Care Home: White Cliffs Lodge

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What the care home does well The manager gives support, direction and guidance to the people at the home and the staff group. She makes sure that the aims and objectives of the home are met and that the service users receive the care they need. One person told us that they liked being at the home. They told us about the different things they had done. They indicated that they enjoyed doing different activities. The home has a friendly atmosphere and is comfortable. Family and friends are welcome at the home and are encouraged to be involved in the care of their relatives. People are protected by the homes recruitment procedures. What has improved since the last inspection? The assessment process is now robust so they will only admit people whose needs they can meet. Compatibility with other residents is going to be considered so that people are more likely to get on together and are not placed at risk. All risks have been identified, recorded and assessed. This means that staff have strategies to follow to reduce and where possible eliminate risks to people. The manager has improved risk assessments. Communication is now well supported, which means people receive the support they need to make choices and decisions. Referrals have been made for speech and language input, the manager has done things to improve communication while waiting for specialist support. There are now procedures in place to show who will be supporting people from day to day and what meals and activity choices are on offer. There are more opportunities for people to live fulfilling lives. This means that there is a wider range of activities on offer in- house and in the community. People have support to be involved and take part in things like the chores, cooking and decorating. The staff have received the training they need to support people in a way that suits them best. Peoples health needs are now supported and monitored and staff promptly seek medical support and advice for people when they need it. The manager has introduced a health action plan for each person so health needs are clearly recorded and monitored. People are receiving the support they need with their personal care. All service users are protected from harm and abuse. The staff are now receiving the training, supervision and guidance that they need to promote the safety of the people living at the home. They are now aware of what good support is and what abuse is and how to recognise and respond to it. Staff have the competencies to support problem and challenging behaviours so people are safe. When incidents do occur staff know how to record and report them properly. Behavioural incidences have reduced at the home.There have been improvements in the auditing and monitoring of the home. The manager has reported to the Commission on a regular basis about the improvements made at the home since the last inspection. What the care home could do better: The manager needs to continually keep the staffing levels at the home under review to make sure there is enough staff available at all times to meet the needs of the service users. Key inspection report Care homes for adults (18-65 years) Name: Address: White Cliffs Lodge Primrose Road Dover Kent CT17 0JA     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: Mary Cochrane     Date: 0 2 0 6 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 32 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 32 Information about the care home Name of care home: Address: White Cliffs Lodge Primrose Road Dover Kent CT17 0JA 01304219213 01304241404 whitecliffs@beaconcaregroup.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): White Cliffs Lodge Ltd Name of registered manager (if applicable) Ms Kirsti Griffin Type of registration: Number of places registered: care home 15 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users to be accommodated is 15. The registered person may provide the following category/ies 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 categories: Learning disability (LD). Date of last inspection Brief description of the care home Caretech Community Services Ltd acquired White Cliffs Lodge Ltd In April 2008. Whitecliffs Lodge, comprises two adjacent buildings. Care and accommodation may be provided in both the buildings. The Court is a purpose built unit of five flats. There is a single one bedroom flat, and four two bedroom flats, providing accommodation for up to nine service users. The Lodge may accommodate up to six service users with complex and additional physical support needs. Care Homes for Adults (18-65 years) Page 4 of 32 Over 65 0 15 1 8 0 1 2 0 1 0 Brief description of the care home The home is situated in a residential area of Dover with access to nearby community facilities such as shops, pubs and post office. There is a local bus service and a main line train station in Dover. The fees at this home range from £1414 to £2623 per week. Please apply to the home for more information about fees and services. 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 peterchart Poor Adequate Good Excellent How we did our inspection: The reason for this inspection was to check compliance with the statutory requirements made at the previous inspection on 18th January 2010. This means the service had to improve certain areas of the service within time limits. At the visit in January concerns were identified about the standard of care being delivered to the people who live at the home and they were receiving poor quality outcomes. Following this recent visit the quality rating for this service is now 2 Star. This means that the people who use this Service experience good quality outcomes. We had a look around the home and various records were inspected. We looked at and discussed peoples individual support plans and their risk assessments. We looked at what people do during the day and how they spent their time. We looked at medication procedures and records. We also looked at staff files and training records. Care Homes for Adults (18-65 years) Page 6 of 32 We saw how the service recruits their staff and the homes quality assurance systems. We also looked at some of the homes health and safety checks. We arrived unannounced at the home at 9:45 and we were there for about three hours. The inspection was a thorough look at how well things are going. We looked at any other information that we have received about the Service since the last inspection. We spoke at length to the home manager and we also contacted professionals who visit the home on a regular basis to see what they thought about the service. There has been a social services lead safeguarding adults investigation at the home. This means the safeguarding team had concerns about the home. They have offered support, advice and input from multidisciplinary agencies to move the home forward in the right direction. This is to make sure the people living at the home are safe and their needs are being met. It was decided that the risk to people has reduced significantly and the alert has now closed. A further multi-agency meeting has been planned to make sure that improvements continue and are sustained. Care Homes for Adults (18-65 years) Page 7 of 32 What the care home does well: What has improved since the last inspection? The assessment process is now robust so they will only admit people whose needs they can meet. Compatibility with other residents is going to be considered so that people are more likely to get on together and are not placed at risk. All risks have been identified, recorded and assessed. This means that staff have strategies to follow to reduce and where possible eliminate risks to people. The manager has improved risk assessments. Communication is now well supported, which means people receive the support they need to make choices and decisions. Referrals have been made for speech and language input, the manager has done things to improve communication while waiting for specialist support. There are now procedures in place to show who will be supporting people from day to day and what meals and activity choices are on offer. There are more opportunities for people to live fulfilling lives. This means that there is a wider range of activities on offer in- house and in the community. People have support to be involved and take part in things like the chores, cooking and decorating. The staff have received the training they need to support people in a way that suits them best. Peoples health needs are now supported and monitored and staff promptly seek medical support and advice for people when they need it. The manager has introduced a health action plan for each person so health needs are clearly recorded and monitored. People are receiving the support they need with their personal care. All service users are protected from harm and abuse. The staff are now receiving the training, supervision and guidance that they need to promote the safety of the people living at the home. They are now aware of what good support is and what abuse is and how to recognise and respond to it. Staff have the competencies to support problem and challenging behaviours so people are safe. When incidents do occur staff know how to record and report them properly. Behavioural incidences have reduced at the home. Care Homes for Adults (18-65 years) Page 8 of 32 There have been improvements in the auditing and monitoring of the home. The manager has reported to the Commission on a regular basis about the improvements made at the home since the last inspection. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 32 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be sure they will receive all the information they need to make an informed decision about living at the home. They know that the home will be able to meet their assessed needs and aspirations. People know what they are paying for and their places at the home are protected. Evidence: The home has an up to date statement of purpose and service users guide. Each person living at the home has a copy which is personalised. The guide is easy to read and is pictorial. It contains all the information needed to let people know what the home has to offer. There is information on activities and what the support staff will offer. It explains about support plans, activities, laundry and catering. There is also information that tells people what they are paying for and it explains how to make a complaint. There have been no recent admissions to the home. This is because there was a Care Homes for Adults (18-65 years) Page 11 of 32 Evidence: voluntary agreement that the home will not admit any new service users while the adult protection alert is open. The alert is now closed and the manager told us they hope they will be able to offer places to people in the near furture. We were therefore unable to look at any new pre- admission assessments of prospective or new service users. At the time of the visit there were four people living at White Cliffs and they have been there for some time. There are policies and procedures in place for new admissions. The tools and documentation for assessments are provided by the company. The manager told us that when they start to take new people into the home they will be fully assessed by herself and another person from the company. She said that the assessment tool has been improved and that they will listen to current service users views about who moves in. They will offer trial stays and visits so people can get a feel of what it is like to live at White Cliffs Lodge. She told us they will not accept any one if they cannot meet their needs. She also said that new admissions will not all arrive together but they will do this in stages so the existing service users, staff and new people get a chance to get to know each other and settle in before the next person arrives. The requirement made at the last inspection has been met. The admission procedure is now robust so that they will not admit people whose needs the staff do not have the skills to meet. Care Homes for Adults (18-65 years) Page 12 of 32 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The assessed needs and personal goals of people living in the home are reflected in an individual plan of care. They are consulted about how they like things done and participate in aspects of life. Risks are taken as part of living an independent and fulfilling life. Evidence: White Cliffs is divided into two adjacent buildings The Court and the Lodge. The people living in the Lodge need more support than those in the Court. Each person has a service user plan called My Plan. We looked at one of the service users plans in detail and at specific areas in another two. They cover aspects of health and social care, medical needs, specialised needs, behaviour management, preferences, and nutritional information. There is evidence available to show that people have been consulted in the development of their plans. Plans are all individual and we saw that the service users were familiar and actively involved in how they were supported and on a daily basis. This means that people get the support and care Care Homes for Adults (18-65 years) Page 13 of 32 Evidence: in a way that they choose and that suits them best. Likes and dislikes are identified and incorporated into the plans. We saw from looking at the plans, speaking to service users and staff and from watching what was happening that people have control over their own lives and are supported to do as much as they can while being kept as safe as possible. Staff are there to fit around them and give them the support that they need. Personal goals and aspirations for the future are identified and recorded and kept under review so staff know if people are getting the right support and doing what they want. Daily records contain relevant information to show how people have made choices and decisions. It was possible to cross reference information. The service users have regular 1 to 1 talk times with their key workers. These sessions are used to make sure that all the service users are listened to and time is allowed to for them to express how they are feeling. It was seen that staff listened to what the service users want and acted on this. Risk assessments are recorded in each support plan. They are used to promote independence and not restrict people. There is concise guidance and direction for staff to assist them in keeping risks to a minimum. Staff help people to take reasonable risks. Work has been done to ensure that all individual risks have been identified and that procedures are in place to minimise them. Staff did report there is a consistent approach when dealing with behaviours and we saw that there is thorough guidelines in place to tell them how to support people in the way that suits them best. The staff we spoke to were able to explain about risks and how to minimise them. When new risks are identified they are documented in the individuals care plan. The requirement made at the last inspection has now been met. Other professionals who have recently visited the service reported an improvement in the documentation. It was evident that staff had been fully involved in collating and recording the information with service users. By engaging with service users to record this information, the manager reported that the increased levels of engagement had impacted positively on service users, evidenced by the reduction in behaviours. Care Homes for Adults (18-65 years) Page 14 of 32 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users are encouraged and supported to take part in appropriate activities. They are part of the local community. Service users are supported to maintain family contact and assisted to exercise choice over their lives. People receive a healthy and varied diet. Evidence: We saw that the activities and pursuits that people are now doing has improved since the last inspection. Staff ask people what they want to do each month and what they would like to achieve. They then make sure that people receive the support that they need to make these things happen. On the day of the visit two people had decided they wanted to do trip to the light railway at Hythe. We also saw that one person wanted to go swimming regularly and staff supported them to do this weekly. Care Homes for Adults (18-65 years) Page 15 of 32 Evidence: During our inspection all the people who live at the home were busy and out and about doing the things that they wanted to. People were also supported to do daily activities like cleaning, washing and preparing meals. When we crossed checked these daily activities against the daily records we found they had happened. If a person decided not to do an organised activity then there was information to say what they did instead. There was evidence in place to show that people are being offered opportunities to take part in meaningful, fulfilling activities either in house or in the community. There is now a shift plan used so staff have direction about who will be doing what and who with. This means that any activities offered happen unless the person decides they do not want to partake and then an alternative is offered. If a person just wants to spend time alone in their room then this is respected. There is now a plan in place to actively involve people in taking part in chores and there are plans in place to support people to develop these skills The AQAA says they plan to support people to apply for college and work placements. We did notice that sometimes there is not a driver on duty to take people out in the homes own transport. The manager told us she is encouraging people to use public transport as this will promote independence and develop skills and confidence. Details about family and friends are recorded in individual plans. There is a record kept of family contact. Family members are invited to review meetings if service users want them to be there. There is a large kitchen dining area in the Lodge part of the home. In the Court side there are flats that have their own kitchen areas. We were told that people are now involved with cooking meals. One person is supported to shop and cook his own meals daily. People are more involved in planning and preparing meals. The people at the Lodge now have their own cupboards and a small fridge so they can access snacks and drinks when they want to. People usually eat together at the Lodge. There is now a behavioural support plan in place so staff know what action to take if there are issues at meal times. This means that meal times are an enjoyable experience for everyone. Care Homes for Adults (18-65 years) Page 16 of 32 Evidence: There are records about nutrition and weight monitoring. Care Homes for Adults (18-65 years) Page 17 of 32 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People know that they will have the support they need to stay healthy. People have the support they need regarding their personal care. Medication practises are safe protecting the people who live in the home. Evidence: During the visit we saw and were able to evidence that personal care is delivered in a way that is flexible, reliable and person centred. We saw that life skills and dignity are promoted. The staff were seen to respect the privacy and dignity of the service users allowing them control over their own life. Each person living at the home has a key worker. This promotes sensitive and individual support to the service users. We saw that individual plans clearly record how the service users like to have their personal needs met. They focus on what people can do for themselves and detail how staff will give the support needed while allowing the service users to be as independent as possible. Staff have taken time with service users and have found out how they like to be supported with their personal care. Routines have been Care Homes for Adults (18-65 years) Page 18 of 32 Evidence: established and guidelines have been written for the staff so that everyone is doing the same thing. We saw that people are well presented. Their clothes were ironed and they were appropriately dressed for the weather. They looked well cared for. There is a flexible approach to daily living activities e.g. getting up, going out, bed, bath and mealtimes. People choose their own clothes and are supported to shop. Staff were seen to approach service users in a caring and supportive manner. Service users health is now closely monitored and if any problems arise they are dealt with promptly and appropriately. The service makes sure that people have access to all the healthcare facilities. We saw that routine checks and monitoring are carried out at the necessary intervals. People are promptly referred to specialists when the need arises. We saw that some people have contact with the local learning disability team. Some of the people have complex health needs. The service was able to evidence that these are now well managed. There is information in the plans, which highlights early warning signs of identified health needs, this means staff can take immediate and appropriate action. A member of staff accompanies people when they are attending appointments. Professionals who visit the service regularly have told us they are confident that the service now manages the health care needs of the people living at White Cliffs. The requirement made at the last inspection has now been met. A report is maintained by the home to evidence dental, chiropody, G.P. and other health care appointments. There was a lot evidence to show that staff are pro active in seeking specialist support when it is needed and do everything possible to make sure the complex needs of the people are met. All health needs are identified, met, monitored and reviewed at the required intervals. Medication is stored safely and at the correct temperature. Medication records are in order with no gaps. The storage of medication is safe and there are records to show what medication people take and how they prefer to take it. All prescriptions sheets had been signed to indicate that service users have received their medication on time and safely. The staff who administer medication have received the necessary training and their competencies are checked. We looked at the records for medication. The people living at the home receive their medication as prescribed by their doctors. Some of the people living at the home are prescribed medication on a when required basis. There are now clear guidelines for giving medication and medication is given to Care Homes for Adults (18-65 years) Page 19 of 32 Evidence: people in a way that is individualised and best meets their needs. This makes sure that the medication is administered consistently and the effects monitored. Care Homes for Adults (18-65 years) Page 20 of 32 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The views of the people living in the home are listened to and acted on. They are now protected from abuse and neglect. Evidence: There was a safeguarding alert open at the home in the Summer of 2009. This means that suspected harm or abuse was reported and the local social services safeguarding team investigated. The safeguarding alert at the home has now closed. This means that social services have investigated the concerns to make sure people living at the home are safe. There was a meeting on the 1st March 2010 with the manager and area manager of White Cliffs, care managers, specialist nurses who visit the service and the Commission. The level of concern about the home has reduced and people report that improvements have been made. They are confident that people are now safe. The necessary steps have been taken by the organisation Care Tech to make sure the people at the home are safe and protected from abuse. At the last visit it was agreed with the service that there would be no further admissions to the home until improvements were made. Improvements have been made and the home are now able to accept new people into the home. For more information please contact the provider. Care Homes for Adults (18-65 years) Page 21 of 32 Evidence: All but three staff have now received training on how to recognise and respond to abuse. The three staff that have not had training are new and are booked on courses in the near future. This means that staff now know how to recognise what abuse is and what to do about it. The last inspection report told us that there have been delays in reporting incidents to professionals so they have not been aware that their clients have been involved and may have been harmed. The homes improvement plan told us that all appropriate and legislative documentation to is completed as required and copied as necessary to all agencies involved. The improvement plan said they would make sure staff understand the reporting of incidents or other significant events to the manager or senior person immediately and this is recorded. There were two requirements made about how to keep people safe at the last inspection. These have now been met. There is a complaints procedure, which is written in a format that makes more understandable for the people who use the service. There was evidence in place to demonstrate that staff support people to communicate so any concerns or complaints they may have will be listened to and acted on. Since the last inspection there has been one complaint to the home. This was dealt with according to the homes policies and procedures. We have received notifications from the home to tell us about events that have affected service users. Some staff have had training about the Mental Capacity Act and two staff have had training about Deprivation of Liberty Safeguards(DOLS). No one is subject to a DOLS authorisation and no DOLS authorisation have been applied for. The manager told us that more training is planned. Care Homes for Adults (18-65 years) Page 22 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from living in a safe, comfortable and homely environment with adequate personal and communal space to meet their needs. Evidence: On the day of our visit the home did was clean and fresh. The staff do the cleaning at the home and support service users to participate with this. This means that they now have support to be involved and increase their skills. Night staff do some cleaning and the laundry. Service users choose how they decorate their rooms and if they want to they can join with the decoration. We did not see any of the rooms that are in use as all the service users were out. The manager told us that all the rooms in use are individual and reflected the personalities of the people who live at the home. This information was in the last report and also in the AQAA. Parts of the home have recently been redecorated and service users were involved in choosing the colours and painting rooms. There is a garden at the back of the home. Since the last inspection work has been done to improve the garden area. A new fence has been put up. New planting has taken place. The staff are supporting service users to develop an allotment and herb garden. The restriction about the kitchen being locked which was identified at the last Care Homes for Adults (18-65 years) Page 23 of 32 Evidence: inspection has been reviewed and changed. The kitchen is now open all the time and it is just the fridge that is locked. Service users have been given cupboards and a small fridge to store small amounts of the food and drink they choose. There is a laundry room which contains all the necessary equipment and service users are supported and encouraged to do their own washing. 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. There is enough staff on duty to support the people living at the home. Staff have had the training to make sure they have the competencies and skills to support people. People are protected by the homes recruitment processes. Evidence: At the time of our visit there were two people living at the Lodge and two people in the Court. We looked at the duty rota for the month of June 2010 and found on some days there were two staff on duty in the Lodge and one in the Court. However on other days there was only one staff on duty for each shift at the Lodge. The people that live here require more support and input from the staff team. The manager told us that on these ocassions agency staff are brought in to cover the staff shortfall. Some people are funded to have one to one and/or two to one support. The manager now keeps a record of how and when this support is provided and by whom. This means that service users are getting the hours of one to one support they need and are paying for at times throughout the month. There are two staff on duty at night. At times the service is using temporary staff from an agency to cover some shifts. They Care Homes for Adults (18-65 years) Page 25 of 32 Evidence: are in the process of recruiting more staff. We saw and the staff told us that they developed good relationships with the service users. The staff support and communicate with service users in a respectful manner and are accessible and approachable. It was evidenced that the staff on duty put the needs of the service users first. People responded positively and openly to staff. At the last inspection serious shortfalls were identified in staff training. Since then the staff have received or are in the process of receiving the training they need to do their jobs effectively and safely. There is a training matrix in place which indicates that nearly all the staff have received the necessary mandatory training. Most of the staff have also received specialist training in autism, epilepsy, Safeguarding Vulnerable Adults and the Mental Capacity Act. More training is planned. All the staff who give out medication have had the training they need to do this safely. Their competencies are checked at regular intervals. This means that people receive the support and care that they need from a staff team with the necessary competencies and skills. The requirements made at the last inspection have been met. There is also an induction programme for new staff. The manager has enhanced this so that competencies of new workers can be checked after they have completed the programme. The manager organises regular staff and service users meetings. There is usually one every month. These meetings allow people to voice their opinions and look at what is working well and what is not. The outcome is to improve the service and enhance the lives of the people who live at White Cliffs. The company has an agreement with the Commission that staff files will be held centrally and home managers are notified that all safety checks and reference have been received before someone starts work at the home. We saw evidence of these notifications. This means that people living at the home are protected by the services recruitment procedures. 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 manager has the qualifications and experienced to run the home efficiently and safely. There are quality assurance systems in place to improve the service and for auditing and recording purposes. People know their health and safety will be protected. Evidence: The manager has been in post at White Cliffs since November 2009. At the time she came to the home serious safeguarding concerns had been raised about the service. It was identified that people were not getting the care and support that they needed and they were at risk. Since the appointment of the new manager the service has significantly improved. People are no longer at risk and they are getting everything that they need to make sure they are living fulfilling and meaningful lives. We will continue to monitor the Care Homes for Adults (18-65 years) Page 27 of 32 Evidence: service to make sure that the improvements continue and are sustained. The manager has the qualifications that are recommended by the Commission. This means that she has the management skills and knowledge to provide a consistent and reliable approach to benefit and improve the service offered to the people who are living at White Cliffs. She is not yet registered with the Commission but has her interview on 17th June 2010. The manager has a positive attitude to running the home and to meet its stated purpose, aims and objectives. She is pro-active and has lots of ideas and plans on how to improve the service for people. The people who live at the home responded in a positive, relaxed manner in the presence of the manager. Opportunities for change and development are on going. Monthly monitoring visits are carried by a senior manager who writes a report of their findings. We have asked for copies of some of these reports and found that since the last inspection the quality of the information has improved and focuses on the outcomes for service users. There are now effective audit and monitoring tools in place for the service which means the standards within the home have improved. At the last visit we requested that the manager send us fortnightly summaries to give us an overview of how the service has been doing and how it has been improving. The requirements made at the last visit have been met. The manager has kept us informed about incidents that have happened at the home which affect the service users. To make sure people have a say in how the service is run and how things are going for them, quality assurance surveys are sent to residents, relatives, and other stake holders. At the time of the visit the results of this were not available at the home. When the results have been collated the shortfalls and strengths of the service will be identified and plans will be put in place on how they plan to improve the service that is offered to people. The manager told us all of the necessary Health and Safety checks have been carried out in the home. The random checks that we did confirmed this. Environmental and personal risk assessments are in place. All fire assessments and checks are done at the required intervals. Water temperatures are taken. The shortfalls identified at the last inspection about staff training in health and safety have now been met. Care Homes for Adults (18-65 years) Page 28 of 32 Evidence: Care Homes for Adults (18-65 years) Page 29 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 30 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 31 of 32 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Adults (18-65 years) Page 32 of 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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