Lodge

What the care home does well People spoken with are happy living at Penfold Lodge. They made positive comments about many aspects of the service and were complimentary about the manager and staff team. These comments are reflected throughout the report. The service treats people as individuals, getting to know their needs, wishes and hopes for the future and developing care plans that meet these needs in a person centred way. The culture of the home encourages and promotes people`s independence. People are supported to develop and maintain skills to cope with daily living and to be as independent as possible. People`s healthcare needs are well met, including their specific needs around mental health. The service works closely with health care professionals to ensure people are supported appropriately with all their health care needs. The environment is bright, clean and well maintained and people told us they like living there. The service provides opportunities for a range of activities and leisure pursuits. Staff encourage and support people to take part so that their lifestyle is enhanced. The manager and staff deal with concerns and complaints promptly and thoroughly. Minor concerns are addressed when they arise so that they do not escalate and become a greater problem. This ensures people`s mental health and emotional welfare is promoted. There is a robust training programme in place which ensures staff`s skills are updated regularly and people living in the home can be confident their needs are met by staff who have the skills and knowledge to provide the support they need. The service is well managed and there is a robust quality assurance process in place that demonstrates the home is managed in the interests of the people who live there. The manager is competent and experienced and people are complimentary about the difference she has made to the home. What has improved since the last inspection? All the statutory requirements and good practice recommendations made at the last inspection have been acted upon in the interests of people who live in the home. Since the last inspection there have been significant improvements in the decor, cleanliness and maintenance throughout all areas of the home. In particular there has been a new, modern kitchen installed, redecoration of communal areas and some individual rooms, replacement flooring in some areas, a new staff room and improvements to the garden areas. As a result of a successful recruitment programme there is now an established staff team in place who are effectively meeting people`s needs. This has eliminated the need to use agency staff. Since the last inspection care plans and risk assessments have been developed further and now contain ample detail to ensure staff understand people`s needs, wishes and aspirations. What the care home could do better: The service should continue with the ongoing programme to improve the environment, including the replacement of older carpets in hallways and on stairs. Key inspection report Care homes for adults (18-65 years) Name: Address: Penfold Lodge 8-10 Penfold Road Clacton on Sea Essex CO15 1JN     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: Ray Finney     Date: 0 3 0 7 2 0 0 9 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 31 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) 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 Care Homes for Adults (18-65 years) Page 3 of 31 Information about the care home Name of care home: Address: Penfold Lodge 8-10 Penfold Road Clacton on Sea Essex CO15 1JN 01255223311 01255223311 manager.penfoldlodge@careuk.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Care UK Mental Health Partnership Limited (Arc Healthcare Limited) Name of registered manager (if applicable) Mrs Tracy Mattin Type of registration: Number of places registered: care home 17 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: Persons of either sex, under the age of 65 years, who require care by reason of a mental disorder (not to exceed 17 persons) Date of last inspection Brief description of the care home Penfold Lodge is a residential care home, registered to provide personal care and accommodation to seventeen persons of either sex, between the ages of 18 - 65 years, who require care by reason of a mental health problem excluding dementia or a learning disability. Although staff do provide support or assistance with personal care where required, the home does not aim to meet the needs of those with a physical disability or illness, and is not equipped to meet such needs. Penfold Lodge is in the seaside town of Clacton-on-Sea and situated in the town centre, close to the sea front. A range of facilities and services such as shopping, Care Homes for Adults (18-65 years) Page 4 of 31 17 Over 65 0 Brief description of the care home education, leisure, public transport and the beach are within walking distance from the home. The home is an older style property made into five separate units or flats. Each flat has single bedrooms, bathroom, kitchen and dining area. Six of the bedrooms having ensuite facilities. Communal areas consist of a main lounge with dining area and a second smaller lounge, where people can relax. There are small gardens to the front and rear of the property. The front garden is laid to lawn with flowerbeds and there is some off-road parking in the driveways. The rear enclosed garden is paved with shingle, a lawn and paths. The home charges £567.21 a week for the service they provide. This information was given to us in July 2009. Other services such as hairdressing, dry cleaning and chiropody are available at an additional charge. Information about the home can be obtained by contacting the manager. Care Homes for Adults (18-65 years) Page 5 of 31 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 last inspection of the service was completed on 10th July 2008. A range of evidence was looked at when compiling this report. Documentary evidence was examined, such as care plans, rotas, menus and personnel files. The manager completed an Annual Quality Assurance Assessment, which is required by law to be completed by the service, with information about the home and sent it to us at the Commission when requested. Throughout the report this document will be referred to as the AQAA. Completed surveys were received from staff working in the home. A visit to the home took place on 3rd July 2009 and included a tour of the premises, discussions with people living in the home and members of staff. Observations of how members of staff interact and communicate with people living in the home have also been taken into account. Care Homes for Adults (18-65 years) Page 6 of 31 On the day of the inspection we were given every assistance from the manager and staff team. Care Homes for Adults (18-65 years) Page 7 of 31 What the care home does well: What has improved since the last inspection? All the statutory requirements and good practice recommendations made at the last inspection have been acted upon in the interests of people who live in the home. Since the last inspection there have been significant improvements in the decor, cleanliness and maintenance throughout all areas of the home. In particular there has been a new, modern kitchen installed, redecoration of communal areas and some individual rooms, replacement flooring in some areas, a new staff room and improvements to the garden areas. As a result of a successful recruitment programme there is now an established staff team in place who are effectively meeting peoples needs. This has eliminated the need Care Homes for Adults (18-65 years) Page 8 of 31 to use agency staff. Since the last inspection care plans and risk assessments have been developed further and now contain ample detail to ensure staff understand peoples needs, wishes and aspirations. What they could do better: 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 31 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 31 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. Through the comprehensive admission process people choosing to live at Penfold Lodge can be confident that their needs will be met. Evidence: The manager told us in the AQAA, Prospective residents are assessed before a placement is offered, guidelines are followed to ensure a smooth and stress free move to Penfold Lodge, including an overnight stay and weekend stay before finalising the choice to move. There is a comprehensive pre-admission process in place using Care UK procedures and documentation. The assessment covers the persons current mental state, cognition, orientation, details of any offences linked to the persons mental state, behaviours, social function, cultural needs and compliance with treatment. The assessment looks at any risk factors including self-harm, violence or aggression, arson, absconding, sexual issues or substance misuse. They also look at the persons psychiatric history that covers things than have happened prior to admission as well as a family history, social history and medical history. Records examined also contain Care Homes for Adults (18-65 years) Page 11 of 31 Evidence: an assessment of the persons current mental state, their lifestyle and interests and a self-assessment. The manager stated in the AQAA, We have built up a good relationship with local professionals and are getting many referrals because of this. On the day of the inspection a healthcare professional visited to view the vacant room. The manager told us that they only have the one vacancy and believe that they are going to fill that soon. Care Homes for Adults (18-65 years) Page 12 of 31 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in Penfold Lodge receive good quality care based on their assessed and identified needs. Evidence: The manager told us in the AQAA that what they do well is, Respect residents rights and individuality. Promoting Independence as far as possible and that they have Regular CPA [Care Programme Approach] meetings and care plan meetings. Since the last inspection the manager has introduced Person Centred Planning and are developing books for people called Reflections of My Life. These document what has occurred for people in the past and looks at their future aspirations. Four Reflections of My Life books were examined. They start with What my life has been like so far and it is written using the persons own words. Important people in my life are recorded, including peoples pets. There is a section on My illness and how it affects me which gives good details of how the person feels and how those feelings have an impact on their behaviour and lifestyle. How I am cared for, My religious beliefs and Care Homes for Adults (18-65 years) Page 13 of 31 Evidence: My future aspirations all give very personal accounts of how life is for the individual and what they wish for the future. There are further sections on My medication, My physical health, My hobbies and interests, Achievements, Photos and How I manage my finances. The manager stated in the AQAA, Care plans have been improved with a person centred approach and that they plan, To continue with the person centred approach and further develop it. A sample of three care plans was examined. Each care plan identifies the need and records both the service user or advocates perception and the carers perspective of the identified need. The aim or desired outcome for the person is identified as well as the short term goal. There are details of what interventions are in place by the service user, key worker and others such as family or healthcare professionals. The manager told us in the AQAA, Residents are continually assessed for self medication, managing their financial affairs and making their own decisions. Care plans contain comprehensive assessments of risk using documentation that identifies the risks using a tick box format. The care plan for each identified need has a related Health and Safety risk assessment. This details existing measures in place and any other measures that are required to reduce or eliminate the risk of harm from the identified hazard. Each care plan is evaluated monthly to monitor how it is meeting the persons needs and whether any changes are required. The sample of records examined contained care plans relating to personal hygiene, daily living skills, mental health needs, keeping living areas tidy and as required medication (usually referred to as PRN medication), which is taken when the need arises rather than on a regular basis. Care plans contain evidence that people manage their own money and sign to confirm they are happy with any arrangements for safekeeping and they can have access to the amounts they ask for. From our observations it was evident that people make choices on what they do during the day, including whether they go out, stay in their room or socialise with others, what they eat, where and when they choose to have their meals and whether they take part in any activities that are going on. Care Homes for Adults (18-65 years) Page 14 of 31 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 living in Penfold Lodge can expect to enjoy a lifestyle that meets their wishes. Evidence: The manager told us in the AQAA, We encourage residents to live as independently as possible by accessing the community, having access to public transport, to go shopping for groceries for their flats, to clean their own flats on a rota basis, to manage their own medication, to make their own choices. We give support and advice when needed. We encourage residents to gain employment. There is an activity planner on the notice board that documents activities available including card games, cooking skills, music, DVD sessions, pool, keep fit, swimming session at the local leisure centre and a visiting singer. Staff spoken with said that many of the organised activities take place in the afternoon or evening, as people go out quite a lot during the day. A senior staff member explained that the Sunday Care Homes for Adults (18-65 years) Page 15 of 31 Evidence: discussion group developed from a suggestion by service users that they would like to have a get together over tea and cakes at teatime on Sundays and this has been very successful. A member of staff who completed a survey told us that one of the things they do well is, Encouraging residents to participate in activities and living skills. The manager stated in the AQAA that one of their plans for improvement in the next year is, To encourage the residents to participate more in the in-house activities programme. Quite a few of them are reluctant to participate. We observed that they are already making progress with this. The manager explained that, because of peoples complex mental health needs, it can sometimes be difficult to get people motivated and interested but they are continually looking at new ways to engage with people. A senior member of staff started a bicycle ride session the previous month and in just a few weeks this has grown from just one person taking part to six people. They go out for a ride on bicycles and then stop off for refreshments before cycling home. They use a camera to take photographs to show what they are doing and how people are enjoying the activity, which helps keep people motivated and encourages others to join in. There is a notice board where information is displayed on the topic of the month, which tackles current issues. This had information leaflets about swine flu and guidance about how to avoid sunburn and how to keep safe during a heat wave. Peoples individual interests are supported and encouraged. One person enjoys oil painting and someone else does art therapy. The manager explained that one person had chosen to take an interest in gardening. They are doing a very good job and have planted up flowerbeds and keep the lawn in the front garden well maintained. Another person has just started a job delivering leaflets and told us they enjoyed it. The manager stated in the AQAA, Feedback from residents say they are happy here and feel the home has improved over the last year e.g. the food is great. The staff are happy, friendly and helpful. They have built up good relationships with staff and feel confident to talk if they have any worries. People were coming and going throughout the day. The atmosphere in the home is very relaxed and it is evident that people are happy in the home. One person spoken with explained how things are so much better now that they were before the manager took over. They told us that they can trust the staff and are confident that they can Care Homes for Adults (18-65 years) Page 16 of 31 Evidence: talk to them and get the help they need. There has been a new kitchen installed since the last inspection. It is bright, clean and modern. People spoken with said they enjoy the food and there are always plenty of things they like such as lasagne or cottage pie. Bedrooms are divided into small groups or flats, each with their own kitchen. People are encouraged to maintain their independence and make their own lunch. We observed this happening during the course of the inspection and people were engaged in making sandwiches, snacks and drinks. These kitchens have been greatly improved since the last inspection and were cleaner and better maintained. The kitchens in two of the flats that previously had old carpet have had replacement flooring which has greatly improved the appearance and removed the malodour. Each kitchen has a notice board and there is a rota for people to take responsibility for cleaning and for purchasing fresh supplies of bread and milk. Staff were observed to consult with people about their choices for the evening meal, which is cooked in the main kitchen. Care Homes for Adults (18-65 years) Page 17 of 31 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service can expect their personal and healthcare needs to be identified and provided with the support to ensure these needs are met as they would wish. Evidence: The manager stated in the AQAA, All residents are encouraged to work with staff to complete the agreed care plans around support. Residents who require prompting with their personal hygiene are supported as required. Overall people living in Penfold Lodge are able to take responsibility for their own personal care needs. As a result of their mental health problems a few people need support to maintain good personal hygiene. Mostly this takes the form of prompting and encouragement and where this is necessary there is a care plan in place. Staff spoken with were able to explain how they encourage people to maintain good standards of personal care. The manager told us in the AQAA, All residents have access to all health care professionals and have health screen opportunities. Support is given to residents who Care Homes for Adults (18-65 years) Page 18 of 31 Evidence: need to attend health professional appointments. Care plans have a health check list with dates of medication reviews and appointments with healthcare professionals including the optician, GP checks, dentist and Psychiatrists reviews. There are also weight monitoring charts in place. People on the Care Programme Approach (CPA) because of their mental health needs also have a CPA care plan in place, drawn up by the Mental Health Professional and agreed with the individual. The manager told us in the AQAA, Residents who self medicate are assessed and closely monitored. The home uses a Monitored Dose System for medication. Storage is in securely locked cupboards in a locked room. There are currently no controlled drugs in use but there is an appropriate Controlled Drugs cupboard should anyone be prescribed medication requiring this level of secure storage. Staff spoken with were able to demonstrate an understanding of their responsibilities around appropriate storage, administration and recording of medication and also of controlled drugs. The manager and senior staff spoken with explained that the new pharmacy who supply the homes medication check in the drugs with staff when they are delivered to ensure everything is in order and they do the same with any unused medication that is being returned. Medicines Administration Record (MAR) sheets examined were all completed accurately. Individual care plans contain a service user drug profile. Where possible people are supported to take responsibility and manage their own medication. Where anyone self-medicates there are protocols and management strategies in place to support them to do this and to monitor compliance and identify any problems promptly. Care Homes for Adults (18-65 years) Page 19 of 31 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service can be confident that their concerns about how they are treated are listened to and acted upon as stated in the complaints and safeguarding procedures. Evidence: As previously reported, the home has a robust complaints procedure in place and complaints are investigated thoroughly. The manager told us in the AQAA, We have a complaints procedure in place. Residents are able to express their concerns and complaints using 1-1 meetings, residents meetings and written if they so wish. We have a residents comments book for them to write anything they like or dislike. On the day of the inspection the manager was in the process of dealing with a complaint from someone outside the home. She had gone to great lengths to put strategies in place to address the issues raised and had recorded fully and accurately what she had done. The manager had also liaised with other agencies including Environmental Health and the Police to ensure the issue was dealt with robustly. Records examined confirmed that the manager had made every reasonable effort to ensure that staff and people living in the home are good neighbours. There is a copy of the complaints procedure available which is displayed on the noticeboards in each of the separate flats. Through discussions the manager and staff demonstrated that they deal with minor concerns promptly and told us that this is Care Homes for Adults (18-65 years) Page 20 of 31 Evidence: essential to ensure that concerns do not have an adverse impact on peoples mental health. People spoken with told us they did not have any complaints but they could talk to staff if they had. They said they were confident that the manager and other staff would listen to any concerns they had. A member of staff who completed a survey told us that what they do well is, Spending time with the residents and listening to their problems and help support them. Records examined confirm that staff receive training around safeguarding (previously referred to as Protection of Vulnerable Adults or POVA now called Safeguarding of Vulnerable Adults or SOVA). Staff spoken with were aware of their responsibilities around keeping people safe. There have been no referrals made to the local authority under their safeguarding procedures, but the manager and able to demonstrate a sound understanding of the process and of their responsibilities. Care Homes for Adults (18-65 years) Page 21 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can enjoy living in an environment that suits their lifestyle and which is well maintained and clean. Evidence: The manager told us in the AQAA, The decoration programme has improved the living areas immensely, we have a full-time handyman. Staff have had training in infection control. The cleaning rota has been improved. A partial tour of the premises included all the communal areas but did not take in peoples private rooms. As a consequence of mental health conditions, many of the people living in Penfold Lodge prefer to maintain their privacy and do not want the intrusion of allowing someone they do not know into their bedrooms. However, people spoken with said they were comfortable in their rooms. The manager confirmed that many of the bedrooms have been redecorated since the last inspection and the staff team now work closely with people to support them to keep their rooms well maintained and clean. Significant improvements were noted throughout the home since the last inspection including redecoration in all the communal areas. A new kitchen has been installed, which greatly improves the facilities; it is bright, modern, clean and well maintained. Care Homes for Adults (18-65 years) Page 22 of 31 Evidence: Bathrooms have been updated and there have been new dispensers installed for liquid soap, sanitising hand gel and paper towels. The smaller kitchens in each of the individual flats have also improved significantly. New flooring has been laid in the kitchens where the carpets were noted to be old and malodorous at the time of the last inspection. There was a marked improvement in all areas of the home. The manager explained that there are further improvements planned but that she is happy with the progress they have made so far. Some more carpets, particularly on the stairs and corridors are due to be replaced but staff have greatly improved the standard of cleanliness throughout the home, therefore the older carpets do not have a significant detrimental impact on the environment at this time. The home was fresh and clean throughout. There is now a full time maintenance person in post and this has also considerably improved the environment. During the inspection the maintenance person was carrying out water temperature checks on all water outlets in the premises. One of the toilets on the ground floor that was unused has been converted into a storage cupboard for cleaning products. This COSHH cupboard (Control of Substances Hazardous to Health) was well maintained and secure. There are notice boards in individual flats with information relating to the fire procedure, complaints procedure, rota for laundry washing days, cleaning and shopping rotas and a list of peoples individual key workers. The laundry has been improved since the last inspection. The maintenance person has put up new shelves and installed a worktop so it is easier to keep clean and tidy. The manager explained that they are awaiting delivery of two new professional laundry machines that are on order. The laundry was observed to be clean and well maintained. Care Homes for Adults (18-65 years) Page 23 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home can be confident they are cared for by a competent staff team who can meet their needs and keep them safe. Evidence: The manager told us in the AQAA, All staff are trained to NVQ level 2 and 3 or working towards completing this. The manager explained that out of a total of 12 care staff, three have achieved a National Vocational Qualification (NVQ) at level 2 and two are working towards level 2, two have achieved NVQ level 3 and two are working towards level 3. The administrator is currently working on an NVQ award in admin and has also completed a certificate in Organising Activities in a Care Setting. The sample of personnel records examined contained evidence of NVQ awards. The manager stated in the AQAA, We have a full staff team, no agency has been used for at least 7 months. Two full time senior care workers have been employed. A fulltime handyman and a full-time admin/activities co-ordinator have also been employed. The rotas confirm that there are sufficient staff on duty to meet peoples needs. Care Homes for Adults (18-65 years) Page 24 of 31 Evidence: During the day there are three care staff on duty, one senior and two carers and at nights there are two care staff. In addition there is a full time admin assistant and a full time maintenance person as well as the manager. We observed that people were interacting confidently with staff and it was evident that there is a good rapport between staff and the people living in the home. One person was complimentary about the manager and the staff team. They said, we can trust the staff now. We noted that there was a good atmosphere in the home and people living there were happy and relaxed. A member of staff who completed a survey told us, All staff work together as a team. The manager told us in the AQAA, Staff are selected carefully according to Care UK policy and procedure. Three personnel files were examined and found to be well organised. There is a photograph of the member of staff on the front and a checklist of contents. All documentation as required by regulations was in place including an application form with no unexplained gaps in employment, two written references, proofs of identity. There was also evidence that people undergo appropriate Criminal Record Bureau (CRB) checks before they commence employment. The manager has introduced an Induction File for new staff to give them an overview of the home. It starts by focusing on the people who live there. It states, Welcome to Penfold Lodge. Penfold Lodge is home to .... [lists names] and explains about their individual approach to care through Person Centred Planning. The document gives a good rundown of the daily routines, staff roles and what is expected of them. The induction process follows the Skills for Care Common Induction Standards. Training records in personnel files contain evidence that staff have completed a range of training. Care UK provide what they have identified as Annual Mandatory Training which covers Health and Safety, Accident and Incident reporting, Infection Prevention and COSHH (Control of Substances Hazardous to Health). The manager explained that a programme of training around the Mental Capacity Act (MCA) is in progress and all staff will receive this course. Some staff have already completed MCA and Deprivation of Liberty Safeguards (DOLS) training. Other training includes training in Fire Safety, First Aid, Medication, Safeguarding of Vulnerable Adults (SOVA), Diabetes Awareness and Supervision training for senior staff. Staff spoken with were positive about the training. They also told us that the staff team work well together. The manager explained that there have been big improvements around staffing in the past year and they now have a stable staff team who are enthusiastic. She said that they are now fully staffed and are no longer using agency staff as they were at the time of the last inspection, which has improved Care Homes for Adults (18-65 years) Page 25 of 31 Evidence: outcomes for the people living in the home. Care Homes for Adults (18-65 years) Page 26 of 31 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can expect to live in a well managed home that ensures their needs are met. Evidence: The day to day management of the home was observed to be good. The manager has completed NVQ level 4 in care and RMA. She explained that she is committed to continuing to update her skills and knowledge and has also completed training around MCA (Mental Capacity Act) and DOLS (Deprivation of Liberty Safeguards), IOSH (Institution of Occupational Safety and Health) training and has completed a course for The Effective Manager run by the local authority. At the time of the last inspection the manager had only been in post for a few weeks, but had already identified and prioritised areas for improvement. In the past year she has continued to develop and improve the service and is to be commended for the good results that have been achieved and the improved outcomes for people living in Penfold Lodge. The manager is supported by a full time admin assistant and two senior carers and from our observations it is evident that the management team work well together. Care Homes for Adults (18-65 years) Page 27 of 31 Evidence: Staff spoken with felt well supported. There was a notice on the staff notice board with the date and time of the next staff meeting. The topic on the agenda was to be Care UK Fulfilling Lives. A member of staff who completed a survey indicated that the manager gives staff enough support and meets with them regularly. There is a robust process in place for assessing the quality of the service provided. This includes an internal audit programme that covers a different area monthly including Health and Safety, Medication, Infection Control and Food Safety. The manager submits a self-audit report. Satisfaction questionnaires are distributed to residents, staff and other interested relatives and friends. The results of these surveys are collated. Some of the comments in these surveys from people living in the home and from relatives included, The new staff are 100 per cent better, I find my stay at Penfold very helpful to my needs and I like living here and staff are very good. When asked if they are made welcome when they visit, a relative stated, much improved. Staff spoken with explained that there are residents meetings held monthly. The manager and care staff do not attend these meetings, so that residents can feel free to discuss what they want. The administrator goes along to take notes and feed back any issues people want raised. A sample of health and safety records was examined. Tendring District Council carried out an Environmental Health Premises inspection and no contraventions were noted. A Tendring Hundred Water visual inspection of the water installation stated that it complies with requirements. Annual maintenance of the gas installation, legionnella checks, routine maintenance of the fire system and fire extinguishers were all in order. A recent room assessment was carried out by the local authority and all rooms were found to be in order. Care UK carry out an annual health and safety audit and this had been completed the previous month. The health and safety file was well organised and all documents examined were in order. Care Homes for Adults (18-65 years) Page 28 of 31 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 31 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 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 Care Homes for Adults (18-65 years) Page 30 of 31 Helpline: Telephone: 03000 616161 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). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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