Care Home: Queens Lodge

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What the care home does well Queens Lodge is a small, clean, comfortable and homely place, with a stable, family atmosphere. As far as possible, people living at the service were able to show a positive contribution to the running of the service. This was evidenced in staff recruitment procedures and the internal decoration. Other examples seen included the "Our Voice" group which Mencap supports people to view their opinions and actively encourages people to socialise together and develop new innovative projects. One person using the service commented "I like the colour of my room". It was also observed that people had personalised their rooms with appropriate support as required and were reflective of their individual personalities. The staff were directly observed supporting and caring or the people who live at the service. Staff always approached people with care and respect. People were directly seen to respond well to the staff manner and approach. One person commented that "the staff are always nice". People living at Queens Lodge felt comfortable asking staff for advice or talking about the things that mattered to them. All people surveyed said that they knew how to make a complaint or who to talk to if they were sad. The AQAA tells us that "written assessments for potential people we are going to support are kept within the service and are used as part of the process to initially develop the persons own individual support plan and risk assessments. We have a comprehensive Statement of Purpose and People we support guide". Detailed assessments were seen during the inspection process. One person who uses the service commented, "I like it here, all the staff are really lovely and helpful too". One survey received back commented in relation to what the home does well, "staff caring towards service users". Care planning processes were detailed and evidenced that the people using the service are offered support which is tailored to their individual needs, wishes and preferences. One person using the service commented, "they are all friendly here, we have a giggle and the staff are kind and caring". The medication management of the service is to a good standard. With accurate records being maintained and each person having a profile of their medication available. The service has strong links with other support teams ensuring that the diverse and changing needs of individuals are closely monitored and managed in their best interest. One person using the service commented "they help me go to the doctor if I am unwell". The service has a good recruitment process which ensures that staff are recruited following suitable pre employment checks. One person using the service commented "all the staff are good, they help me and are nice, they take me on holiday too". What has improved since the last inspection? A number of areas have improved at the service since that last inspection and includes an increase in the number of staff that have obtained and or are obtaining their National Vocational Qualification. The service has also developed the care planning process which makes the monitoring and reviewing of care plans stream lined. The process also highlights areas of risk for the individual so appropriate risk assessments can be implemented in the persons best interest if required. The AQAA tells us that the service has also improved by "resourced and purchased service specific furniture for one particular person. New purchases of profile beds and person specific easy chair. Developed a small pond and water feature within the garden area and re-constructed some of the flower beds. Installed low voltage recessed light in the persons room". The service has almost completed the door widening through the service. This will empower and enable all the people who use the service to have access to all areas and facilities. Further progress has been made with the use of pictorial symbols and images in order to further develop communication with some of the people who use the service. The AQAA tells us that improvements have been made to the monitoring and management of medication systems. During the inspection improvements to the management of medication was observed. The Safeguarding of Vulnerable Adults training has been revised and reviewed in order to reflect any changes in legislation. There has also been a drive to increase community based activities. During the inspection photographic evidence as seen of a recent trip out to an old time music event. What the care home could do better: A small number of requirements have been made as part of this inspection and include the need for the service to increase staff supervisions and to record the temperatures of the storage areas of medication. In addition to this a number of good practice recommendations have been made and include review of the terms and conditions of residency, the replacement of the medication cupboard, displaying the complaints procedure and the removal of furniture from the side of the building. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Queens Lodge 3b Queens Road Colchester Essex CO3 3NP     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Louise Bushell     Date: 2 6 0 6 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. 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. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 35 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 35 Information about the care home Name of care home: Address: Queens Lodge 3b Queens Road Colchester Essex CO3 3NP 01206575410 01206564816 Fiona.Macdonald@mencap.org.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Royal Mencap Society Name of registered manager (if applicable) Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 6 Number of places (if applicable): Under 65 Over 65 6 learning disability Additional conditions: 6 Persons of either sex, aged 45 years and over, who require care by reason of a learning disability (not to exceed 6 persons) Persons of either sex, aged 65 years and over, who require care by reason of a learning disability (not to exceed 6 persons) The total number of service users accommodated in the home must not exceed 6 persons Date of last inspection Brief description of the care home Queens Lodge is owned by the Royal MENCAP Society. The home provides residential care for 6 individuals with learning disabilities, some of whom may be over 65. Accommodation is offered in a bungalow situated in a residential area on the outskirts of Colchester whereby service users can access local facilities. The premises have been extended to provide extra communal space. All rooms are single occupation. There is parking to the side of the property and a pleasant garden to the rear. Care Homes for Adults (18-65 years) Page 4 of 35 Brief description of the care home A Copy of the most recent inspection report from the Care Quality Commission was accessible to service users and their representatives on a corkboard in the dining room. Care Homes for Adults (18-65 years) Page 5 of 35 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 focus of the inspections undertaken by the Care Quality Commission is upon outcomes for the people who use the service and their views of the service provided. The primary method of inspection used was case tracking which involved selecting a number of people and tracking the care they received through looking at their care records, discussion where possible with the people who use the service, the care staff and observation of care practices. The last key inspection took place on the 25th June 2007. The visit was unannounced and planning for the visit included assessment of the notifications of significant events, which had been received from the service to the Care Quality Commission. Care Homes for Adults (18-65 years) Page 6 of 35 We looked at the last Inspection Report and information on safeguarding and complaints since the last inspection. We also looked at the Annual Quality Assurance Assessment (AQAA), it is a legal requirement that the service completes an AQAA annually. We reviewed what the service has improved in the last twelve months and its plans for the next twelve months. We also read about how the service believes it meets the standards and what evidence shows that they do this well. During the visit information was gathered directly from the staff, people who use the service and feedback received in questionnaire format from relatives and health and social care professionals. The visit took place between 9:15am and 14:00pm. This enabled the inspector to directly and indirectly observe the care practices and the day to day operations of the service. A selected tour of the building was conducted during which the inspector spoke with people who use the service, staff and visitors and the manager. What the care home does well: Queens Lodge is a small, clean, comfortable and homely place, with a stable, family atmosphere. As far as possible, people living at the service were able to show a positive contribution to the running of the service. This was evidenced in staff recruitment procedures and the internal decoration. Other examples seen included the Our Voice group which Mencap supports people to view their opinions and actively encourages people to socialise together and develop new innovative projects. One person using the service commented I like the colour of my room. It was also observed that people had personalised their rooms with appropriate support as required and were reflective of their individual personalities. The staff were directly observed supporting and caring or the people who live at the service. Staff always approached people with care and respect. People were directly seen to respond well to the staff manner and approach. One person commented that the staff are always nice. People living at Queens Lodge felt comfortable asking staff for advice or talking about the things that mattered to them. All people surveyed said that they knew how to make a complaint or who to talk to if they were sad. The AQAA tells us that written assessments for potential people we are going to support are kept within the service and are used as part of the process to initially develop the persons own individual support plan and risk assessments. We have a comprehensive Statement of Purpose and People we support guide. Detailed assessments were seen during the inspection process. One person who uses the service commented, I like it here, all the staff are really lovely and helpful too. One survey received back commented in relation to what the home does well, staff caring towards service users. Care planning processes were detailed and evidenced that the people using the service are offered support which is tailored to their individual needs, wishes and preferences. One person using the service commented, they are all friendly here, we have a giggle and the staff are kind and caring. The medication management of the service is to a good standard. With accurate records being maintained and each person having a profile of their medication available. The service has strong links with other support teams ensuring that the diverse and changing needs of individuals are closely monitored and managed in their best interest. One person using the service commented they help me go to the doctor if I am unwell. The service has a good recruitment process which ensures that staff are recruited following suitable pre employment checks. One person using the service commented all the staff are good, they help me and are nice, they take me on holiday too. Care Homes for Adults (18-65 years) Page 8 of 35 What has improved since the last inspection? 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 set out on page 4. Care Homes for Adults (18-65 years) Page 9 of 35 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 10 of 35 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 11 of 35 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 use the service can be assured that there needs will be identified through a detailed assessment process, including a visit to the service. Evidence: The service has developed a statement of purpose, which sets out the aims and objectives of the service, and includes a guide, which provides information about the service and the specialist care the service offers. The guide details what the prospective and current individuals can expect and gives a clear account of the specialist services provided, quality of the accommodation, qualifications and experience of staff and how to make a complaint. All new people are given a copy of the guide and the services makes one available for all to view as they wish. Four surveys were received from the people who use the service. Three stated that they had enough information regarding the service before they moved in. Two care files were observed of two of the individuals using the service. Assessments tools were observed for both of these people. It was evident that admissions are not made to the service until a full needs assessment has been undertaken. A skilled and trained Care Homes for Adults (18-65 years) Page 12 of 35 Evidence: person always completes the assessment prior to admission to the service. The assessment was detailed and appropriate to the policy and procedure in place. The assessment explored areas of diversity including preferences, religious and cultural needs, involvement from family, partners and advocates, race, gender, age and disability. The service has the capacity to support people who use the service and respond to diverse needs that may have been identified during the assessment process. Information was also gathered from all relevant other professionals in order to ensure that the needs of the person were placed at the centre of the care and support being provided. It was evident on each occasion that essential links had been gained and maintained with, for example the community nursing team and social workers. Surveys returned determined that the care services assessment arrangements ensure that accurate information is gathered and that the right service is planned for people. One person directly commented this is a very good home. The AQAA tells us that written assessments for potential people we are going to support are kept within the service and are used as part of the process to initially develop the persons own individual support plan and risk assessments. We have a comprehensive Statement of Purpose and People we support guide. One person who uses the service commented, I like it here, all the staff are really lovely and helpful too. One survey received back commented in relation to what the home does well, staff caring towards service users. One of the files seen showed that the person had a statement of their individual terms and conditions of residency. The second file did not show that the person had a statement of their terms and conditions. It was seen that this document had not be revised or reviewed for some period of time. The format of the document did not also enable people who use the service to have an opportunity to understand their rights. The AQAA also identifies that the service is able to highlight its own developmental areas and is stating that over the next twelve months it is aiming to use newly purchased IT software to develop the Statement of Purpose and Guide into a more assessable documents, using pictures and symbols. We are in the process of developing menu choices in photographic form to assist the people we support to have more informed choices into their choice of meals. Evidence of this was observed during the inspection. Care Homes for Adults (18-65 years) Page 13 of 35 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 who use the service can be assured that staff have detailed information available in order to meet their needs. Evidence: A total of two care plans were case tracked fully. It was established that people who use the service receive personal and healthcare support, which is suitable to meet their needs. Personal healthcare needs including specialist health and dietary requirements are recorded in each persons care plan. The care plan provides information and a guide for staff to know how to support the person. The service has recently introduced a new computerised programme which enables the holistic needs of the person to be presented in a detailed format. The process enables peoples needs to be linked to aspirations and risks. The format is person centred and puts the person at the focus of the care plan. The care plan presented as a working document with regular reviews. Care Homes for Adults (18-65 years) Page 14 of 35 Evidence: The care plan is generated from the pre admission assessment and includes guidelines, risk assessments for the management and control of a range of issues, manual handling and where appropriate behavioural support guidelines. The guidelines and care plans are specific to the person and direct the staff on how to meet that specific individual persons needs, wishes and or preferences. An example of this was shown in a persons care plan with regards to their personal communication method and techniques. One person using the service commented, they are all friendly here, we have a giggle and the staff are kind and caring. The AQAA states that the people we support are consulted on a daily basis in ways that suit their chosen method of communication. Support Plans are developed and update to reflect any changes in their particular support needs and this is done in consultation with the individual to ensure they are realistic. We actively support service users to achieve their aspirations and to ensure they are reflected within their day to day activities. Staff including key workers are endeavouring to develop person centred ways of working. The people we support and able to take the necessary risks in order to live the life they want. This is done within a structured risk assessment strategy and monitoring style. Evidence of appropriate risk assessments were seen and reviewed as part of case tracking. It was evident that risk assessments were enabling people to take every day risks as part of developing an independent life style. It was observed that personal support is responsive and tailored to meet the individual choices, needs and preferences. Staff were observed to respect the privacy and dignity of all people. An example of this was seen during the inspection with staff communicating with individuals in a respectful manner and offering them personal hygiene tasks discreetly. The service listens and responds to individual choices and decisions about who delivers their personal care. People are supported and helped to be independent and can take responsibility for their personal care needs. One person using the service commented they help me the way I like them to help me. The AQAA states that minutes from the meetings of the people we support. Daily monitoring form that are filled out for each individual and where possible the users are encouraged to either sign or make their mark of agreement where they have been involved in support plan content. Evidence of this was seen during the inspection. Care Homes for Adults (18-65 years) Page 15 of 35 Evidence: The service has also identified areas of improvement in relation to introducing more pictorial information to developed and empower people using the service to make more choices over their lives. The AQAA states to further increase the use of photos to support the process of making the service more service users led. During the inspection it was directly observed that confidential records were being stored appropriately. Care Homes for Adults (18-65 years) Page 16 of 35 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 use the service are provided with support to make choices about their lifestyle and to develop their life skills. Evidence: People who use the service are supported to enjoy a full and stimulating lifestyle with a variety of options to choose from. Staff members were able to report that people who use the service were supported to attend various activities, go to the theatre, cinema, shows, and many other appropriate activities. The people who use the service have opportunities at internal meetings to voice their wishes regarding social events and all other issues they wish to discuss. During the inspection recent pictures were seen where individuals attended an old time music event. One person using the service commented I like doing knitting and shopping. Care Homes for Adults (18-65 years) Page 17 of 35 Evidence: On the day of the inspection one person confirmed that they were going on holiday soon with staff and were really looking forward to it. Most of the people who use the service had chosen and arranged their annual holidays with the support of the staff team. The manager confirmed that a range of holidays had been booked this year based on the wishes of the individuals. One person using the service stated that when I go away I am going to eat fish and chips and dance. The service sought the views of the people who use the service and their representatives and considered these when planning the routines of daily living and arranging activities. Routines and activities were flexible and focused around individuals changing needs and choices. Due to the ageing needs of the people who use the service, activities are arranged with a flexible approach for all. Records are maintained where people have engaged in activities. Discussions occurred with the acting person in charge regarding how records of activities are recorded. The person in charge stated that this is an area where recording could improve. One member of staff commented staff encourage the people we support to enjoy their lives and take part in outings, holidays and events in the community. They always have a choice and are listened to about their point of views. This practice was directly observed during the inspection where staff were observed listening to peoples views and taking action as requested by the individual. The service supports people to voice their opinions and holds regular service user groups. Mencap also co ordinates a service user group where the people using Mencap services hold events and publish a news letter. The group supports people to voice their opinions, creates interest groups, promotes independence and encourages activity. The AQAA tells us that the people we support are encouraged to be involved in meaningful activities of their choice e.g. leisure time activities. We actively support the service users to maintain and and develop relationships with family and friends. Mealtimes are tailored to the individual and choice of food is made on an individual basis. This may mean people eating at different times and eating different meals for each other, taking into account likes and dislikes. It was observed that meals were well balanced and nutritional, catering for the varying choices and dietary needs of the people living at the service. Food stocks were of good quality and in appropriate quantities. The people who use the service selected the weekly menu with the aid of picture books. One person commented I like the food, its nice. A further person nodded their head and smiled when asked if they liked the food. Care Homes for Adults (18-65 years) Page 18 of 35 Evidence: Feedback received from a relative commented I can not think of any way of improving the service. Care Homes for Adults (18-65 years) Page 19 of 35 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 use the service can be assured that their health needs are being met in their best interest. Evidence: Individuals files included information of individuals health needs and how these were to be met, however the information was contained within a variety of sources such as the daily records, the assessment and the care plan. It was identified that the holistic needs of each person using the service was available. The care plans and health needs documentation put the person at the centre of their care. It was evidenced on numerous occasions where different specialists are involved directly with the care and support of the person. Examples of this included community nursing team, outreach services and mental health support services. Records were well maintained. Feedback received from a social and health care professional stated manager is very good at liaising with health staff and following up actions and recommendations. The AQAA details information regarding a good practice example of working in the best interests of the person using the service and linking with other Care Homes for Adults (18-65 years) Page 20 of 35 Evidence: multi disciplinary teams. It states Queens Lodge has built a reputation of high quality healthcare and the ability to recognise and adapt to the changing needs and wishes of the people we support. These wishes and needs are also reflected in the support plans for each individual. With have a good relationship with local healthcare professionals and have been recently praised for the support and commitment that has been given by the whole team is the support of the person discharged from section as we had to manage this almost single handed as the additional support services that were promised were unable to cope with the demand on their services and unfortunately the person we were supporting was not classed as a priority case. Therefore we had to support X trough a very difficult transition period on our own. The service currently does not provide a specific Health Action Plan, however all the information required was available. The acting person in charge spoke about the introduction of the Health Action Plan booklet in order to make it easier when supporting a person to hospital or an appointment, rather than taking the entire folder. This approach would also dignify the person further. One person using the service commented they help me go to the doctor if I am unwell. Personal care and support was provided in private and by a person of the same gender where possible. Guidance and support is provided with personal hygiene tasks where required although where people are able to attend to their own personal hygiene needs they were encouraged to do so. Medications were stored appropriately in a locked cupboard. However this cupboard was not a prescribed medicating cupboard. Medication administration records viewed at this visit and were satisfactorily maintained. The service operated a system of checking the medication administration routines to further protect the health and well being of the residents. In general bottles and boxs used where recorded with a date of opening, this aids the service in auditing medication and checking expiry own opened. Records were well maintained and records were accurate when medication had been stock checked in. The individual person had a medication profile in place which detailed the allergies specific to the person and a picture of the person for staff recognition. Temperatures of the room were not being recorded to ensure that medication was being stored in the correct environmental conditions. The service had a reviewed medication administration policy and procedure in place. The AQAA states, medication and monitoring systems have been reviewed and Care Homes for Adults (18-65 years) Page 21 of 35 Evidence: updated. A staff member commented that they had received training in medication. Training records showed that training is offered to all staff regularly updated. Care Homes for Adults (18-65 years) Page 22 of 35 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 use the service can be assured that their concerns are listened to and acted upon. Evidence: The service has an open culture, which allows people to express their views and concerns through a variety of methods. Feedback gained from one of the people who uses the service confirmed that they are aware of what to do if they are unhappy and wish or wish to make a complaint. The individual stated, I can talk to staff if I am unhappy or sad, they are good and help me. The service has a clear complaints policy and procedure. The procedure was not on display within the service even though there is a service user notice board. A detailed complaints and compliments record is maintained and this is also internally monitored each month and actions clearly recorded. The AQAA tells us that the service has not received any recent complaints. During the inspection there were no recent complaints held on the file. The person in charge reported that any points raised by the people or their representatives were addressed in a timely manner as per the procedure. The AQAA tells us that staff actively encourage the people we support to speak out if they are dissatisfied with a particular service that we are provide them with and every effort is made to either make changes or to reach compromises. All staff are subject to enhanced CRB (Criminal Records Bureau) checks and satisfactory references before Care Homes for Adults (18-65 years) Page 23 of 35 Evidence: taking up position. A discussion was held regarding the recognition of complaints and the positive way in which they could be used as tools to drive the quality of service provision forward. The AQAA added that further improvements could be made by development and implementation of a monitoring tool to identify possible triggers for peoples discontentment, which would enable us to reduce the triggers for this discontentment. The service understood the procedure for safeguarding vulnerable adults. Training in the safeguarding and protection of vulnerable people is scheduled periodically and the training has recently been revised in order to incorporate any changes in legislation. The policies and procedures relating to recruitment promotes the safety of the people who use the service through the completion of an enhanced Criminal Records Bureau (CRB) disclosures and two written references before a new staff member starts work at the service. Care Homes for Adults (18-65 years) Page 24 of 35 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. The people using the servicce reside in a suitable, safe, hygienic and homely environment. Evidence: The service continues to be homely, clean, and safe and truly reflects the individuals needs by design and adaptations provided. The people who use the service are fully involved in decisions about the decoration of the service and furniture this includes individual bedrooms and all communal areas. Peoples rooms are very personalised with pictures, and furnishings that the person has been supported in choosing. One person using the service commented I like the colour in my room. Individuals choose to meet with families or friends in communal settings or privately. They also have access to a phone where they can make calls confidentially. Individuals have full access to all facilities, enabling their independence to grow. During the inspection works were being finalised to widen the door frames so people using wheelchairs could access all areas of the building. People using the service made positive comments regarding the environment and one person stated I like my room. A further person expressed satisfaction with the developing raised bed sensory area. Care Homes for Adults (18-65 years) Page 25 of 35 Evidence: The AQAA indicates that the service continues to make improvements. It states that the following improvements have been made over the past twelve months. A number of these were observed during the inspection. resourced and purchased service specific furniture for one particular person. New purchases of profile beds and person specific easy chair. Developed a small pond and water feature within the garden area and re-constructed some of the flower beds. Installed low voltage recessed light in the persons room. One person using the service stated, I like it here. A further person communicated their satisfaction by nodding and smiling when asked if they liked the home and their room. The outdoor space available is of a good size and enables people to move around freely. The garden is maintained and there is a large covered pergola area with seating available. The person in charge spoke about erecting an outdoor summer house which would enable people who smoke to access a warm covered area. On the day of the inspection the garden appeared reasonably tidy, however at the side of the property there were many items awaiting disposal. The person in charge stated that they are in the process of getting these items removed. One person using the service is also growing their own vegetables with the support from staff. Care Homes for Adults (18-65 years) Page 26 of 35 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 people who use the service can be assured that their care and support needs are met and are provided by a competent qualified staff team. Evidence: People who use the service have confidence in the staff who care for them. People using the service were relaxed within their own environment and staff were directly observed communicating with individuals in a dignified manner. People using the service feedback in the survey that they feel that the staff and manager treat them well and act upon what they say. Rotas show well thought out and creative ways of making sure that the service is staffed efficiently, with particular attention given to busy times of the day and changing needs of the people who use the service. There are enough staff on duty to meet the needs of the people using the service. At the time of the inspection there was a total of five people working. This included the person in charge who was available to support if required. The service also operates an on call support system. The AQAA tells us that the people we support benefit from a staff team that is varied in their interests, competent and well trained. We have a comprehensive programme of all mandatory training and access to service specific training as the need arises. Mencap Care Homes for Adults (18-65 years) Page 27 of 35 Evidence: has a comprehensive recruitment policy and encourages the people we support to have an active role in the selection of staff for their service. All new staff have to complete an Induction programme within 12 weeks of their commencement and are required to attend two guided study days along with their mandatory training areas. All training completed by staff is then pass on monthly to the TRAMS dept of Mencap and put onto their central database where this can be monitored and reviewed. Staff members undertake qualifications. The person in charge encourages and enable this and recognise the benefits of a skilled, trained workforce. Records showed that some staff have completed or are in the process of completing their National Vocational Qualification. Training records showed that there is a structured training plan in place and that all mandatory training needs have been identified and plans in place to provide the training. The system used is effective a identifies any shortfalls. Training has been provided in Deprivation of Liberty and Safeguards as well as the Mental Capacity Act. During the inspection records were seen of the structured induction programme that staff undertake. One staff member commented I have completed my induction, it was very detailed and informative. Feedback received from the staff surveys reflected that staff have information available to them regarding the needs of the individuals and that the induction programme covered the areas of the job that they would be doing. The service indicates in their AQAA that further improvements over the next twelve months include the availability of comprehensive training materials on Mencap intranet, the opportunity for staff to access the charity on line learning and the skills web sites are both cost effective training and refreshers course and staff have the opportunity to develop their keys skills as well in reading writing and maths. All staff are required to provide satisfactory references and CRB checks before they commence employment. Four staff files were reviewed on the day of the inspection and were seen to hold all the required documentation. There is a robust probationary period to ensure that staff is able to achieve the desired level of competency. A comprehensive training and development program is in place which not only addresses the mandatory training needs for new staff but also provides professional and development opportunities for all staff. There is a good recruitment procedure that clearly defines the process to be followed. This procedure is followed in practice with the home recognising the importance of effective recruitment procedures in the delivery of good quality services and for the protection of individuals. Staff recruited confirm that the home was clear about what was involved at all stages and was robust in following its procedure. The AQAA tells us that the people who use the service are involved in the recruitment of staff. One person using the service commented all the staff are good, they help me and are nice, they take me on holiday too. Care Homes for Adults (18-65 years) Page 28 of 35 Evidence: Supervision records were observed. It is clear that due to the inconsistency of a long term registered manager that on occasion supervision of staff has not been occurring as scheduled. The person in charge stated that this is an area which he intends to move forward further. A number of records were seen and explored personal development issues, key working and training and development. Care Homes for Adults (18-65 years) Page 29 of 35 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 who use the service can be assured that the person in charge has appropriate leadership skills and offers guidance and direction to all staff. This means that the people live in a well managed service. Evidence: The person in charge at the time of the inspection was the person who has been running the service over the last nine months. Time was spent with this person during the inspection process. It was clear that the person communicates a clear sense of direction to staff is able to evidence a sound understanding and application of best practice operational systems, particularly in relation to continuous improvement, customer satisfaction, and quality assurance. This was evidenced on the day of the inspection by the people using the service and the staff both making positive comments regarding his leadership and management style. One staff member commented he works with the team and devotes a lot of his time to the home and is exceptional with the clients. In addition to this a further staff member commented he Care Homes for Adults (18-65 years) Page 30 of 35 Evidence: has supported staff in all the needs and is very good. Equality and diversity, human rights and person centred thinking are given priority by the person in charge, who is able to demonstrate a high level of understanding and demonstrate best practice in these areas. The AQAA tells us that the service is run on the principle that all aspects should be led by the people we support and take into account their views and opinions within the decision making process. There is a continuous improvement plan in place, which underpins the day to day running of the service by highlighting shortfalls and provides a method by which we can improve and continue to grow. The ethos and leadership style of the service supports and enables people to express their diversity needs including their race, gender, sexuality and age. The manager is able to demonstrate through robust operational systems and professional experience that they are knowledgeable and highly competent in a range of areas. Examples include people being supported and empowered to make personal choices and the documentation of preferences. The person in charge ensures that staff follow the policies and procedures of the service. These are available in the office and were seen to be working documents. The staff are also required to sign each of the guidance and polices once they have read and understood them. There is strong evidence that the ethos of the home is open and transparent. The views of both people who use the service and staff are listened to, and valued. The AQAA contains good information that is fully supported by appropriate evidence. The service demonstrates a good level of self-awareness and recognises the areas that it still needs to improve, and has clearly detailed the innovative ways in which they are planning to do this. The service has efficient systems to ensure effective safeguarding and management of residents money and valuables, including record keeping. People are supported to manage their own money where possible. Those who do not currently have the skills are encouraged and supported to develop to become as independent as possible. They have access to their records whenever they wish. Record keeping is of a good standard. Records are kept securely and staff are aware of the requirements of the Data Protection Act. Risk assessments are in place regarding financial management and risk for all individuals. The service has a comprehensive range of policies and procedures to promote and protect residents and employees health and safety. Care Homes for Adults (18-65 years) Page 31 of 35 Evidence: There is full and clearly written recording of all safety checks and accidents. The person in charge, senior team, and staff at all levels have a good understanding of risk assessment processes which is underpinned by promoting independence, choice and autonomy. These principles are taken into account in all aspects of the running of the service. The person in charge ensures that all staff are trained in health and safety matters. Individual training records reflect this and regular updates are planned ahead. Care Homes for Adults (18-65 years) Page 32 of 35 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 33 of 35 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 20 13 Daily temperatures must be recorded where medication is stored. To ensure that medication is stored in environmental conditions as prescribed by the manufacture. 17/08/2009 2 36 18 Staff must receive regular supervision. To ensure that they are suitably supported and appraised. 31/08/2009 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 2 3 5 20 22 Terms and conditions of residency should be in a format suitable to meet the needs of the people using the service. The service should obtain a metal medication cupboard. The complaints procedure should be displayed for people to access. Care Homes for Adults (18-65 years) Page 34 of 35 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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