Care Home: White Lodge

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What the care home does well Observation of staff showed positive attitude and relationships with people who used the service. Staff told us that they strive for high standards within the service and have supported people who use the service in a sensitive and supportive way. Staff training had been given a priority, and staffing levels had been maintained. Staff had received supervision, induction and appropriate training according to their role and responsibilities. Induction to the home is Skills for Care based. This involved the completion of a workbook by both the staff member which is endorsed by a senior member of staff. Each person using the service has a person centred, comprehensive, clear and pictorial plan of care, which they have helped to develop. Some people living in the home needed support to communicate with others. Staff spoken with knew exactly how to care for those individuals. People are involved in a variety of leisure and educational activities. Staff support people to identify what activities they want to be involved in on a daily basis. People are able to develop life skills, staff said they are committed to supporting people to achieve identified goals. People are supported to maintain their interests and hobbies, and to go on visits, out for meals, or to the pub. Staff enable and support people to keep in touch with their family and friends, either by arranging visits, and or by phone or letter. Visitors are made welcome at any reasonable time by the service. What has improved since the last inspection? This was the first inspection of this service following the change of Registered Provider to Lifeways. What the care home could do better: Consideration should be given to the layout of the rear outside space, particularly in regard to the health, welfare and safety of people using the service, and to the safety of wheelchair users. Consideration should be given to the purchasing of domestic sized equipment such as a washing machine and dryer which would then enable individuals to learn how to use them. Staff should receive training in Mental Capacity Act 2005 and Deprivation of Liberty guidance. To ensure the safety of the people using the service. Key inspection report Care homes for adults (18-65 years) Name: Address: White Lodge White Lodge New Penkridge Road Cannock Staffs WS111HT     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: Pam Grace     Date: 0 2 0 7 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 Lodge White Lodge New Penkridge Road Cannock Staffs WS111HT Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) www.lifeways.co.uk Lifeways Community Care Ltd Type of registration: Number of places registered: care home 7 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability mental disorder, excluding learning disability or dementia physical disability sensory impairment Additional conditions: The maximum number of service users to 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 Both whose primary care needs on admission to the home are within the following categories Physical disability code PD Learning disability code LD 2. Date of last inspection Brief description of the care home White Lodge is registered to care for seven younger adults with a learning disability and other needs, including behavioural support, possible self harm, health, emotional, Care Homes for Adults (18-65 years) Page 4 of 32 Over 65 0 0 0 0 7 0 7 0 Brief description of the care home practical and social needs or mental health needs. The home is managed by Lifeways Community Care Limited, and is located on the outskirts of Cannock town centre, in a community setting, which facilitates access to normal community based activities that people using the service can regularly attend. White Lodge was an established service under the National Health Service (NHS), and has recently undergone a change of ownership from the NHS to Lifeways. The service occupies the ground floor of the building, there are five bedrooms with wash hand basins, and one bedroom with an en suite shower. There is a dining area, kitchen, laundry, lounge and activities room. There are adequate toilet facilities, two assisted bathrooms, and a level access shower room. Adaptations and aids are used in conjunction with specialist assessments, therefore Occupational Therapy and or Physiotherapy. The service is intended to provide short breaks and respite care to adults between the ages of 18 - 65 years, and both male and females can be served, as accommodation is single bedrooms. Fee information is not included in this report, the reader may wish to obtain more up to date information directly from the care service. 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 quality rating for this service is 2 stars. This means the people who use the service experience good quality outcomes. This visit was an unannounced key inspection and therefore covered the core standards. The inspection took place over approximately 5 hours by one inspector who used the National Minimum Standards for Younger Adults as the basis for the inspection. Prior to the inspection, the registered care manager had completed an Annual Quality Assurance Assessment (AQAA) for us. There were also three Have Your Say surveys received from people who use the service. Observation of the environment was undertaken. Care Homes for Adults (18-65 years) Page 6 of 32 On the day of the inspection, the home was accommodating 2 people. We spoke with people who use the service, examined records, carried out indirect observation, and spoke with three staff on duty, as well as the registered care manager. Two care plans and three staff records were examined and observation of daily events took place. Medication procedures were inspected so that we could see how safe they were. We did not make any requirements, but made 3 recommendations as a result of this unannounced inspection. Care Homes for Adults (18-65 years) Page 7 of 32 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking Care Homes for Adults (18-65 years) Page 8 of 32 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 who may use the service and their representatives have the information needed to choose a home that will meet their needs. Evidence: The Annual Quality Assurance Assessment completed by the care manager told us: White Lodge provides prospective service users and their families with comprehensive information about our services prior to placement. This is provided in an appropriate format. Any proposed service users using White Lodge will have completed a comprehensive assessment to ensure the service can meet the individuals needs. The assessment covers: Personal details Independence skills washing, dressing etc Mobility Communication Behavioural needs Medication Finance Dietary issues Security Health and safety Kitchen skills Transport requirements Activities Cultural requirements Relationships Aspirations Care Homes for Adults (18-65 years) Page 11 of 32 Evidence: Assessments are detailed, individualistic and holistic, with information gathered from the service user and significant others, and attention maintained throughout the assessment consultation process to ensure that prospective services are planned to meet the individual needs and aspirations of each service user. Combined with this assessment process prospective individuals are supported to visit White Lodge. Introductory tea visits are usually introduced to enable the service user to get used to their surroundings, although each introduction period may vary, depending on the need and wish of the individual. We looked at 2 care and support plans which were comprehensively and uniformly completed, person centred, pictorial and very clear. Both plans contained pre admission assessment information, which had then informed the care planning process. Each care plan contained a copy of the Statement of Purpose and Service user Guide. We were told that this information is given to prospective people wishing to use the service, and or their representative. Pre admission assessments are also undertaken by Social Services and or the specialist community learning disabilities service. The care manager confirmed that a person wishing to use this service would always undergo a multi disciplinary and holistic assessment prior to admission. Surveys received confirmed that they had received appropriate information before their admission into the home. 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. Individuals are involved in decisions about their lives, and play an active role in planning the care and support they receive. Evidence: The Annual Quality Assurance Assessment completed by the care manager told us: All service users at White Lodge are supported throughout their short break to make as many decisions as possible for themselves, this can consist of decisions about what time they go to bed, what food they want, and activities they choose to participate in. If service users require or want access to advocacy Lifeways staff will assist them to achieve this. All service users at white lodge have a comprehensive support plan package, which covers all aspects of personal, social and health care needs. Including risk assessments, which identify a risk whilst enabling service users to take risks as part of an independent lifestyle. We looked at two care and support plans, both plans were pictorial and person Care Homes for Adults (18-65 years) Page 13 of 32 Evidence: centred, with a client profile, and uniform and clear information, based upon all activities of daily living. Risk assessments seen identified in detail the risks for each individual. These were up to date and clear, and staff were able to tell us exactly how to care for each person. Evidence of health services input was also seen. Each plan was individualised, and recognised the personality and needs of the person. The plans were reviewed on a regular basis; any changes to the skills achieved were recorded. Evidence contained within care plans seen pointed to there being regular reviews held for each person. People spoken with and surveys received confirmed that they were consulted and encouraged to be involved in their care plan. This consultation was also confirmed when we spoke with staff during the inspection. Surveys received from people who use the service told us that individuals are usually consulted about what they do each day, such as activities and domestic tasks, and that they can do what they choose to do each day, during evenings, and at weekends. Comments received included, I like my room, I can play my own music and watch films on television. I am happy here. We noted that one person was going out shopping and for a meal with a staff member during our visit. We saw that people were asked by staff if they wanted drinks, food and snacks, which were made available throughout the day, with a choice of options for hot or cold food and or drinks. Menus are displayed on the notice board in the dining room, these showed that individual choices are encouraged and that staff support those choices. 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. People who use this service are able to make choices about their life style, and supported to develop their life skills. Social, educational, cultural and recreational activities meet individuals expectations. Evidence: The Annual Quality Assurance Assessment completed by the care manager told us: All proposed Service Users have a clear and comprehensive assessment of their needs completed prior to the commencement of service. Whilst accessing White Lodge, Service Users are supported to continue to attend social clubs and maintain links with their friends through day services and continue to fulfil already established participation in daily activities. In addition to these already established activities, White Lodge strives to create further meaningful activity leisure opportunities for Care Homes for Adults (18-65 years) Page 15 of 32 Evidence: Service Users during their stay which incorporates a wide range of leisure pursuits. These include day trips, themed evenings and parties at the home, participation in daily activities around the home and local community, general positive relaxation, and socialisation with friends. All activities leisure time is structured and planned on an individual basis and in response to specific individual interests, likes, dislikes and aspirations. During their stay at White Lodge each service user is positively encouraged and supported to be actively involved in choosing how to spend their time, and options and opportunities made available. On the first day of their stay the staff will discuss with the service user what activities they would like to participate in during their stay, and have now started to plan in advance with the service user for any forthcoming stays. As well as supporting clients to effectively maintain established activities whilst at White Lodge and creating other such opportunities, White Lodge is also committed to providing, enabling and supporting individuals in all areas of daily routine in a manner that is respectful of the individual, their privacy and their dignity, and focused upon their needs, rights and individualism. Lifeways ethics encourage the progression of service users to maintain and increase independence and have control and choice in the way they are supported. Service users health and well being is promoted during their stay by ensuring a healthy, balanced diet is provided for Service Users. And all efforts made to ensure that meals are provided which respect individual preferences and choices and where required are prepared in response to specific health or cultural needs. Service Users are encouraged to be a part of meal preparation, which is a new concept at white lodge, as prior to Lifeways taking over the service used to have an industrial kitchen. The concept of Person Centred Planning for each service user accessing White lodge has been introduced to further enhance these opportunities and to positively guide and influence individuals structured support whilst at White lodge. Lifeways is committed to providing services that reflect the diversity of the local community and the individuals who receive support, the Service Manager and Manager are working closely together with Service Users, families, carers and other professionals. We looked at two care and support plans. Information regarding triggers to any known behaviour, for example what may upset a person, or known fears were included within the care plan. Information was recorded in regard to how the person communicated. Assessments covered all aspects of daily living for example mobility, traffic awareness, personal care. Information relating to the persons culture and religious needs were included in the plan, and how these were to be met. Personal risk assessments recorded identified risk, level of risk and how to support the Care Homes for Adults (18-65 years) Page 16 of 32 Evidence: person. Surveys received from people who use the service all supported the view that they can do what they want to do, during the day, evenings and at weekends. Activities on offer included television, WII games, trips out, eating out, art, crafts, themed events, shopping, ironing, cooking, laundry, cleaning, setting the table and washing up. Menus and activities are planned according to individual preferences, programmes for these are written up and posted on the display board in the dining room. Discussion took place with staff and people who use the service during the visit. This covered their daily programmes, activities, visits to the local day service and to see their families and friends. Daily activities and life continued as normal during our visit. Staff explained the inspection process to people using the service, during the inspection visit. People spoken with said that they do shopping, choose their own menus, that they enjoyed their food very much. We go to the pub, and staff take us out on trips. 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. 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. Evidence: The Annual Quality Assurance Assessment completed by the care manager told us: Lifeways believes that all service users should have access to all healthcare services appropriate to healthcare need. Care plans are in place to ensure that known health issues are responded to appropriately, and staff know what to do in the event of a health or wellbeing emergency. Risk Management Plans support the individual client to maximize their independence, whilst at the same time ensuring that risk to self or others is managed accordingly. Support Care Plans are structured and devised based on supporting individuals to meet personal needs in a way that maintains and respects the privacy and dignity of the individual. Specific attention is given to the race, culture, religion, age, gender and sexuality of the individual. The emphasis within all care and support planning is to promote services that enable the individual to increase their choice, autonomy, and control over their own lives. Health related needs are Care Homes for Adults (18-65 years) Page 18 of 32 Evidence: clearly documented within support plans, and reviewed regularly from a multidisciplinary approach to ensure that each individual is supported effectively to maintain and manage their own health. White lodge is committed to multidisciplinary working and has developed good working relationships with the local multi agency health professionals, guidance and support for individuals is sought. Referrals are made as appropriate, and individuals supported to access local healthcare facilities and resources. White lodge has a robust medication policy and procedures in place which ensure effective recording, storage, handling, administration and disposal of medication at White lodge. All support with medication is risk assessed and where able, Service users are supported to administer their own medication within a risk management framework. Individual Service users bring their own medication into White lodge at the beginning of their stay and a robust booking in, stock control system is in place to record all medications received and returned home. We looked at two health care plans, these recorded health care needs and how people were to be supported. For example: if a person had epilepsy, a record would be kept of any seizures, and actions taken. Staff spoken with confirmed that they had undergone specific and appropriate medication training which had covered conditions such as epilepsy and PEG feeding. Each person was registered with a local General Practitioner (GP). There were good relationships fostered between the service, the learning disabilities service, the GP and the local pharmacist. Other specialists maintain further contact and support. For example: where necessary, district nurses were approached for advice, information and any equipment necessary. People using the service attend surgery and or clinics as appropriate to their health needs. The evidence to support this was contained within daily records, and care plans seen. Medication was stored appropriately, and correct administration of medication was observed on the day of the inspection visit, ensuring the health, safety and welfare of the people using the service. Discussion took place in relation to the daily auditing of medication by senior members of staff. There were no people self medicating at the time of the inspection visit. Surveys told us that the care staff and managers listen and act on what people say, and that they treat people well. Discussions with staff revealed that they knew people well, and knew how to support each individual. Care Homes for Adults (18-65 years) Page 19 of 32 Evidence: 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. People who use the service are able to express their concerns and have access to a robust, effective complaints procedure, are protected from abuse, and have their rights protected. Evidence: The Annual Quality Assurance Assessment completed by the care manager told us: White Lodge proactively supports service users to discuss views and concerns before they develop into problems and formal complaints. This aim is also enhanced by Lifeways Quality Assurance Programme which provides opportunities for Service Users to express views and raise necessary concerns. There is a robust and comprehensive complaints procedure at White lodge that takes into account the communication needs of the individuals who receive support. Lifeways is able to provide a range of user friendly procedures using symbols, pictures, and translation into other languages as appropriate. Complaints are investigated within timescales and appropriate records are maintained. White lodge has policies and procedures relating to safeguarding adults and whistle blowing, staff are made aware of protocols to follow should they suspect or be informed of abuse. Lifeways is committed to protecting clients from abuse, working within multi agency guidelines, Protection of Vulnerable Adults Policies and Procedures and No Secrets, Department of Health guidance. As part of their induction all staff within Lifeways receive safeguarding training, which reiterate such policies, identifies all aspects of client abuse, early recognition and awareness and the Care Homes for Adults (18-65 years) Page 21 of 32 Evidence: reporting procedures, whistle blowing. All allegations and incidences of suspected or actual abuse, actions taken in these circumstances are recorded and in these cases Lifeways ensures that where necessary staff identified to be unsuitable to work with vulnerable adults are referred for consideration for inclusion on the POVA register. Surveys and staff spoken with confirmed that people know who to speak to if they are not happy, and know how to make a complaint if they need to. The complaints procedure is readily available, and in pictorial format to enable individuals using the service to undertand it. We were told by staff that they talk to people on a daily basis, to ascertain their wishes and preferences, and that any grumbles or complaints would be dealt with straight away. Staff spoken with were aware of Safeguarding protocols to follow should they suspect or are informed of any abuse of a vulnerable adult. There had been no complaints and or Safeguarding referrals made or received against the service. Staff induction and ongoing training includes Safeguarding. Staff recruitment files seen, evidenced that a robust recruitment process is in place, which included Identification, two references, Criminal Record Bureau and Safeguarding of Vulnerable Adult security checks. Personal monies held on behalf of individuals are kept safely and securely, with a daily checking and handover system in place. Receipts for items purchased are also kept within those records. Care Homes for Adults (18-65 years) Page 22 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The physical design and layout of the home enables people who use the sevice to live in a safe, well maintained and comfortable environment, which encourages independence. Consideration should be given to the rear outside space particularly in regard to the health, welfare and safety of people using the service, and to wheelchair users. Evidence: The Annual Quality Assurance Assessment completed by the care manager told us: White lodge has recently been registered as a care home. Prior to March 2010 it was run by South Staffordshire and Shropshire healthcare as a respite service. Lifeways has recently adapted the building to improve its surroundings. It has had the following adaptations: New Kitchen, enabling service users to have access too. Wet Room. Redecorations of rooms. One ensuite. All bedrooms made into single use, comprise of new TV, and sinks. All bedrooms have all new assisted beds, to which staff have received training in their use. Adequate furniture is provided in all bedroom areas and awareness maintained to ensure that items are of a satisfactory standard and suitable for their intended use. To further enhance the service users independence whilst at White lodge Care Homes for Adults (18-65 years) Page 23 of 32 Evidence: requirements for specialist equipment would be identified as part of each individuals pre assessment process. The Registered Manager works collectively with the relevant multi disciplinary professionals, occupational therapy and physiotherapy to assess these needs and identify any specific requirements. Any Specific equipment utilised at White lodge is checked regularly to ensure safe working use and processes are in place in the home to ensure that maintenance and repairs are carried out as required. To further ensure a safe and comfortable environment at White lodge all efforts are made to maintain effective hygiene and cleanliness within the home. Relevant policies and procedures are in place to ensure safe working practices in relation to infection control COSHH, clinical waste management etc. Monthly audits carried out within the home monitor the management of the above processes and pro actively identify areas of continued improvement or where required resolution. Observation of the environment confirmed the comments made in the Annual Quality Assurance Assessment as above. However, we did note that access to the garden at the rear of the property is downhill, and would be very steep for a wheelchair to use. We noted that immediately outside the rear door there is a small paved level access area with limited space for wheelchairs. We were told by the care manager that the service is located at this site on a temporary basis, and that this is a lease agreement for approximately 18 months duration. Lifeways intends to move to a more suitable premise after that time. The kitchen is domestic in nature and replaced the original larger kitchen. We were told that people using the service do use the kitchen to make snacks and drinks, however we noted that the height of worktops and electric sockets etc. is not ideal for wheelchair users. There is a large washing machine and dryer in the laundry area, which is not domestic in size. People using the service would benefit from being able to use domestic sized equipment, this would enable them to use equipment at home. This was highlighted and discussed with the care manager at the time of our visit. Equipment and adaptations had been safely maintained and serviced. We were told that specific requirements made by either the Occupational Therapist and or the Physiotherapist would be organised, and adhered to. Individuals bring in their own slings from home, for use with the Oxford hoist, ensuring that the correct sizes are used and safety is maintained. We noted that overhead tracking hoists and assisted baths are also used and maintained. Care Homes for Adults (18-65 years) Page 24 of 32 Evidence: Staff told us that they had received appropriate Control of Substances Hazardous to Health training (COSHH), and that protective clothing including aprons and gloves were available and used as needed. The care manager confirmed that monthly audits in regard to health and safety and infection control are routinely undertaken, ensuring the health, safety and welfare of the people using the service. Communal areas were spacious, homely in appearance, and comfortably furnished. There was also a room provided for activities, which contained a pool table, tables and chairs. Care Homes for Adults (18-65 years) Page 25 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 in the home are trained, skilled and in sufficient numbers to support the people who use the service, in line with their terms and conditions, and to support the smooth running of the service. Evidence: The Annual Quality Assurance Assessment completed by the care manager told us: White lodge staff team currently comprises of a Registered manager, who tuped over from South Staffordshire and Shropshire healthcare in March 2010, where she had worked as a qualified nurse since 1998, and been manager at White Lodge from 2007. Also tuped over were 4 staff nurse who now work as team leaders, who deputise in the absence of the registered manager, they mainly work shifts, and support in the supervision of support staff. We have had a number of new support workers since the transfer, as well as tupe support staff, and the number on each shift depends on the needs of the service users. Staffing levels are regularly reviewed and will continue to be reviewed to reflect service users changing needs. White Lodge staff team comprises of: 1 Registered Manager. 4 Team leaders. 11 support workers 1 handyman 1 Administrator 1 domestic Job descriptions are maintained on staff files clearly indicate roles and responsibilities of staff positions within the home to ensure effective team working and all required tasks within the home. All staff within Lifeways receives Care Homes for Adults (18-65 years) Page 26 of 32 Evidence: induction training within this training, specific roles and responsibilities are explored and emphasised along with the aims and objectives, standards, policies and procedures within the organisation. In addition to this and to further enhance staff abilities and awareness all support staff receive appreciation of the support worker role training. Robust recruitment and selection procedures are in place and followed. The recruitment process is comprehensive and includes an equal opportunities statement in the advertisement, face to face interviews conducted in private, prior to appointment the receipt of two written references, verification of identity, qualification and training, declaration of criminal offences, and the completion of a CRB and POVA. We spoke with staff and examined the staff rota week commencing 28th June to 11th July the rota confirmed the staffing levels as per the Annual Quality Assurance Assessment as above. Staff told us that they had received appropriate induction and training, for example privacy and digity awareness, PEG feeding, Diabetes, Medication, First Aid, Safeguarding, Moving and Handling and Food Hygiene. However, we recommend that staff should receive training in regard to Mental Capacity Act 2005 and Deprivation of Liberty guidance. This ensures the safety of the people using the service. We spoke with staff and were given a copy of the staff Supervision rota, these evidenced that staff are receiving regular and formal supervision as per the National Minimum Standard (NMS). Care Homes for Adults (18-65 years) Page 27 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, has effective quality assurance systems developed by a qualified, competent manager. Evidence: The Annual Quality Assurance Assessment completed by the care manager told us: The Registered Manager is a registered nurse, and has over 10 years experience of working with learning disabilities, and residential care settings. She is committed to ensure the effective running of the home and to meet its stated purpose, aims and objectives. To enhance the management structure at White Lodge, 4 staff nurses tupe over and are now working as team leaders, deputising in the absence of the manager. There are clear lines of leadership, management and accountability at White lodge to ensure that the home runs effectively and in the best interests of the service users accessing the service. The service is line managed by a Service Manager who provides ongoing support to the manager and the staff group. Lifeways has developed Quality Assurance encompassing QA tools to measure quality standards in the organisation. The utilisation of these tools ensure effective monitoring and review of the standards Care Homes for Adults (18-65 years) Page 28 of 32 Evidence: maintained in the service. Comprehensive policies and procedures are maintained within the home, ensure that service user rights and best interests are safe-guarded. The registered manager at Stretton observes and ensures that these practices are followed to maintain the health, safety and welfare of staff and service users at all times. We found that safe practices are in place, ensuring the health, safety and welfare of the people using the service. There had been no complaints and or Safeguarding referrals made against the service at the time of this report, and staff are inducted and trained to respond to any form of abuse or suspicion of abuse. Staff told us that they receive the necessary support and information in order to care for the people using the service, that included any changes in the persons care plan, medication and or risk assessment. Staff induction and training had been given a high priority. Staffing levels had been maintained, and staff told us that they had received regular formal supervision, and had been well supported by the care manager in their duties, role and responsibilities. Care plans are based upon activities of daily living, and were uniformly and clearly presented in a pictorial format that is person centred. Staff spoken with knew exactly how to care for each person using the service. We were told by staff and surveys received that the service is well managed, and that staff and management listen and act upon what people say. There is a quality assurance system in place, we discussed ways of expanding the existing system to include other stakeholders such as the General Practitioner (GP), District Nurse, Community Learning Disability team etc. The care manager told us that the service is well supported by other health professionals, including the Learning Disabilities team, and that advice and guidance is always available. 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 1 24 Consideration should be given to the layout of the rear outside space, particularly in regard to the health, welfare and safety of people using the service, and to wheelchair users. Consideration should be given to the purchasing of domestic sized equipment such as a washing machine and dryer which would then enable individuals to learn how to use them. Staff should receive training in Mental Capacity Act 2005 and Deprivation of Liberty guidance. To ensure the safety of the people using the service. 2 29 3 35 Care Homes for Adults (18-65 years) Page 31 of 32 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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