Care Home: The Lighthouse

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What the care home does well Each person has a daily activities plan which includes work, learning and social opportunities and how they are being supported with their independent living skills. All food is freshly cooked and there is a good choice. People are accessing the health care services they are in need of, including specialist services such as counselling. One person told us "I`m happy here and I like my review with the manager and my family and my social worker". All staff have the national vocational qualification (NVQ) in care at level 2 or 3. What has improved since the last inspection? Improvements to the premises have included the redecoration of the kitchen, lounge and dining room. Equipment purchased since our previous visit has included a fridge, washing machine and computer with internet access for people living in the home. Staff have supported people to attend more outside activities, including education, work and voluntary work, and social events. Fire safety checks are now being regularly recorded, and the previous requirement concerning this was assessed as met. What the care home could do better: The service has not evidenced that staff are receiving regular training in safeguarding vulnerable adults to ensure they are up to date with good practice in protecting people who live in the home. The service has not evidenced that the views of people living in the home, their relatives or advocates, and stakeholders in the community have been obtained as part of the service`s plans for improvement. Key inspection report Care homes for adults (18-65 years) Name: Address: The Lighthouse 65 Hillfield Road Selsey Chichester West Sussex PO20 0LF two star good service The quality rating for this care home is: A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Edward McLeod Date: 2 3 0 6 2 0 0 9 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should:  Be safe  Have the right outcomes, including clinical outcomes  Be a good experience for the people that use it  Help prevent illness, and promote healthy, independent living  Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home:  3 stars – excellent  2 stars – good  1 star – adequate  0 star – poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area Outcome area (for example: Choice of home) These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by:  Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice  Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983   Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Information about the care home Name of care home: Address: The Lighthouse 65 Hillfield Road Selsey Chichester West Sussex PO20 0LF 01243601602 01243601632 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Dignity Group Ltd care home 9 Number of places (if applicable): Under 65 Over 65 9 0 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 9 The registered person may provide the following category of service only: Care home only - PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following category: Learning disability - LD Date of last inspection A bit about the care home The Lighthouse is a care home registered to provide personal care for up to nine people in the category of learning disability. It is a detached property located within the village of Selsey and is close to both local amenities and the seafront. The property has been adapted for its current use. The accommodation is provided in nine single rooms which are located on the ground and first floors. The lounge and dining room are located on the ground floor. The home has its own private garden which is well maintained. The service is owned by The Dignity Group. The manager provided information that weekly fees for the service range from 600 to 723.16 pounds per week. Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home How we did our inspection: This is what the inspector did when they were at the care home The visit was arranged to update our assessment of the services compliance with the key national minimum standards for care homes for adults (18-65). The inspector was accompanied by an expert by experience, and was on the premises on the 23rd June 2009 from 1.20 p.m. to 4.35 p.m. We prepared for this visit by obtaining from the provider the homes annual CQC quality assessment audit, which told us about how the home is continuing to meet the needs of the people living in the home. We also obtained written CQC survey responses from three people living in the home and four staff. The AQAA included all the information we asked for and was completed by the manager, Mrs Carol Chivers. In preparing for this visit we also took into account notifications and other information received from the service and any information provided by other sources. Four people living in the home were involved in the inspection, and information was gathered from the manager Mrs Chivers and a member of staff. What the care home does well What has got better from the last inspection Improvements to the premises have included the redecoration of the kitchen, lounge and dining room. Equipment purchased since our previous visit has included a fridge, washing machine and computer with internet access for people living in the home. Staff have supported people to attend more outside activities, including education, work and voluntary work, and social events. Fire safety checks are now being regularly recorded, and the previous requirement concerning this was assessed as met. What the care home could do better If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Edward McLeod The Oast Hermitage Court Hermitage Lane Maidstone Kent ME16 9NT 01622724950 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website http:/www.cqc.org.uk/. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line - 0870 240 7535. Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People 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. Evidence: The three people living in the home who responded to our CQC survey told us that they had been asked if they wished to move in and that they had received enough information to help them decide about moving in. We sampled two recent needs assessments carried out by the home, and we found that the assessments indicated that peoples needs were being properly assessed before admission was arranged. We discussed with the manager Mrs Chivers the introductory visits arranged for one person who had a short stay placement in the home. Mrs Chivers advised us that the person had come for a meal, an overnight stay, and a weekend stay before the placement was commenced. Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples 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 appropriae information on which to base decisions. Evidence: We sampled the care plans for two people living in the home, and found that peoples personal goals and assessed needs and how they were to be met were being set out in the care plan. The manager Mrs Chivers told us that a person centred plan was going to be introduced after each persons next review, and showed us the form which the resident would be using for their person centred plan. Mrs Chivers told us that staff training in personal care planning had been recently provided for staff. The three completed CQC survey forms we received from people living in the home told us that managers and staff treat them well and act on what they say. People we spoke to during our visit told us they loved the home and that the staff treat them well. One person told us in their survey form Im happy here and I like my review with the Evidence: manager and my family and social worker. Its important. In the care records for two people which we sampled we found that care plans are reviewed usually twice a year at a meeting which includes the person, their relative or advocate, their key worker and social worker, and the manager. We found that people living in the home are consulted on and participate in all aspects of life in the home. This is done through the house meeting which people in the home lead, and the meeting gives them an opportunity to decide, for example, what holidays will be booked, what birthday celebration arrangements will be made, and changes to menus. Care records seen included daily and monthly reports, progress reports and goal planning and attainment. Discussions with people living in the home and care plans sampled indicated that peoples independence is being encouraged, for example being supported to travel by public transport. During our visit people told us staff support them to get out and about in the local community and people are supported twice a week to cook their meals. People told us that their keyworkers help them with their shopping and money matters. 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. 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. Evidence: The AQAA tellls us that all people accomodated are attending college, education, work experience, voluntary or paid work. We looked at the care records for two people and found that each person had a daily activities plan which included learning opportunities, things to help develop their independence skills, and social opportunities. Evidence: One person we spoke to was doing tapestry and needlework which she said she enjoyed, and she told us that staff are always ready to support her when she needs it, for example when she runs out of thread. People told us that when the weather is good they have parties and barbecues in the garden. One person living in the home told us in their CQC survey form that they enjoy the trips out and that they are being helped to find work. The AQAA tells us that each person has a choice of holidays which are supported by staff. The AQAA tells us that staff support service users to visit cinemas, theatres, restaurants, clubs, pubs and discos. One of the people we talked to told us that staff support him to travel by train to visit his family. One of the care plans we looked at also indicated the person was being supported to improve their independent travelling skills. A member of staff we spoke to told us that the key worker can support people maintain contact with their family if this is needed. The three people living in the home who responded to our CQC survey told us they liked the meals being provided. The AQAA tells us that people are being more involved in planning and cooking meals, and the manager told us that lunch had been cooked by one of the residents on the day of our visit. During our visit people told us they choose what food they have and are in involved in planning the menu. A member of staff who completed our CQC survey form wrote to us that there is always a good choice of food. Fresh fruit and salad is always available and that food is freshly cooked, including home cooked pies, tarts, cakes and biscuits. 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 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 the care home supports them with it in a safe way. Evidence: The manager Mrs Chivers showed us the person centred support plans which the home is to introduce. These support plans will help record the way the person wishes their support to be provided, and monitor if this is being achieved. We are told in the AQAA that each resident has a personal health action plan. A member of staff we spoke to told us that the key worker takes responsibility for ensuring that appointments are arranged and attended, and that the person chooses who their key worker will be. The member of staff also told us that the key worker will build up a good relationship with the person and encourage their confidence and independence skills - for example by supporting them to budget and manage their money and establish hygiene and living routines. Care plans we sampled indicated that people are accessing the health care services they are in need of, including specialist services such as counselling. The manager tells us in the AQAA that medication is reviewed regularly by their GP and Evidence: the medical team at Chichester CTPLD which also provides OT and counselling services, and that all staff are trained in handling and administering medicines 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. 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 is taking action to safeguard people from abuse, neglect and self-harm, but this would be improved by staff updating their practice by receiving training or refresher training in safeguarding. Evidence: The three people living in the home who responded to our CQC survey told us on their forms that they had someone to speak to if they felt unhappy and that they knew how to make a complaint in the home. Mrs Chivers advised us that each person was given a copy of the complaints leaflet around six months previously, and the leaflet had been explained at a residents meeting. A member of staff told us that staff encourage people to say something if theres anything thats bothering them, and this can be discussed with their key worker or if more appropriate in house meetings. No complaints have been recorded since our previous visit. During this visit we noted that the home has two copies of the local safeguarding procedures. Mrs Chivers provided evidence that she had attended a Safeguarding Adults in Sussex briefing in May 2008, and said that the training had been discussed at a staff meeting at The Lighthouse. We sampled the training records for three members of staff in the home. There was no evidence, for example training certificates, to indicate that the three staff had undertaken safeguarding training in the past two years. We discussed this with Mrs Chivers and no evidence was provided that there had been Evidence: safeguarding training or refresher safeguarding training for staff during the past two years. There was no evidence that this training has been planned for staff. Notifications we have received from the provider indicate that where appropriate action is being taken to safeguard people living in the home when incidents of concern have taken place. Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People 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. Their room feels like their own, it is comfortable and they feel safe when they use it. Evidence: We found the home to be light and airy, with a large lounge, dining room and kitchen where people living in the home participate in cooking meals. There is a large accessible garden with a sitting area, a lawn, flowers and fruit and vegetables. People living in the home assist with the upkeep of the garden if they wish to. Improvements to the premises since our previous visit have included the redecoration of the kitchen, lounge and dining room. Equipment purchased since our previous visit has included a new fridge and washing machine, and a computer with internet access for residents. We found that the home has a system in place for the reporting and undertaking of maintenance issues. The premises are being well maintained, and all areas of the home visited were clean, hygienic, homely and comfortable. People are encouraged to personalise their bedrooms and to bring the furnishings and belongings they wish to. Evidence: We visited one of the bedrooms, and the person told us they liked their room and had personalised it for themselves in different ways including bringing some of their own furniture. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. 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. Peoples 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. Evidence: The three staff who responded to our CQC survey told us that their induction training covered the things they needed to know and that they were receiving training which was keeping them up to date with the skills and knowledge they needed. The AQAA tells us that all six care staff have the national vocational qualification (NVQ) in care at level 2 or 3, and during our visit we saw the NVQ3 certificate for one member of staff. The AQAA tells us that all staff employed in the last 12 months have had satisfactory pre employment checks. During this visit we looked at the recruitment records for three members of staff, and found that the required checks and references are being obtained for staff to ensure they are safe to work with the people living in the home. A member of staff we spoke to during our visit said that the staff team was well established and stable. The manager told us that no new staff had joined the team in the past year. Evidence: A member of staff we spoke to told us that they had been receiving regular one to one sit down supervision to support them in their work. We looked at the supervision records for one member of staff which indicated they had been receiving regular one to one sit down supervision and appraisals. Three of the four staff who responded to our CQC survey indicated that there were usually enough staff available to meet the needs of the people accomodated. During our visit staffing levels were sufficient for one member of staff to be accompanying a resident on an outing and for a second member of staff to be supporting people in the house with the activities they were engaged in. 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 have confidence in the care home because it is run and managed appropriately. The service is not evidencing that peoples opinions are central to how the home develops and reviews their practice, so that 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. Evidence: The manager has continued to update her training, and attends the statutory trainings provided for the team. It was our observation during this visit that the home has a good atmosphere, and everyone seemed relaxed and at ease with each other. Staff were seen to be approachable, responsive and helpful. We found that since our previous visit there has not been a survey or other approach to bringing together views on the service from residents, their relatives or advocates, or stakeholders in the community. Mrs Chivers advised us that there was not a plan to carry out such a survey in the near future. Mrs Chivers told us that people discuss issues at supper or at house meetings such as where people would like to go on holiday, or how a birthday is to be celebrated. Evidence: Records of house meetings we saw indicated that these take place every three months or so. In the AQAA the provider has advised us of the most recent services and tests carried out on equipment in the home. At our previous visit a requirement was made concerning the need for fire safety checks to be documented. At this visit we sampled the weekly fire test records and staff training records. The previous requirement was found to have been met. Mrs Chivers tells us in the AQAA of the recent checks and services that have been carried out on equipment in the home. Are there any outstanding requirements from the last inspection? Yes  No  Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No Standard Regulation Requirement Timescale for action Requirements and recommendations from this inspection Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No Standard Regulation Description Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set No Standard Regulation Description Timescale for action 1 23 13 The registered person shall make arrangements by training staff or by other measures to prevent service users being harmed or suffering abuse or being placed at risk of harm or abuse. 30/09/2009 Arrangements for training staff in safeguarding are not fully protecting the people receiving a service. 2 39 24 The registered person shall 30/09/2009 establish and maintain a system for reviewing at appropriate intervals and improving the quality of care provided at the home. The system shall provide for consultation with service users and their representatives. The views of people using their service, their Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set No Standard Regulation Description Timescale for action representatives, and stakeholders in the community, are not being formally obtained as part of the homes arrangements to measure success in achieving the aims, objectives and stafement of purpose of the home. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Helpline: Telephone: 03000 616161 or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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