Care Home: Quality Lifestyle Ltd

What the care home does well The management culture of the home is open, positive and inclusive.The home is large with plenty of space; it is comfortable, clean and homely.People`s rights and different interests are supported and respected. People feel safe living in the home.Each person has a support plan that contains very detailed information about care and support needs. The staff team support people to take part in various activities in the community.The staff are properly trained to support the people who live in the home. What has improved since the last inspection? This is the first inspection of the home. What the care home could do better: We have not asked the home to make any improvements. Key inspection report Care homes for adults (18-65 years) Name: Address: Quality Lifestyle Ltd 334 Tavistock Road Plymouth Devon PL6 8AL 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: Jane Gurnell Date: 1 8 0 2 2 0 1 0 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should:  Be safe  Have the right outcomes, including clinical outcomes  Be a good experience for the people that use it  Help prevent illness, and promote healthy, independent living  Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home:  3 stars – excellent  2 stars – good  1 star – adequate  0 star – poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area Outcome area (for example: Choice of home) These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by:  Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice  Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983   Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2010) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Information about the care home Name of care home: Address: Quality Lifestyle Ltd 334 Tavistock Road Plymouth Devon PL6 8AL Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Andre Drury Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 4 0 care home 4 Quality Lifestyle Ltd learning disability Additional conditions: The maximum number of service users who can be accommodated is 4 The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary needs on admission to the home are within the following category: Learning disability - (Code LD) Date of last inspection A bit about the care home 334 Tavistock Road is owned by Quality Lifestyles Ltd and has been a care home since 2009. There is parking for several cars at the front of the house. The house is the same as the other houses on either side. Two people lived at the home at the time of inspection. The house is close to shops. There are two lounge rooms and a dining room as well as a big kitchen for people to use. Each person has their own bedroom. No-one has to share a bedroom. Everyone has their own bathroom with a bath and a shower. The home has a nice garden and a summer house. The home has its own car for people to use. In February 2010 the weekly fees ranged from £2700 to £3200 for 24 hour 1:1 support but may change depending on people’s needs. 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 This inspection was carried out by one inspector who visited the home without telling anyone she was going to come. She was there from 10.00am to 13.00pm on Thursday, 18th February 2010. Throughout this report, the term we will be used as the report is written on behalf of the Care Quality Commission. We talked to one person who lived in the home as well as the staff member and the deputy manager. We looked all round the home We looked at the care records for both people who lived in the home. We looked at other records that told us about how the home is run. This included staff records and health and safety records. Before the inspection an Annual Quality Assurance Assessment (AQAA) was completed by the manager and this gave us lots of information about the home. What the care home does well The management culture of the home is open, positive and inclusive. The home is large with plenty of space; it is comfortable, clean and homely. Peoples rights and different interests are supported and respected. People feel safe living in the home. Each person has a support plan that contains very detailed information about care and support needs. The staff team support people to take part in various activities in the community. The staff are properly trained to support the people who live in the home. What has got better from the last inspection What the care home could do better We have not asked the home to make any improvements. 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 Jane Gurnell Colston 33 33 Colston Avenue Bristol Avon BS1 4UA 01179307110 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website http:/www.cqc.org.uk/. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line - 0870 240 7535. Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who choose to live in the home can be confident that their support needs are assessed prior to admission and they will have opportunities to visit the home to meet the other people who live there and the staff team. Evidence: There are two people currently living at the home and the staff confirmed that one person is currently being assessed and introduced to the home. The assessment for this third person was available: it was very detailed and gave staff clear information about the persons needs. The assessment included information about what the person could do for themselves, their preferences about how they wished to live their lives, and how staff should provide assistance and support with consideration given to managing risks. The assessment process included consultation with the person concerned, their relatives or representatives and other professionals involved in the persons care, such as social and learning disability services. The staff explained that additional staffing had been arranged every afternoon to support this person to meet the other people living in the home, participate in activities and have a meal at the home. Staff confirmed that this would continue for several more weeks until the person felt ready to move in. The person had already started to personlise a bedroom. Both the people living in the home and the person considering moving in had been provided with a Service User Guide which provided information about the home using simple explanations and pictures to make it more understandable. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who live in the home are enabled to participate in, and make decisions about, all aspects of their lives. Written plans reflect personal goals and preferences. Evidence: A discussion with the staff and the deputy manager as well as observation showed that the running of the home, and all routines and activities, are organised around the wishes, choices and needs of the people who live there. The staff team encourage, enable and support people to make their own decisions, choices and be as independent as possible. Evidence was seen that for one person an independent advocate was involved to help with decision making about what is in their best interests. It was also evident that family involvement is very much encouraged and supported. One person living in the home was spoken with and staff were observed interacting with both people and it was evident they had a good relationship. Staff were seen to be clear in their communication with people and encouraged people to make decisions about what they would like to do. Detailed written plans have been developed for each person following the needs assessment prior to and upon admission. The plans provide staff with information about the type of support and help each person needs on a day-to-day basis from their personal care routine, their meal preferences, their daytime activities as well as longer term goals such as learning new skills or being involved in new experiences to increase their confidence and independence. Activities that people participate in, such as shopping, swimming, going to the gym and cycling, are assessed for possible risks, to make sure that they are kept safe from harm. It was clear from the plans and from discussion with Evidence: staff that people are not expected to undertake activities together unless they choose to do so and staffing is provided in such a way that each person can be independent and choose what they wish to do. People were supported to participate in the day-to-day activities involved in running the home, such as cleaning, shopping, cooking and laundry. The plans also contained information about issues that might cause people to become anxious or agitated and what staff must do to keep people safe. The plans were found to be very detailed and easy to follow, there was evidence that these had been updated and reviewed regularly with the person concerned, the staff and others involved in their care such as family members and the Learning Disability Support Team. Discussions with the staff and the deputy manager, confirmed that staff are fully aware of the needs of each person. The home is commended for the quality and clarity of this information. Neither of the people living in the home were able to manage their own finances and people’s finances were either managed by the Court of Protection or the family. The home does keep some money for each person for purchasing items whilst out of the home such as magazines or for the hairdresser. At the time of the inspection, the Company Secretary was undertaking an audit of the money held in the home, both that belonging to the people living in the home as well as that belonging to the Company. All monies were found to be accurate and the deputy manager explained that all money and records are checked for accuracy every day by the staff. The records relating to the money held for people in the home were checked by us as well and were found to be clear, neat and accurate: receipts for expenditure were obtained. The people living in the home are expected to pay for personal items, for example toiletries, clothing and hairdressing. Currently neither of the people living in the home are in receipt of mobility allowance and therefore are not expected to make a contribution towards the cost of fuel for the homes car. 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 who live in the home are supported to lead active lives and learn life skills. They participate in community and leisure activities, choose their own daily routines and maintain regular contact with their families. Evidence: Discussions with a person living in the home, staff and the deputy manager, as well as observation and information contained in personal files, showed that people are enabled to live as full a life as they wish to. People have opportunities for personal development, risk taking and decision making. The ethos of the home is based on promoting individual opportunities to broaden experiences, support people to develop socially and emotionally and to understand responsible risk taking. People are encouraged to participate in all the domestic activities in the home and to take part in leisure activities of their choice. Staff explained that one person preferred an active outdoor lifestyle, such as walking and cycling, while the other person preferred more gentle activities such as shopping and going to restaurants and cafes. Staff explained that people can chose what they would like to do each day and they are offered the opportunity to go out of the home every day. The deputy manager said that individual holidays are being planned for each person with the cost of these being met by the Company from the weekly fees. People participate in menu planning, do the shopping with staff support and help to prepare and cook meals at a time of their choice. Staff said people are free to choose where they wish to take their meals, either in the kitchen or the dining room. On the day Evidence: of the inspection, each person chose their own lunch and ate at different times. Records show that varied and well balanced meals are provided. There was plenty of fresh and dried food stored in the kitchen and freezer which was of good quality and allowed people choice with snacks and main meals. Privacy is respected and staff were seen to knock on bedroom doors before entering. Bathroom and bedroom doors have locks which staff are able to override in an emergency. All doors in the home, including wardrobe doors in peoples bedrooms, have additional star locks fitted to the top of the door. These were fitted at the time of the homes conversion should it be assessed that people moving to the home were at risk from having unsupervised access to their en suite bathroom and to their clothing. It was clearly described in the written plans looked at that these locks were not needed and should not be used. 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 who live in the home can be confident that personal support is provided in the way, and at the time, that they want and need. Health care needs are addressed as soon as they are identified. Evidence: The written support plans provide information about personal, social, emotional and health care needs. This means that the staff team are fully aware of each persons specific needs and will respond in a consistent manner. Information in the plans showed that people have contact with representatives from Social Services, Learning Disability Services, doctors, dentists, chiropodists and various other healthcare professionals who provide specialist advice such as a Speech and Language Therapist. Preferences such as when to get up and go to bed, have meals, bathe and go out during the day or evening were clearly documented in the written plans and it was evident from the daily care notes that these preferences were respected. Through discussion with the staff and observation it was clear that timings are flexible and the choice of the people who live in the home. None of the people who live in the home administer their own medication because they are not safe to do so and therefore this is done by staff. Medication was locked away safely and regular medication reviews with health professionals take place. Records pertaining to the administration of medication were up to date and the practice of administering medication, described by the deputy manager, was found to be safe. Information contained in staff files showed that each staff member receives training on how to administer medication and the deputy manager confirmed that no staff member administers medication unless she believes they are competent, and they feel confident, in doing this. 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 who live in the home are protected from abuse, neglect and self-harm. People can be confident that any concerns or complaints will be listened to, taken seriously and acted upon immediately. Evidence: Staff were seen to have a respectful relationship with the people living in the home and took time to listen to what they were saying. People were not rushed and were able to undertake tasks and make choices in their own time. Discussions with the staff and the deputy manager demonstrated that the open culture of the home and the recognition of peoples rights, ensure that people are protected from harm. All staff have undertaken training in safeguarding vulnerable adults and discussion with the deputy manager confirmed that she knew what action to take should she suspect that any person in the home was being abused or not treated respectfully. There was also written guidance in the home for the staff to follow should they need to. Each person has a copy of the homes complaints procedure which has been written in easy language and symbols to make it easier to understand. Staff said they recognise through changes in peoples body language if they are upset about anything and try to identify what the problem is. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The standard of the environment and decor within this home is excellent, providing people with a very comfortable, spacious and homely place to live. Evidence: The home is very spacious; it has a large entrance way, a large lounge and dining room, a smaller separate lounge room, a very large kitchen with a dining table and five large en suite bedrooms, one of which is on the ground floor. Furniture and furnishings were of very good quality. The home was found to be safe, clean and very well maintained, providing a homely environment for the people who live there. The house is no different from any other house in the area therefore blends into the neighbourhood because there is nothing to distinguish it as a residential home. Each person has a large single bedroom with an en suite bathroom that also has a large shower cubicle. Bedrooms are individually furnished and decorated, containing many personal possessions. The home has a toilet on the ground floor close to the lounge rooms. Hot water is thermostatically regulated to reduce the risk of scalds. A laundry room is situated on the ground floor and people are supported to undertake their own laundry. There were no concerns at this inspection about the risk of any cross infection, based on the needs of the people living in the home. 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. Recruitment procedures are robust and people who live in the home benefit from a well trained, well supported and supervised staff team. Evidence: As noted above, staff were seen to have a respectful and friendly relationship with the people who live in the home. At the time of the inspection, there were 3 members of staff as well as the deputy manager on duty and staff explained that a forth member of staff would come on duty later in the morning to enable both people to go out of the home. The duty rota indicated that staffing was flexible and arranged to meet peoples needs as well as any planned activities, which meant that the numbers on duty varied throughout the day and from day to day: there were never less than two people on duty. Two waking staff were on duty overnight and, should it be necessary, there was a bedroom available for a third member of staff to sleep-in for additional support. The registered manager and deputy manager were not included in these numbers and provide additional support during the day. The duty rota indicated staff responsibilities such as who is to take responsibility for the management of the home in the registered managers and deputy managers absence, who is to give medicines, and which manager is providing on call support over weekends and at night. The recruitment and training files for two of the staff on duty were looked at. These contained all the required information such as written references and criminal record bureau checks to ensure as far as possible only suitable people are employed at the home. Staff meetings and individual 1:1 supervision sessions between the registered manager and staff are held regularly. These meetings address the principles and values of the organisation, staff performance and training and development needs, as well as Evidence: day-to-day support issues. A training profile is held for each member of staff and an over view allows an easy audit of who needs training updates. Records showed that staff are expected to attend a variety of training relevant to their roles including qualifications in working with people with learning disabilities. These courses include topics such as first aid, health and safety, food hygiene, epilepsy, managing behaviour that challenges, care planning and communication. Staff new to the home undertake induction training and are enrolled on a National Vocational Qualification. Staff performance is reviewed periodically during their probationary period as well as annually once permanent employment has been confirmed. 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 management approach is open, inclusive and positive, providing clear leadership and guidance. Empowerment and enablement of people is the focus of the organisation. Peoples rights, health, safety and welfare are protected and promoted. Evidence: The registered manager has many years experience in managing a care home for people with a learning disability. She has a level 4 National Vocational Qualification (NVQ) in Health and Social Care and the Registered Manager Award. Staff confirmed that the ethos of the management approach is open and inclusive with the home being organised to meet the needs and aspirations of the people who live there. Lines of accountability are clear and the organisation has a management structure that enables it to cover absences when required, and provide an effective on call system to support staff. The registered manager and staff team are supported by the Company’s Responsible Individual who visits the home several times a week to discuss day-to-day management issues and future development plans. An external agency is used to undertake the required visits and reviews as detailed in Regulation 26 of the Care Homes Regulations 2001, which reviews the quality of the service provided to the people living in the home and to ensure the regulations are met. The registered manager produces a report each month for the Responsible Individual detailing significant events that have occurred. The organisation has a quality assurance system in place which includes consultation relatives and representatives and health care professionals involved in people’s care. The deputy manager said the results of this consultation are reviewed by the registered manager and the Responsible Individual and the results are shared with the staff team. Evidence: Health and safety checks, including fire equipment and gas safety are carried out regularly. Fire safety training is carried out with both staff and the people who live in the home. Discussion with the deputy manager, as well as staff training records, confirmed that all staff complete training in emergency first aid, health and safety and food hygiene. This means that staff have the knowledge and skills to deal with emergencies. All accidents and incidents are recorded and the registered manager monitors these to look at the circumstances of each incident and look for any patterns that may emerge so that the staff team can take action to prevent a recurrence. 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 Helpline: Telephone: 03000 616161 or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2010) Care Quality Commission (CQC). 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