Care Home: The Limes

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What the care home does well Care plans are person centred and provide detailed guidelines to enable staff to meet peoples needs consistently. People are being supported to have more choices and the acting manager and her team are keen on developing this further making use of pictures and symbols as required.The LimesDS0000069313.V376466.R01.S.docVersion 5.2People have a good quality of life and staff support them to complete a range of activities either individually or in small groups. Medication administration is managed effectively and this minimises the potential risks to people in the home. Peoples personal care needs are identified and care plans provide staff with detailed guidelines to meet those needs. People have health action plans that identify their wishes, needs and important relevant health information that may be required by another health professional. The home and it grounds are well maintained by a handyman employed by the organisation. People live in a comfortable, homely and safe environment. Staff are respectful, friendly and supportive of the people they work with. What has improved since the last inspection? All staff employed in the home have job descriptions detailing their roles in the home and the expectation of the management team. Staff have completed training in autism and it was agreed this was a good introduction but further training is required to ensure that all staff have a good understanding. More staff have been employed since the previous inspection was completed and this has meant that people in the home benefit from being supported by staff in sufficient numbers that know them. Recruitment records for staff employed since the previous inspection showed the acting manager/organisation are meeting the criteria of these regulations. A number of the areas identified as the "service does well" are also improvements form last year. This includes care planning, activities, choice and health action plans. What the care home could do better: The acting manager must ensure that her team`s note taking/record keeping is consistent. All risks assessments must be reviewed at regular intervals to ensure that people are not being put at unacceptable risks.The LimesDS0000069313.V376466.R01.S.doc Version 5.2 The service provider needs to ensure that the home`s petty cash is replenished at regular intervals to ensure that money is always available for activities, etc. The service provider must ensure that all staff receive regular training to meet peoples needs. The service provider must ensure that policies and procedures are reviewed at regular intervals. Key inspection report CARE HOME ADULTS 18-65 The Limes 76 Church Road Longlevens Gloucester GL2 0AA Lead Inspector Mr Paul Chapman Key Unannounced Inspection 17 and 24th June 2009 09:00 th The Limes DS0000069313.V376466.R01.S.doc Version 5.2 Page 1 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. 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 home adults 18-65 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. The Limes DS0000069313.V376466.R01.S.doc Version 5.2 Page 2 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 The Limes DS0000069313.V376466.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Limes Address 76 Church Road Longlevens Gloucester GL2 0AA 01452 413003 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) marian@look-forward.com Look Forward (Gloucestershire) Limited Manager post vacant Care Home 6 Category(ies) of Learning disability (6) registration, with number of places The Limes DS0000069313.V376466.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: 2. Learning disability (Code LD) The maximum number of service users who can be accommodated is 6. Date of last inspection Brief Description of the Service: The Limes is a residential home for up to 6 adults with learning disabilities. The home is a large detached building, situated approximately two miles from the centre of Gloucester. The home is close to local amenities and within easy access to public transport. Accommodation is provided over two floors, with communal areas on the ground floor and bedrooms on the second floor. There is a garden to the rear of the property that people make use of and there is a parking area to the front of the house. The home has a Statement of Purpose and Service User Guide. Fees per week for living at the home are dependent on people’s assessed needs. The Limes DS0000069313.V376466.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This inspection site visit was completed over 2 visits to the service, the acting manager was present during the 1st day and on the 2nd day we spent time speaking to members of the staff team. During our site visits we observed the relationships between staff and people in the home. These were seen to be respectful, friendly and supportive. It was difficult for us to ask people living in the home for their opinion of the service due to communication difficulties. We examined the care of 2 people living in the home in detail. We examined needs assessments against the care plans and risk assessments created by the acting manager and her staff team. We read documents detailing the activities that people take part in and the food they eat and how their choices are promoted. We completed a tour of the premises with staff. In addition to the above we examined staff recruitment and training records, health and safety procedures and quality assurance practices. Before completing the inspection site visit to this service we (the CQC) sent the registered manager questionnaires to distribute to people living in the home and for staff to complete. In addition to questionnaires the registered manager also completed an AQAA (Annual Quality Assurance Assessment). This document asks a service provider/registered manager to rate the services performance against the National Minimum Standards (NMS). A service provider/registered manager will be asked to provide evidence of what the service does well, what has improved in the past 12 months and their planned improvements for the next 12 months. What the registered manager tells us in this document helps to form a hypothesis and focus on different areas depending on what the AQAA tells us. In addition to providing evidence about how the home meets the NMS it also provides us with a Dataset (information about staffing, health and safety, complaints, the environment, policies and procedures and the people living in the home). In this case of this service we received the AQAA after the inspection site visit had been completed. What the service does well: Care plans are person centred and provide detailed guidelines to enable staff to meet peoples needs consistently. People are being supported to have more choices and the acting manager and her team are keen on developing this further making use of pictures and symbols as required. The Limes DS0000069313.V376466.R01.S.doc Version 5.2 Page 6 People have a good quality of life and staff support them to complete a range of activities either individually or in small groups. Medication administration is managed effectively and this minimises the potential risks to people in the home. Peoples personal care needs are identified and care plans provide staff with detailed guidelines to meet those needs. People have health action plans that identify their wishes, needs and important relevant health information that may be required by another health professional. The home and it grounds are well maintained by a handyman employed by the organisation. People live in a comfortable, homely and safe environment. Staff are respectful, friendly and supportive of the people they work with. What has improved since the last inspection? What they could do better: The acting manager must ensure that her team’s note taking/record keeping is consistent. All risks assessments must be reviewed at regular intervals to ensure that people are not being put at unacceptable risks. The Limes DS0000069313.V376466.R01.S.doc Version 5.2 Page 7 The service provider needs to ensure that the home’s petty cash is replenished at regular intervals to ensure that money is always available for activities, etc. The service provider must ensure that all staff receive regular training to meet peoples needs. The service provider must ensure that policies and procedures are reviewed at regular intervals. 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. The Limes DS0000069313.V376466.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Limes DS0000069313.V376466.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 2 People using the 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 service’s admission procedures minimise the potential risk of a person being admitted whose needs cannot be met. EVIDENCE: At the time of the previous inspection site visit an assessment process was being completed for a person who subsequently moved into the service. There have been no new admissions to the service since then. The home has an admissions procedure. The AQAA we received from the acting manager stated an area where they could improve was in developing a more pictorial guide that shows all the things that people do at the Limes, should someone else want to move in. The Limes DS0000069313.V376466.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9 People using the 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 care needs of people living in the home are assessed and care plans in place provider staff with instructions that minimise the risk of peoples needs not being met. People are able to make choices in their day to day lives and staff support them to do this where required. Risk assessments have not been reviewed recently and this makes it impossible to confirm that people are not being put at unnecessary risks. EVIDENCE: The previous inspection report made a requirement that care plans must be person centred, providing staff with clear goals and instructions that enable them to meet people’s needs consistently. The Limes DS0000069313.V376466.R01.S.doc Version 5.2 Page 11 Looking at records for all of the people living in the home it showed that each person’s care was reviewed by their funding authority in 2009. We examined the care for 2 people in detail and this included the last person admitted to the service. Plans for peoples care have been divided into 8 sections; Communication, Healthcare, Personal care, Things that put me at risk, My money, Housing needs, Food/diet and social/emotional needs. In each of these sections the reader was provided with a good level of detail to enable them to meet the person’s needs consistently. All of the care plans we examined had only recently been created and at the time we examined them were not due for review. We discussed the proposed review schedule with the acting manager and the planned system of review will meet this standards. When speaking with some of the staff we asked them their opinion of the care plans. Comments we received included, “They give us a good overall view of peoples needs”, “As a team we work to them, they accurately reflect peoples needs”. In addition to care plans to address peoples needs there are also “Listen to me” workbooks that detail things that are important to each individual (their likes/dislikes, friends/relatives, goals, etc). Person Centred Plans (PCP) will be introduced in the near future and to enable this to happen an outside professional has been used to come in and speak to the management team about developing PCPs in the future. At present the home does not have a key worker system and the acting manager said they intend to introduce this in the near future. The previous inspection report made a requirement that people living in the home must be empowered by staff to make choices and staff must be available to support them with this. Daily notes are completed by staff and these gave some examples of people being given choices about the activities they take part in and the food they want to eat. Importantly notes also provided examples of people being offered choices and them declining. We spoke to 4 staff individually on the 2nd day of our site visits and they gave us a range of examples of people making choices. Due to the communication difficulties of the people living in the home it was difficult to ask their opinions of what they thought of the service. As we have mentioned previously staff complete daily notes for each person, these are then compiled into monthly summaries. We examined a range of these notes for the 2 people whose care we were studying in detail. This showed that there was a variation in the level of detail in the notes. We The Limes DS0000069313.V376466.R01.S.doc Version 5.2 Page 12 discussed this with the acting manager who agreed with our findings and stated that they were already taking steps to address this with training staff. We examined the risk assessments in place for both people which showed there was a wide range of risks assessed. Unfortunately these had not been reviewed in the past 6 months making it difficult to confirm that the assessments were still relevant and people were not being put at unnecessary risks. It becomes a requirement of this inspection report that the acting manager ensures that risks assessments are reviewed at regular intervals. The AQAA completed by the acting manager states they plan to monitor, review and evaluate all of the support and careplans regulary and to action any changes. It is planned to give the parents and others involved with the care and support of people living in the home more opportunities to contribute to any decisions etc. This will be acieved by having more contact through letters or phone calls, updating them on any changes or new information and regular parent meetings. The acting manager plans to research the local area and make links with other services in order to provide more opportunities for people to access activities and to meet other people. The Limes DS0000069313.V376466.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): This is what people staying in this care home experience: 12, 13, 15, 16, 17 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home lead active lifestyles and staff support them to do this appropriately. EVIDENCE: In the hallway of the home there was an activity rota on the wall, this is good practice and helps to enable people in the home to see what is happening. This showed regular activities bowling, horse riding, cooking, music, gardening, visiting a social club and local pub and watching DVDs. When we spoke with staff the agreed that the number of activities taking place has increased over the last few months. Staff confirmed that these activities were taking place and also provided examples of other activities including art and craft, using a multisensory room, swimming, shopping, walking and cycling. The Limes DS0000069313.V376466.R01.S.doc Version 5.2 Page 14 In addition to these regular activities staff also spoke about day trips to Drayton Manor Park and Longleat. 1 person has been on holiday with staff, 2 people are going away with their parents while another person will be supported by staff to have day trips. In addition to a range of group activities people also have the opportunity for 1 to 1 activities with staff. Staff we spoke with made the following comments about the home in recent months “we are doing more with people”, “people living in the home have a good quality of life”, “It’s a lot calmer here now”, “days are more structured”. Since the previous inspection was completed the acting manager has spoken to parents and families about the method and frequency of communication they prefer. This is a good practice, and as a result some staff will contact parents each week and feedback to them what a person has been doing and any significant information they may require. All of the people in the home have relationships with their parents/family. This may mean visiting them regularly, or them coming to the home to see them. Currently the home uses a 4-week “rolling menu” which is reviewed with people in the home quarterly. 2 staff have completed a course on healthy nutrition. Speaking with the acting manager and staff they are aware of need to empower people to have greater choice about the menu and speaking with the acting manager they intend to start using pictures of food to enable people to become more involved. 1 person enjoys cooking and it is planned that in the future they may go and purchase the ingredients before cooking. An idea that was due to start after this site visit was “foods of the world”, with people having the opportunity to have nights where different foods/meals will be prepared. The menus seen by us showed that people have a good choice of foods and it was confirmed by staff that if people do not want what is on the menu they can choose something else. The AQAA completed by the acting manager states that they plan to provide more opportunities for people to engage in different indoor and outdoor activities. It is planned to involve the people living in the home in the buying, preparation and cooking of their own food and drink and to record the process identifying support needs and progression. The acting manager will regularly review menu plans to ensure that people are being given a varied and balanced diet. People will be encouraged to get involved in the growing, picking and cooking of foods from the garden and this process will be recorded. People will be given the opportunity to try different foods, drinks etc. The Limes DS0000069313.V376466.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 People using the 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’s personal care needs are assessed and plans are in place providing staff with guidelines to meet those needs. The home makes good use of other health and social care professionals to meet people’s needs. The management of medication in the home minimises potential risks to people. EVIDENCE: Each of the files we sampled contained a good range of plans that detailed peoples personal care support needs and what staff must do to meet those needs. Each of the files contained a healthcare assessment and an action plan. The acting manager stated that she thought these were alright but wanted to implement more detailed documents in the future. This was also highlighted in the AQAA. The Limes DS0000069313.V376466.R01.S.doc Version 5.2 Page 16 Each file contained good records for appointments with other professionals. Medication administration and storage were assessed and seen to be managed effectively. Staff complete training before they are allowed administer medication and good record keeping minimises the risk of medication errors. The Limes DS0000069313.V376466.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 People using the 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 has a complaints procedure but the staff knowledge of people’s behaviour is important because if a person was unhappy their behaviour would be an important indicator. Where required people have behaviour management plans that identify the behaviour they may display and what actions staff should take to support them. Financial management procedures minimise potential risks to people who are unable to manage their finances themselves. EVIDENCE: The CQC has not received any complaints about the service since the last inspection was completed. The acting manager stated they were in the process of dealing with a complaint at the time of this site visit. The home has a complaints procedure. Due to the communication difficulties of the people in the home it may be difficult for them to use this procedure, so staff have to be aware of other methods to identify whether a person is unhappy. The 2 files we sampled contained behaviour management plans. These plans identified common behaviours they may display and what actions staff should take to support that person. Where there are incidents when people display The Limes DS0000069313.V376466.R01.S.doc Version 5.2 Page 18 behaviours that challenge staff record what has happened and the steps they have taken to support them. As mentioned earlier staff recording has improved but is still inconsistent and the acting manager is taking steps to address this. None of the people living in the home is able to manage their own finances and it is the responsibility of the acting manager and her staff to manage their day to day spending. The records we sampled were detailed and minimised potential risks to people in the home. When speaking with staff they mentioned that sometimes the “petty cash” does not arrive from the organisation’s main office until later in the week. This leaves the home short of money and sometimes limits what activities people can do. It is a recommendation of this inspection that the service provider ensures that the home’s petty cash is made available to them at regular intervals. The AQAA states that over the next 12 months the acting manager will support her senior team to be more creative in their shift planning and how to support the staff in identifying when a behaviour may occur and why. Staff will have more support from their seniors on how to spot early warning signs or triggers pre-incident. Staff will be supported to record more accurate evidence when people in the home are going through difficult times resulting in an increase in behaviours i.e. recording information consistently on ABC charts, etc. The Limes DS0000069313.V376466.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 27, 28, 30 People using the 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 provides people with a comfortable, warm and well maintained environment that meets their current needs. EVIDENCE: We completed a tour of the premises with a member of staff. On the ground floor of the home communal areas include 2 lounges, a dining room and the kitchen. All of these areas are a good size and meet the current needs of the people living in the home. All of these rooms are decorated to a good standard and are fitted with a range of good quality fixtures and fittings. On the wall of the lounge was artwork created by people in the home. The Limes DS0000069313.V376466.R01.S.doc Version 5.2 Page 20 Each person living in the home has an individual bedroom. We were able to see each of the bedrooms, all were decorated to a good standard and reflected the interests and hobbies of the people to whom they belonged. All of the bath/shower rooms and toilets were seen by us and no issues were identified. Since the previous inspection the service provider has taken advice from the local fire officer about the fire safety around the home. As a result of this all of the bedroom doors are to be modified and major modifications will be made to the hall/stairs area. As a result of this the carpet on the landing has not been replaced and we were told this will be done when the modifications have been completed. To the rear of the property is a good-sized garden. Since the previous site visit this area has continued to be improved with people living in the home being encouraged to get involved in the gardening. There is also a trampoline and a quad-cycle owned by a person in the home. The AQAA states that the acting manager and her team have discussed the current use of the 2nd lounge and they feel it could be better used as a sensory environment as people in the house really enjoy this. The Limes DS0000069313.V376466.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 34 People using the 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 staffing, recruitment and training of staff has improved significantly since our last inspection which has improved the quality of the service being provided and minimised potential risks to people in the home. EVIDENCE: Last years inspection report made a number of requirements against these standards. The 1st requirement against these standards related ensuring that all staff have job descriptions. Examination of records on this occasion showed that all staff now have job descriptions. The 2nd requirement was that staff needed to complete specialist training in autism to meet the needs of people living in the home. This has been achieved, speaking to staff they stated that the training had been really good. All of the staff we spoke to about this agreed that the training was good introduction but The Limes DS0000069313.V376466.R01.S.doc Version 5.2 Page 22 further training would be of great benefit. It becomes a recommendation of this inspection report that further training in autism is arranged for all staff. After completing the site visit the organisation sent us the staff training matrix. This showed us that the majority of staff had completed training in fire safety, safeguarding adults, behaviour management and person centred planning in the previous 2 years. We identified a number of areas where training records showed shortfalls, these included; medication, equality and diversity, food hygiene and autism awareness. This was brought to the attention of the service provider and it becomes a requirement of this inspection report that these areas are addressed. The 3rd requirement against these standards related to the staffing in the home. We examined staffing rotas and spoke to staff about how the home is staffed. This showed that between Monday and Friday there are 4 staff on duty at anytime up to 2200hrs, when 1 member of staff works a “waking” night shift. Presently at weekends 2 people living in the home go and stay at their parents and as a result staffing numbers are reduced to a minimum of 2 staff per shift. Staffing of the home has improved considerably since the previous inspection. Staff we spoke with agreed that with more staff being employed and the training they receive it has really helped to provide a better quality of life for people living in the home. The 4th requirement of the previous inspection report had been repeated from the previous report and it was to ensure that staffing records met the criteria of these regulations. We examined the recruitment records for a new member of staff and this showed that the manager/organisation now ensure that the information required by these regulations. The AQAA completed by the acting manager confirmed that over the next 12 months: Training to be arranged that is specific to the needs of people in the home. The roles and responsibilities of the staff team will be developed. All staff annual appraisals to be completed. All staff will receive training in report writing and information recording. The induction pack will be reviewed, specifically to include review the in house service specific part, which would benefit from having more updated information about how the house operates on a day to day basis. The Limes DS0000069313.V376466.R01.S.doc Version 5.2 Page 23 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 40, 42 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Health and safety procedures minimise potential risks to people living in the home. EVIDENCE: At the previous inspection we noted that the home’s insurance certificate was out of date. After that site visit the provider sent us a copy of the up to date insurance certificate. Since the previous inspection was completed a new person has been appointed as manager. They have submitted an application to the CQC to become a The Limes DS0000069313.V376466.R01.S.doc Version 5.2 Page 24 registered manager. The acting manager has been in post since September 2008 and it is clear that during this time they have worked hard to address the shortfalls of the previous inspection report. Throughout the site visit the acting manager provided good examples of what they had achieved since they had been in post and where they felt the service still needed to improve. Speaking with staff they agreed that over the past year the service has improved due to practices implemented by the acting manager, training and more staff being employed. Staff commented that they felt supported by the acting manager. The previous inspection report made a requirement that Regulation 26 (*NB) visits must be completed each month as required in these regulations. These are now being completed regularly and copies of the reports have been sent to us. The previous inspection report made a requirement that there must a quality assurance policy in place. This has now been written and a number of practices to have been implemented to support quality assurance. Examples of this include holding meetings with parents 6 monthly and having weekly contact with parents. The home has a range of policies and procedures and the acting manager was aware of the need to review them. They suggested they may review a policy each month. It becomes a recommendation of this inspection report that all policies and procedures are reviewed regularly. Health and safety around the home is well-managed on the whole. All of the cleaning chemicals are stored securely and there are data sheets available for each chemical. Since the previous inspection was completed the acting manager has implemented a system of weekly house audits. We looked at a sample of these documents which showed a range of health and safety areas being checked regularly. Examining the records for fire safety showed that 1 evacuation is completed each month and a qualified engineer serviced the system in January 2009. The acting manager should ensure that the alarms are tested each week and the fire risk assessment for the home must be reviewed. The AQAA completed by the acting manager states that plans for the next 12 months include: Being able to demonstrate more effectively how issues raised by other parties advocating for people in the home get incorpaorated into the service and how these issues help affect positive change and develop the service. All home’s policies to be reviewed and updated where needed. To utilise Regulation 26 visits ensuring that the link between the manager/providers objectives and monthly manager’s report filter through to all team members. The Limes DS0000069313.V376466.R01.S.doc Version 5.2 Page 25 *NB (where a provider is not in day to day charge of the service they must visit the service monthly unannounced and complete a report of their findings). The Limes DS0000069313.V376466.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 3 28 3 29 X 30 3 STAFFING Standard No Score 31 3 32 3 33 3 34 3 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 2 X 2 X Version 5.2 Page 27 The Limes DS0000069313.V376466.R01.S.doc No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA9 Regulation 13(4) b Requirement The service provider must ensure that risk assessments are regularly reviewed to minimise the risk of people being put at unnecessary risks. The service provider must ensure that staff receive the training identified in the body of the report. Timescale for action 21/08/09 2. YA35 18(1) 18/12/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard YA23 YA35 YA40 Good Practice Recommendations The service provider should ensure that the home receives its petty cash at regular intervals to ensure that shortages do not occur limiting people’s activities. The service provider should ensure that all staff receive specialist training to meet the needs of people in the home. The service provider should ensure that all policies and procedures are reviewed regularly. The Limes DS0000069313.V376466.R01.S.doc Version 5.2 Page 28 Care Quality Commission Care Quality Commission South West Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries.south west@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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