Care Home: Walkley Lodge

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What the care home does well Those people who may wish to use the service and their representatives have the information needed to choose the home that will meet their needs. Individuals and their representatives are satisfied that they are able to get involved in decisions about the residents` lives, and play an active role in planning the care and support they receive. The people who use Walkley Lodge are able to make choices about their lifestyle, and receive support to develop their life skills. Social, educational, cultural and recreational activities organised by the staff meet individuals expectations. The health and personal care that people receive is based on their individual needs. The principles of respect, dignity and privacy are put into practice. The people who use the service are able to express their concerns and have access to a complaints procedure. The people are protected from abuse, and have their rights protected by the home`s policies and the staff training and supervision.. The physical design and layout of the home enables people who use the service to live in a safe, well maintained and comfortable environment, which encourages independence. The staff working in the home are trained, skilled and in sufficient numbers to support the people who use the service. What has improved since the last inspection? The staff have documentary evidence to show that the people using the service and their representatives were involved in the planning of care. We also received comments from the relatives to confirm this. The care staff have received appropriate training and continue to be supported by senior staff when looking after people with challenging behavior. The key workers were better able to discuss the care plans of the individuals and explain the goals set and the progress achieved. To maintain safety and privacy at the home the front doors have been strengthened and blinds have been fitted to some of the windows. The staff induction has been improved and the recently recruited staff seemed confident in what they were doing. What the care home could do better: Service users` nutritional needs should be reviewed and the risk factors associated with weight loss or gain should be taken into account when helping to prepare meals for the service users. The care staff should receive help when preparing weekly menus. The management should review the budget for food and make sure staff receive guidance on purchasing food for the service users.All medication must be kept securely at temperatures recommended by the manufacturer. Handwritten entries and changes to MAR charts should be accurately recorded and detailed. This makes sure that the correct information is recorded so that each person receives their medication as intended. The supplying pharmacy should be advised of all medication no longer in use and asked to provide up to date MAR charts. This makes sure people are only getting medication that is currently prescribed. The manager and the staff office temperature was around 30 degrees which was unacceptable. Arrangement for relocation must take place without delay. So that the staff have access to an office which is fit for purpose and complies with the health and safety regulations. Key inspection report Care homes for adults (18-65 years) Name: Address: Walkley Lodge Commonside Walkley Sheffield South Yorkshire S10 1GE The quality rating for this care home is: two star good 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: Marina Warwicker Date: 1 8 0 8 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 Care Homes for Adults (18-65 years) Page 2 of 32 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 Care Homes for Adults (18-65 years) Page 3 of 32 Information about the care home Name of care home: Address: Walkley Lodge Commonside Walkley Sheffield South Yorkshire S10 1GE 01142678925 01142678291 walkleylodge@activecarepartnerships.co.uk 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) : Southern Cross Healthcare (Focus) Limited care home 7 Number of places (if applicable): Under 65 Over 65 7 0 learning disability Additional conditions: The maximum number of service users who may be accommodated is 7. The registered person may provide the following category of service only: Care home only - Code 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 code LD, maximum number of places 7. Date of last inspection Care Homes for Adults (18-65 years) Page 4 of 32 A bit about the care home Walkley Lodge is a listed building, which has been converted into a home for seven adults. The home maintains the charm and charactor of a manor house. There is provision for seven adults with learning difficulties. Walkley Lodge is situated in a residential area of Sheffield. It is within easy reach of public transport and shops. The weekly fee changes each year. On 18th August 2009 the fee ranged from 1,902GBP to 2,700GBP. The fee included the hotel fee and the personal care. However, the individuals use their allowances to buy clothes, toiletries, pay for transport and personal items such as games, magazines and comics. The date of last Key inspection: 12/08/2008. 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: 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 Care Homes for Adults (18-65 years) Page 6 of 32 How we did our inspection: This is what the inspector did when they were at the care home 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. The last key unannounced inspection was on 12th August 2008. The quality rating for this service is 2 star. This means that the people who use this service experience good quality outcomes. An inspection of this service was carried out on Tuesday 18th August 2009 between 2pm and 6pm. The staff, the management, the people using the service or the visitors were not informed of our visit and therefore it was unexpected. The people who use the service and five visitors to the service were consulted. We also spoke with five staff that were on duty. A further 5 staff and four professionals who came into contact with the people were communicated with by post and telephone to obtain their views on the service. Comments received from the surveys have been included in the Care Homes for Adults (18-65 years) Page 7 of 32 body of the report. Time was also spent observing and chatting with staff and the people using the service. The registered manager was on duty at the time of our visit. We informed her of our findings, which helped both parties to verify and start taking action if and when it was required. The premise was inspected, which included bedrooms of people using the service and communal areas. Private areas i.e. bedrooms, were accessed with the permission of the people and/or the staff at the home so that we respected the peoples wishes. Samples of records such as the care plans, staff recruitment and training files were checked. Our pharmacy inspector joined us at the beginning of the visit and helped us complete the inspection of medicine management. He spent time with the manager and the deputy interviewing them, checking the medicine management within the home and has reported on his findings. We would like to thank the people who live at Walkley Lodge, their relatives, the staff who took part and the management for their contribution toward this process. Care Homes for Adults (18-65 years) Page 8 of 32 What the care home does well Those people who may wish to use the service and their representatives have the information needed to choose the home that will meet their needs. Individuals and their representatives are satisfied that they are able to get involved in decisions about the residents lives, and play an active role in planning the care and support they receive. The people who use Walkley Lodge are able to make choices about their lifestyle, and receive support to develop their life skills. Social, educational, cultural and recreational activities organised by the staff meet individuals expectations. The health and personal care that people receive is based on their individual needs. The principles of respect, dignity and privacy are put into practice. The people who use the service are able to express their concerns and have access to a complaints procedure. The people are protected from abuse, and have their rights protected by the homes policies and the staff training and supervision.. The physical design and layout of the home enables people who use the service to live in a safe, well maintained and comfortable environment, which encourages independence. The staff working in the home are trained, skilled and in sufficient numbers to support the people who use the service. Care Homes for Adults (18-65 years) Page 9 of 32 What has got better from the last inspection What the care home could do better Service users nutritional needs should be reviewed and the risk factors associated with weight loss or gain should be taken into account when helping to prepare meals for the service users. The care staff should receive help when preparing weekly menus. The management should review the budget for food and make sure staff receive guidance on purchasing food for the service users. Care Homes for Adults (18-65 years) Page 10 of 32 All medication must be kept securely at temperatures recommended by the manufacturer. Handwritten entries and changes to MAR charts should be accurately recorded and detailed. This makes sure that the correct information is recorded so that each person receives their medication as intended. The supplying pharmacy should be advised of all medication no longer in use and asked to provide up to date MAR charts. This makes sure people are only getting medication that is currently prescribed. The manager and the staff office temperature was around 30 degrees which was unacceptable. Arrangement for relocation must take place without delay. So that the staff have access to an office which is fit for purpose and complies with the health and safety regulations. 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 Care Homes for Adults (18-65 years) Page 11 of 32 please contact Marina Warwicker St Nicholas Building St Nicholas Street Newcastle upon Tyne Tyne and Wear NE1 1NB 01912333300 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 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 12 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 13 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who may wish to use the service and their representatives have the information needed to choose the home that will meet their needs. Evidence: To check this outcome area we contacted the service users, five staff, six relatives and five professionals who were involved with Walkley lodge. We also checked the records relating to admission of people to the home. Since our last site visit there has been one admission to the home. We can confirm that the staff at the home have followed the correct procedure when admitting the service users. The staff had received a copy of the individuals needs assessment by the placing authority. There was documentary evidence that multidiciplinary team meetings had taken place in the time preceding the admission. We spoke with the key worker to this individual who was able to tell us how the home was able to meet the needs including the training and preparations which took place before the admission. This was some of the feedback we received. Preparation for admission goes on for months. First the service user and the care staff need to develop a trusting relationship. They need to be able to relate and communicate with each other. This can Care Homes for Adults (18-65 years) Page 14 of 32 Evidence: be difficult. I find it very useful to visit the clients in their own home to see what they were used to having around. What family dynamics they were used to. Each individual is different and each has their own special needs. I find it interesting learning about the different causes and diagnoses. I have been on courses to learn about it. The comments from our surveys concluded that the people were able to visit the home when they wanted to and meet the staff. Often the service users visited the home following arrangements between the staff and their representatives. Two relatives said that it was helpful for the service users to take their time moving into the home. One person said, It is difficult to assess the suitability of the placement straight away. I realised that the staff needed to take on board the impact on the other people living at the home. I am very happy about how they deal with admissions. Care Homes for Adults (18-65 years) Page 15 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals and their representatives are satisfied that they are able to get involved in decisions about the residents lives, and play an active role in planning the care and support they receive. Evidence: We checked three care plans and interviewed four care staff. We interacted with the young people who were at the home. We have taken into account what the surveys told us about the service and the homes annual quality assurance assessment told us (AQAA). The care plans have been developed with the help of the residents and their representatives. The documentation reflected the current needs and the aspirations of the individuals. The key worker system helped the residents to form a working relationship/buddy system with the care staff. There was evidence that the care plans had been reviewed regularly with the help of the young people, their relatives, their key workers and the multidisciplinary professional workers. The key workers were able to communicate with the residents using various methods. These were some of the comments we received relating to this outcome area. Care Homes for Adults (18-65 years) Page 16 of 32 Evidence: The care staff at Walkley are marvelous. They call me to let me know if there has been any changes to A s care. We are satisfied. The carers are always happy to let us know how our daughter is getting on. They invite us to the reviews. We often dont get to the meetings. The care staff will tell us if anything changes. The care plans checked had risk assessments and plans to minimise the harm to people if they were to take on certain activities. These decisions helped people to have independence and a good quality of life. The risk assessments and the plans to manage the risks had been discussed at the multidisciplinary meetings prior to implementation. The following example was given to us by a staff. We know when we take D out to the park, just an outing or shopping she sometimes sits down on the middle of the road or anywhere without warning and refuses to get up. We have not stopped taking her out but we do the following. We make sure we dont go walking on the main busy roads. We take the transport to the places. If she sits down then we make sure we stay with her and keep her safe. During our conversation with the care staff and the relatives we ascertained that confidentiality of service users were respected by all staff working at the home. Care Homes for Adults (18-65 years) Page 17 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use services are able to make choices about their lifestyle, and supported to develop their life skills. Social, educational, cultural and recreational activities meet individuals expectations. Evidence: We sought feedback from the staff, the relatives, other professionals who came into contact with the young people about the lifestyle of the service users. We were informed by the staff that the daily routine for each individual varied as to what they had planned to do on the day. However, staff said that they encouraged the young people to get involved in activities as a way of keeping them occupied and avoid boredom. The young people kept their community contact by going shopping, visiting their families and visiting their local hairdressers. This was some of the feedback from the staff and the relatives. We help the young people to find out about developing new life skills and look into opportunities for education. At the review meetings we discuss these with the others and Care Homes for Adults (18-65 years) Page 18 of 32 Evidence: decide how best to move forward. Most of the young people go out to day-centres during the week. They have a time table/plan as to what they want to do each day. We have found this helpful for the residents. When A visits home regularly, she gets to meet the relatives. I make sure an aunt or some friends of the family visit. Often Walkley Lodge has parties and we get invited. We meet other relatives and get to know others. We try to encourage healthy eating and provide fruit. But people would rather have crisps. It depends on the mood they are in. We saw people eating fruit. All service users knew where the kitchen was and were able to help themselves or get assistance to food and drink. We would like the management to look into the food budget. We dont think its enough. We spoke to the manager about this since we have had several comments about the lack of money for the provisions. The management have assured us that they would be looking into it and adjust the budget accordingly. On the day of our site visit (this was an unannounced visit) there was plenty of food available which included fruits. The menus on display were satisfactory and one of the senior care staff said that the menus were prepared with the help of the residents taking into account their likes and dislikes. However, we have requested that the care staff receive some guidance and assistance from a qualified cook with regards to meals served at the home. Care Homes for Adults (18-65 years) Page 19 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care that people receive is based on their individual needs. The principles of respect, dignity and privacy are put into practice by the staff at the home. Evidence: We have analysed the feedback from the surveys, the annual quality assurance assessment from the service and the findings on the day to conclude this outcome area. We noted that the staff provided personal care in a sensitive manner maintaining privacy and dignity at all times. People were able to choose their own clothes, make up and hairstyle. The staff gave them support if and when they needed. The care staff said that they helped service users keep their health care appointments by reminding them and making transport arrangements. These were some of the comments. I like P to help me when I get ready. She is my favourite. I go to the doctors with her. The key workers sort out the hospital appointments. A needs help to attend doctors surgery. The care staff see to that. We take B to the hospital so that we can find out what was said at the clinic. If we are unable to take B the staff will take her. W & X like getting dressed to go out. They like to look their best and we help them. Sometimes we suggest that they wear a coat or extra clothes if it was wet or cold. But we cant make them do it. Its their choice. Care Homes for Adults (18-65 years) Page 20 of 32 Evidence: Our pharmacy inspector checked the management and administration of medication at Walkley Lodge between 14:20 and 16:30hrs on the day of the Key inspection. Verbal feedback given to the registered manager, and to the deputy manager during visit.These were his findings. Storage and handling: All medication kept securely in locked cupboards or in a locked fridge in the managers ground floor office. Room temperature thermometer 27 degrees Celsius and records showed high room temperatures of up to 30C during last 3 months. Fridge temperature records OK but no maximum or minimum readings taken. The registered manager and the deputy both stated neither they nor the staff were sure about using and resetting the thermometer to obtain accurate readings each day despite clear instructions displayed on fridge door. Medicine cupboard and fridge clean and tidy. All contents correctly labeled. No expired products found. Creams and oral liquids marked with date of first opening (good practice). Unwanted medicines awaiting disposal kept in large envelope in medicine cupboard. Discussed the need for further segregation of these medicine to prevent accidental use. The deputy agreed to move them to a clearly labeled shelf kept solely for this purpose. Boots ordering and disposal records examined and correct use found. Regular monthly prescriptions seen, copied, retained and checked by the deputy manager before Boots deliver medicine (good practice). The registered manager stated that regular checks of remaining meds take place during the month but records not seen to confirm this. Medication Administration Record Sheets (MARs) - general 6 MARs week commencing 10.8.09 examined. Kept in Boots ring binder with dated staff signature list. The manager confirmed on questioning that this list was up to date. Each persons MARs separated by rigid divider displaying name, photograph, date of birth and allergies. MARs accompanied by list of current medication, patient information leaflets and guidance for use of meds prescribed when required (all good practice). PRN (when required or as and when) protocols should be reviewed and updated more regularly to reflect current needs. No gaps found, explanations of omissions and changes sometimes recorded on reverse of MAR. All staff should be encouraged to do this consistently. Many examples seen of discontinued meds still printed on MARs MARs - individual A hand written amendment to dose of senna tablets not signed, dated, referenced or witnessed. The manager produced hospital discharge letter authorising change. No records or use of Sudocrem. The deputy explained that the service user used this herself but later told us that she no longer did this and that the cream was discontinued. Another hand written entry for paracetamol tablets lacks essential dose information, safety warnings and it was not signed, dated, referenced or witnessed. Accuracy check 5 MAR chart items were checked in presence of PG to see whether the actual amount remaining would match the amount predicted from the records of administration, quantity received and quantity brought forward. Care Homes for Adults (18-65 years) Page 21 of 32 Evidence: Care Homes for Adults (18-65 years) Page 22 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. People who use the service are able to express their concerns and have access to a complaints procedure. The people are protected from abuse, and have their rights protected by the homes policies and the staff training and supervision. Evidence: The manager had a record of all the comments and concerns brought to their attention by the residents and/or the people visiting the home. The relatives and the staff said that they knew how to make a complaint and what they were to expect from the management. One relative said, I speak to the key worker or the deputy manager if I have any problems and I have always been satisfied. The following comments were received as feedback. Families are anxious and sometimes we are misunderstood. It is our job to explain and make them feel confident that the resident is well looked after day and night. We have all had training on Protection of Vulnerable Adults and know what procedures to follow when referring an incident to safeguarding. The management had taken appropriate action when there had been allegations and had contacted the appropriate safeguarding teams and followed the correct procedures. Care Homes for Adults (18-65 years) Page 23 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 physical design and layout of the home enables people who use the service to live in a safe, well maintained and comfortable environment, which encourages independence. Evidence: The premises suited the stated purpose. It was accessible, safe and well maintained. It met the needs of the residents individual and collective needs in a comfortable and homely way. On the day of our visit the premise was clean and free from offensive smells. The service users with the help of the care staff were able to use the laundry facilities. We were informed sometimes service users helped staff with their individual laundry. 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. Staff working in the home are trained, skilled and in sufficient numbers to support the people who use the service. Evidence: Four staff files were checked. The management had operated a thorough recruitment procedure and had complied with the Care Home Regulations 2002. During the staff interviews they said that during supervision they identified their learning needs and were able receive training and support. The manager had access to the training matrix and was aware of the staff training needs. One staff said, I had five days induction before I started work. This included reading some policies, working with senior staff getting to know the young people. I am now doing the common induction programme. Three staff were asked about the supervision they received. They said, it was a 1:1 time with their seniors or the manager talking about their performance and any concerns or suggestions they had relating to their work. They said it was quite informal and non threatening and they felt that the management appreciated them. This was some of the feedback we received relating to this section. There are always staff around to help residents. Sometimes people need a bit of space and we let them have it. This may look like us not being around to some visitors. Those people who have 1:1 care/support have the support at certain times of the day. For example when they are going out or during an activity. The staffing is arranged to Care Homes for Adults (18-65 years) Page 25 of 32 Evidence: accommodate this. We cant complain about the staff they work hard and they work well as a team. We know it can be very challenging at times. 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 management and administration of the home is based on openness and respect The manager has quality assurance systems to measure the progress and introduce plans to make improvement in areas. Regular provider visits help maintain contact with the staff and service users and thereby help monitor delivery of good quality care. Evidence: The registered manager is experienced and qualified to manage the home and meet the purpose of the home. People working at the home said that the management were committed to equal opportunities and were very fair in their decisions. The company carried out various quality assurance surveys and we saw evidence of the feedback and action plans based on the outcome by the management of the home. These were some of the comments we received during this process. G (the manager) is very fare and she listens to what we have to say. G and the deputy work well and give us support. It is sometimes hard emotionally when we are supporting the same person. I was able to speak to the manager and find a way of resolving my worries. I have seen the operations manager visiting the home. S/he is here almost every two to three weeks and always acknowledges us. The management are approachable and Care Homes for Adults (18-65 years) Page 27 of 32 Evidence: helpful. The staff office is very warm and the door needs to be left open when it is occupied. The temperature can be well over 26 degrees sometimes. Training is very good here. We can attend training if it is useful to the person we are working with. I have also attended mandatory training in the last 12 months. We noticed that the registered manager through risk assessments, staff training and reviews of the service continues to ensure that the health, safety and wellbeing of the people living and working at the home were promoted. As part of the review of the environment the staff office is to be located to an area where it will be habitable and have natural light. We have been informed that work is to commence within this month (Aug.09). Care Homes for Adults (18-65 years) Page 28 of 32 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 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 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 20 13 All medication must be kept securely at temperatures recommended by the manufacturer. 25/09/2009 This helps to make sure medicines are safe to use when needed. 2 42 23 25/09/2009 The manager/staff office temperature was around 30 degrees which was unacceptable. Arrangements for relocation must take place without delay. So that the staff have access to an office which is fit for purpose. 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. Care Homes for Adults (18-65 years) Page 30 of 32 No Refer to Standard Good Practice Recommendations 1 17 Service users nutritional needs should be reviewed and the risk factors associated with weight loss/gain should be taken into account when preparing menus. The care staff should receive help when preparing residents weekly menus. The management should review the budget for food and make sure staff receive guidance on purchasing food for the service users. Handwritten entries and changes to MAR charts should be accurately recorded and detailed. This makes sure that the correct information is recorded so that each person receives their medication as intended. The supplying pharmacy should be advised of all medication no longer in use and asked to provide up to date MAR charts. This makes sure people are only getting medication that is currently prescribed. 2 17 3 20 4 20 Care Homes for Adults (18-65 years) Page 31 of 32 Helpline: Telephone: 03000 616161 or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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