Care Home: Teesside Cheshire Home

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What the care home does well People get good information from the home so that they can make a decision about whether to move here. The home has good care records so that staff know how to support people in the right way. People keep their own care records in their rooms so they can see them any time. People who live here said that they are treated with respect. They said, "Its like a family" and "Its a lovely place to live." There is an excellent range of activities for people, and people can lead their own lifestyle. People said that the quality of the meals is "excellent". People can choose what they want to eat and where they dine. The home makes sure that people have very good access to health care services. The home is very well equipped and fully accessible by the people who live here. Staff have good training so they know how to support the people in a safe way. The home is well managed, and is run in the best interests of the people who live here. What has improved since the last inspection? People have more opportunity to be involved in running the home through their own committees. The home now employs a physiotherapy assistant to help people with their exercises. People have full use of the main recreation hall and an IT suite. The home now employs a volunteer co-ordinator. She has arranged for more volunteers who can support people to go out more. The home has a polytunnel so that residents can grow their own vegetables. There are three new rooms with en-suite facilities. What the care home could do better: There are no requirements made at this inspection. A small number of good practice recommendations are made for consideration. These include; fitting bathroom cabinets in communal bathrooms and toilets so that latex gloves can be discreetly stored; having a cupboard for one person`s nutritional supplements to be kept in (rather than in the corridor); and providing mental capacity act training for staff. Key inspection report Care homes for adults (18-65 years) Name: Address: Teesside Cheshire Home Marske Hall Redcar Road Marske-by-Sea Redcar TS11 6AA     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Andrea Goodall     Date: 2 5 0 3 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 32 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 32 Information about the care home Name of care home: Address: Teesside Cheshire Home Marske Hall Redcar Road Marske-by-Sea Redcar TS11 6AA 01642482672 01642759973 sue.obrien@LCDisability.org www.lcdisability.org Leonard Cheshire Disability Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Type of registration: Number of places registered: care home 30 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 physical disability Additional conditions: The maximum number of service users who can be accommodated is: 30 The registered person may provide the following category of service only: Care home with nursing - Code N To service users of the following gender: Either Whose primary care needs on admission to the home are within the following category: Physical disability - Code PD, maximum number of places: 30 Date of last inspection Brief description of the care home Teesside Cheshire is a care home registered for 30 adults with a physical disability. Marske Hall is a grade 1 listed building situated in the centre of the village and is close to all local amenities such as pubs, leisure facilities, churches and shops. Transport facilities provided by the home are available to all residents. All rooms are single accommodation with a mixture of toilet ensuite and full ensuite facilities. Care Homes for Adults (18-65 years) Page 4 of 32 Over 65 0 30 1 4 0 9 2 0 0 9 Brief description of the care home The home offers a range of communal areas including an atrium with fishpond, conservatory, lounge, dining room, and exercise room/gym. There is a passenger lift giving access to the first floor. There are extensive grounds which are accessible and include an aviary. Fees may depend on individual circumstance so the home should be contacted for up to date information about fee levels. Care Homes for Adults (18-65 years) Page 5 of 32 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: three star excellent 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: Before the visit we looked at information we have received since the last key inspection visit on 3rd April 2007, the last annual service review on 1st April 2009, and a random inspection that a pharmacy inspector carried out to look at medication errors on 14th September 2009. We looked at any changes to how the home is run. We looked at how the service has dealt with any complaints or concerns since the last visit. We asked the Provider for their view of how well they care for people in their AQAA (an annual quality assurance assessment). We received surveys from seven residents and seven staff. We made an unannounced visit to the home on 23rd March 2010, and another visit on 25th March 2010 to speak with the manager. During the visits we talked with people Care Homes for Adults (18-65 years) Page 6 of 32 who use the service, their relatives, the manager and staff, and visitors. We joined residents for meals and looked at how staff support the people who live here. We looked at information about the people who use the service and how well their needs are met. We looked at other records which must be kept by a care service. We checked whether staff had the knowledge, skills and training to meet the needs of the people they care for. We looked around parts of the building to make sure it was clean, safe and comfortable. We checked what improvements had been made since the last visit. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations, but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. Care Homes for Adults (18-65 years) Page 7 of 32 What the care home does well: What has improved since the last inspection? What they could do better: There are no requirements made at this inspection. A small number of good practice recommendations are made for consideration. These include; fitting bathroom cabinets in communal bathrooms and toilets so that latex gloves can be discreetly stored; having a cupboard for one persons nutritional supplements to be kept in (rather than in the corridor); and providing mental capacity Care Homes for Adults (18-65 years) Page 8 of 32 act training for staff. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 32 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents are fully assessed before they make a decision about moving here so that they are assured the home can meet their needs. Evidence: Teeside Cheshire provides good written information for potential residents about its services in a service users guide and a statement of purpose. These are easy to read and set out the homes service and its aims and objectives. This information is also available in the home for visitors to read. At this time there is no information available at the home in other formats, such as CDs, for people who have difficulty reading. Some people move to this specialist home from other areas of the country, but wherever possible the home encourages people and their representatives to visit the home and spend time here before making a decision. There is also some brief written information about the home on the Leonard Cheshire website. The Teeside Cheshire home provides residential and nursing care for people who have significant physical disabilities. Before moving here each persons needs are fully Care Homes for Adults (18-65 years) Page 11 of 32 Evidence: assessed to ensure that the home is a suitable place for them. The assessments involve the person, their relatives (if appropriate) and the social and health care professionals involved in their care (for example, care managers from the local authority, and representatives from the Primary Care Trust if the person requires nursing care). The homes pre-admission assessments are carried out by the home manager and care supervisor. It is good practice that a key worker from the staff team is also involved in the assessment, where this is possible, and this is beneficial for the persons transition to the home when they arrive. The home enjoys a very high level of occupancy. A few months ago the home increased its registered number from 27 to 30 places, and these places are already filled. At the time of this visit there were 29 people living at the home and one more person was waiting to move in. One resident said, I lived in and visited a few homes before, and this is the best one there is. Care Homes for Adults (18-65 years) Page 12 of 32 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live here are fully involved in decisions about their lives, so they play an active role in planning the care and support they receive. Evidence: Care plans are records that are used by all care services to show what sort of help each person needs and how staff will provide that care. For example, how to support someone to bathe, and supporting them towards independent goals such as becoming independently mobile. The care plans at this home are called ISPs. It is very good practice that care plan files are kept by the person in their own rooms so that they have ownership of these records and can refer to them at any time. (Some people have chosen not to keep the files in their own rooms, but are still fully involved in the decisions about their care.) It was clear from care plans that people are fully involved and included in their own care planning, and wherever possible people had signed their own goals and needs Care Homes for Adults (18-65 years) Page 13 of 32 Evidence: records. All care records are written in a sensitive and supportive way that shows how the person would like to be supported. It was also clear that the goals and needs are regularly reviewed, and full annual reviews are held. It was clear from discussions with people, staff and visitors that people are encouraged to make their own daily decisions. It was evident from records that peoples right to lead their own individual lifestyle is supported and respected. One person said that one of the best things about the home is I do what I want and I can go wherever I want. People are also invited to be involved in group decision-making and are invited to take part in the homes Residents Committee, health & safety committee and fund-raising committee. Residents talked about a recent fund raising event that they were involved in, and described how they used the monies to buy a huge flat screen television which they now use in one lounge for cinema evenings. Some residents also like to get involved in larger fund raising events for Leonard Cheshire. One person commented that this makes them feel purposeful and said, We have raised thousands of pounds and I like taking part. Everyone has a copy of Right to Take Risks information in their care files, and the home supports people to take acceptable risks as part of everyday living. There are risk assessment records to show where risks are involved and what the home does to support the person to minimise those risks. Examples included getting sunburnt, ironing, and using a wheelchair strap when outside the home. There are also very detailed risk assessment about the use of bedrails by those people who are at risk of falling from bed. Care Homes for Adults (18-65 years) Page 14 of 32 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents have excellent support with social interests and can make choices about their own daily routines so that they lead a lifestyle that matches their individual preferences. Evidence: The people who live here enjoy a variety of day time occupations. The home employs two activities co-ordinators, and people also have their own outside interests and activities. Some people have one-to-one support arrangements (depending on their individual funding arrangements) and many use this support to go out to their own preferred activities. The main recreation hall, which was formerly used as a day care centre for the local community, is now used by the people who live here. It has been refurbished and now provides people with a main events hall. During this visit several people were engaged Care Homes for Adults (18-65 years) Page 15 of 32 Evidence: in a number of activities whilst sitting together and enjoying the social occasion. The home also has an IT suite which has several computers for people to use. Activities at the home can include art classes, IT sessions, gardening, and various games. Several visitors and relatives also commented on the support people receive and the range of activities. One relative said, Its like a family here. His keyworker is particularly caring and involves him in all kinds of activities. It is very good practice that the home employs a volunteer co-ordinator who has now has 48 volunteers to call on to support people with activities and transport. The home has two minibuses that people can use to go out. Activities outside the home include bowling, cinema trips, swimming, pub meals, and walks on the beach or in local woods. Some people have their own events that they go to outside the home. For example one person goes to an art club, and one person is involved in a university department. One person said, I go out daily, depending on the weather. Ive been on exchange holidays and I can go wherever I want. The home is excellent for that. In discussions with people living here it was evident that everyone has the opportunity to go on at least one holiday a year, and people spoke about recent holidays to Benidorm, Blackpool, Keilder, Cornwall or wherever they had chosen to go. Several people said that activities and holidays are some of the things that the home does really well. It is also good practice that people are able to promote the home if they want to. As well as various committee that they can take part in, some people also visit schools to raise awareness of the home. Some people have enjoyed growing vegetables and tomatoes in the homes polytunnel and then selling them to raise funds for the home. All the residents and their visitors were very complimentary about the excellent quality of meals. Residents are offered a good range of main dishes and several alternatives. For example during this visit people were offered vegetable chilli, chicken roast dinner, omelette, ham salad or sandwiches. It is very good practice that residents have a copy of the menus and can make an informed choices at each mealtime. Meals are made to individual order and preference. It was very clear from discussions with the cooks that they have a good knowledge of each persons individual preferences. For example they will make a hot curry for one person who enjoys these. At the time of this lunchtime meal there were relatives and Care Homes for Adults (18-65 years) Page 16 of 32 Evidence: visitors who joined residents for lunch. Visitors said, There are always lovely meals here. There is a pleasant dining room on the ground floor which has recently been refurbished, but people can dine wherever they prefer, and some residents prefer to dine in their own rooms. Where people needed some assistance with eating their meals this was done in a sensitive and engaging way. Care Homes for Adults (18-65 years) Page 17 of 32 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live here receive good support so that their personal and health care needs are well met. Evidence: All of the people who come to live or stay here have significant physical disabilities. Some people may also have other needs, such as sensory, mental health or learning needs, due to their disability, illness or injury. Teeside Cheshire can provide residential and nursing care. At the time of this visit 11 people were receiving nursing care whilst living here. Everyone has a keyworker who provides some specific support for each person. Most people are matched to their keyworker by the personality and skills of that support worker, but residents confirmed that they can also request a change of keyworker at anytime. One person said, All the staff are very kind and caring. Its a lovely place to live. People are asked to sign a gender-consent form to state whether they have a preference about the gender of their people who provide their personal care. However Care Homes for Adults (18-65 years) Page 18 of 32 Evidence: there is only one permanent male support worker on the staff team at this time, which limits the choice for those people who may prefer a male support staff. The home employs a number of RGNs (Registered General Nurses) who carry out the nursing care tasks for those people receiving nursing care. The home also employs a physiotherapy assistant who ensures that plans provided by visiting physiotherapists are put into practice to support the people who live here. The home has very detailed moving and assisting plans which show staff how each person needs support with their mobility. Health care records show that the home ensures that people have access to the right health care services when required. These include occupational therapists, physiotherapists, tissue viability services, and speech and language services. Everyone has access to a GP and people who are here on residential care placements have access to district nursing services. It is good practice that there are medical consent forms in each persons file about the type of over-the-counter medication that they can take safely. The manager said that the home would support people to manage their own medication if they chose to and were assessed as capable of doing so. Assessment records show that some people have been assessed as capable of managing their own medication, but they seem to have chosen for the staff to manage this on their behalf. For one person managing their own medication is a future goal towards their independent living skills. At this time no-one manages their own medication. Instead medication is managed by the nursing staff. Each persons individually prescribed medication is securely stored on their behalf and administered by nursing staff from a medication trolley. There were three medication errors made by staff at the home between August and September 2009. On those occasions staff gave the wrong resident someone elses medication. In one case a resident had to be taken to hospital because he was given the wrong medication. CQC became very concerned about this and a pharmacy inspector carried out a random inspection at the home on 14th September 2009. The pharmacy inspector found that medication was not being kept in its original containers and that this had increased the chances of errors occurring. An area manager of the organisation took disciplinary action about these errors. A further incident occurred in January 2010 when a person was given their lunchtime medication twice by two different staff. Care Homes for Adults (18-65 years) Page 19 of 32 Evidence: Since then the home has made several improvements to the way medication is managed to reduce the possibility of further errors. Discussions were held with the new manager about the possibility of individual medication cabinets in each room, as this would further minimise the risk of error and also support those people who are capable of managing their own medication. Care Homes for Adults (18-65 years) Page 20 of 32 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents and their representatives have clear information so they would know how to make a complaint. The staff team have had suitable training so they know how to protect residents from abuse. Evidence: The home has good written information for people about how to make a complaint. This is included in the services users guide and the Have Your Say leaflet which each person is given. People are also encouraged to make any comments at the Residents Committee meetings. Some of the people who live here have limited communication skills, and some people may find it difficult to comprehend the concept of a complaints procedure. However most people are able to express dissatisfaction with a situation either through speech, gesture or mannerisms. It was clear from discussions with staff that they have built up a very good understanding of different residents likes, dislikes and communication needs. The home has dealt with three complaints by relatives over the past year. The complaints records show that these were investigated and resolved, with written responses to the complainants. This shows that the home takes comments seriously in order to continually improve the service for the people who live here. Care Homes for Adults (18-65 years) Page 21 of 32 Evidence: All staff have had some training in the protection of vulnerable adults, and they receive refresher training in this every 2 years. The manager is aware of the local authority safeguarding arrangements. In this way staff are clear about how to protect the people who live here. Staff have not yet had training in the Mental Capacity Act guidance, which is designed to support people who may not have the ability to make their own decisions. The manager agreed that this would be beneficial. Care Homes for Adults (18-65 years) Page 22 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is very well maintained and equipped so that people live in accommodation that is safe, accessible and comfortable. Evidence: Teeside Cheshire is based in Marske Hall, a grand, grade 1 listed building set back in its own extensive grounds near the sea. For many years it has provided accommodation for people with significant physical disabilities, and the premises have been discreetly but very effectively converted for this use. It now provides 30 single bedrooms, all with large en-suite facilities, and all have telephone points for the people who live or stay here. All areas of the home are well decorated and furnished to a high standard. The home has a very good range of communal areas including a seated area in the main entrance hallway, a quiet lounge, a large dining room, a central atrium with fish pond, IT suite, and a large recreation hall that is used for activities and social events. The home also has well maintained patio and garden areas with an aviary. There is also a small exercise room/gym, and residents make use of this for exercises to support their mobility. All areas of the home are accessible to residents, with level access into the hallway, wide corridors and doors, passenger lift, and ramps to Care Homes for Adults (18-65 years) Page 23 of 32 Evidence: externals areas. The home promotes peoples independence wherever capabilities allow. Some people have their own key fob for the front entrance and others can use the door-entry system. Several residents commented very positively about the standard of their accommodation. For example, one person said, I really like my room. Ive got my own big bathroom with a shower and toilet, and I can use these myself. I can get around all the home really easily. The home provides domestic staff and laundry services. All areas of the building were very clean and odour is well managed. The home was awarded 5* by Environmental Health in July 2009 for its excellent food hygiene standards. In addition to individual en-suite facilities, there are also a number of communal toilets, bathroom and shower rooms around both floors. One shower room on the first floor was very cool due to the draught from the sash windows. There are currently no curtains at the window to prevent this. In some communal toilets there were boxes of examination gloves toilets on display, which could compromise infection control and peoples dignity. In one corridor there were boxes of nutritional supplements being stored as they could not fit in the persons own bedroom. Care Homes for Adults (18-65 years) Page 24 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides suitable, competent, trained staff to ensure that the needs of the people who live here are met. Evidence: The staff team consists of a manager, a care supervisor, registered general nurses, seniors and care assistants, as well as housekeeping and catering staff. There are also activities staff and maintenance staff. There is a good mix of age and experience amongst the staff team. Some of the staff have worked here for some years and there is clearly a good team spirit and good relationship with residents and visitors. The morning staffing levels provided at this home are two qualified nurses, one senior and eight care assistants. In the afternoon this drops to one nurse, one senior and four care staff as people have reduced support needs then. During the night there are one qualified nurse, one senior and two care staff. These are satisfactory staffing levels to meet the number and needs of the people who currently live here. Staff responded quickly and sensitively to requests for support, and there was good staff presence around the home. Around six people have funding for additional one-to-one support arrangements for Care Homes for Adults (18-65 years) Page 25 of 32 Evidence: between 10 hours and 56 hours a week. This is provided by support staff that the individual person has selected themselves during interviews. For one resident who is blind with limited speech the staff observed how well she responded to staff voices to help them choose the right support staff that would suit her. The home has a relatively low turnover of staff, and there are no current vacancies for staff. Several staff had positive comments to make about working here. One staff said, I have worked here for years and I love it because I feel were doing something really valuable for people who would either live in an institution or in isolation. Leonard Cheshire is an equal opportunities employer, and has robust recruitment and selection processes to make sure that only suitable staff are employed here. It was clear from personnel records that no staff start work until satisfactory checks, reference and police clearance (called a CRB disclosure) have been received. There is always one resident on the interviewing panel for applicant staff. Discussions with staff and the training records show that staff have very good opportunities for training. One staff said, Its a very good service to work for. We are well supported and well trained. The home employs a part-time Training Development Officer who is responsible for ensuring that all new staff have full induction training and that all staff have up-todate training. Training records show that all care staff have had required health & safety training, such as fire safety, Infection Control and food hygiene. At this time 34 of the 47 care staff (about 75 ) have completed a recognised care qualification, called NVQ level 2. Care Homes for Adults (18-65 years) Page 26 of 32 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well managed so that it is run in the best interests of the people who live here. Evidence: The registered manager left about one year ago. The provider has carried out robust recruitment & selection processes to appoint a new manager. Recently the former care supervisor was appointed as the new manager. She is a qualified nurse and has been covering the management role for the past year. In surveys staff said that they felt supported by the homes management arrangements. They felt that they could approach the manager with any suggestions, and one staff said, The manager always has an open door. Overall residents and visitors also felt that the management of the home was supportive and approachable. One residents survey suggested that the management team could be slightly more flexible in how things are done. The home is audited at least monthly either by a peer manager or by an area Care Homes for Adults (18-65 years) Page 27 of 32 Evidence: manager. In this way managers of other Leonard Cheshire homes visits each others services to look at the standard of service. These monthly visits include residents views, staff views, observations, training records and personnel files. The home also uses residents comments to assess the quality of the service it provides, for example at the Residents Committee meetings. The home has on-site maintenance staff who carries out health & safety checks such as water temperatures and fire safety checks. It is good practice that one nurse is allocated 7 hours a week to monitor and promote health and safety awareness in the home. Residents are also involved in health & safety committee meetings with this delegated health & safety staff. It is good that the home has designed individual fire evacuation plans for each of the people who live here based on their mobility needs and location within the home.All staff have up to date training in all health and safety matters, and they used safe working practices when supporting the people who live here. In this way the home promotes the safety of the people who live here. Care Homes for Adults (18-65 years) Page 28 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 29 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 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 1 Consideration could be given to having the service users guide available at the home in audio format for people who have visual or reading difficulties. Consideration could be given to how the home could further promote and support people to manage their own medications, where capabilities allow. The home should arrange for staff to have awareness training in the Mental Capacity Act 2005. It would be better if a cupboard was made available for the storage of one persons nutritional supplements, rather than these being stacked in a corridor. It would be better if the first floor communal shower room had curtains to prevent the draught from windows, and the heating in this room should be checked to ensure it can achieve a comfortable temperature. It would be better if communal bathrooms and toilets were fitted with small bathroom cabinets in order to discreetly store protective equipment such as examination gloves. 2 20 3 23 4 26 5 27 6 27 Care Homes for Adults (18-65 years) Page 30 of 32 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 7 37 The manager should now apply for registration as manager of this service. Care Homes for Adults (18-65 years) Page 31 of 32 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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