Care Home: Windmill Lodge

Similar services:

• Thorndene
• Insight - Eastchurch
• Southfields
• Magenta
• Seabourne House
• 33 St John`s Church Road
• Dovedale Court
• Lyncol House

What the care home does well This property was a pair of domestic dwellings before it became a residential care home, which means that it has retained many of its original features and is homely, and it has been redecorated to reflect he service users` tastes. It is two storey property, which means bedrooms and communal facilities are within reasonable reach. The way staff interact with service users is kind, friendly and caring. Clearly team working is a strength in this home. What has improved since the last inspection? The AQAA told us about a range of improvements: Assessments and risk assessments have been looked at and are service user led. More input from service users has led to them going out unescorted and more input from relevant specialists. Service users have become more involved in daily routines /skills development. They have been on a holiday of their choice, and have been accessing local clubs, discos, bowling, leisure centre, swimming, snooker, pubs i.e. good community access. They have also been encouraged to vote. In terms of health care, service users have been supported to attend hospital appointments and with emergencies. Staff have ensured hospital staff are aware of their individual needs. The home has developed good liaison with local pharmacy. One service user has been supported with diet/weight control to good effect. The home`s complaints procedure is now available in a pictorial / easy read format and it is also available to relatives. Service users receive ongoing support with managing money / shopping. The property is subject to an ongoing refurbishment programme. Carpets are being replaced and some service users` rooms have been redecorated. The lounge furniture has been replaced and a large screen TV installed, along with Wii for exercises / entertainment. And a part time cleaner has been employed. The exterior has been repainted. Garden trees have been treated to admit more light. The home has new patio furniture and a BBQ. Service users have been encouraged to become more involved in gardening - vegetables, flowers, hanging baskets. In terms of the home`s staffing arrangements, the AQAA told us that the staff team has been increased to include another senior support worker to take lead on supervising staff, service user care so as to allow manager to concentrate on strategic planning, innovation and staff training. Recruitment has been tightened and two new staff are NVQ3 qualified. Five staff are currently undertaking Learning Disability Qualification training to levels 2 and 3 Staff told us, "I think it`s a homely atmosphere to work in. The clients feel they can come and tell us anything. This is a really good, open staff team. You can praise and criticise without offence being taken. The service users are put first. The home is for them. It is service user led". What the care home could do better: The AQAA tells us that, notwithstanding the improvements listed above, there have been some barriers to overcome. Staff turnover has improved but not as much as was hoped, so some planned improvements were delayed. The home has also experienced difficulties obtaining the funding required to cover the cost of meeting increased needs such as behaviour and continence management. The home has tried to reduce the impact of these barriers by tightening up recruitment, investments of staff training and incentives. It has also developed more partnership working with the hospital LINK services to improve communication with service users. The decor needs attention and there needs to be a formal business planning process in place, which can demonstrate how feedback from stakeholders (service users, relatives or advocates, and health and social care professionals) can influence the way services are delivered. Key inspection report Care homes for adults (18-65 years) Name: Address: Windmill Lodge 26 Springhead Road Northfleet Gravesend Kent DA11 9QY     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: Jenny McGookin     Date: 1 8 0 2 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 29 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) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 29 Information about the care home Name of care home: Address: Windmill Lodge 26 Springhead Road Northfleet Gravesend Kent DA11 9QY 01474354212 01474354212 joe.hosanee@tiscali.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mr Abdoollah Hosanee care home 8 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 8. 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 Windmill Lodge provides accommodation and support for up to eight people with learning and some physical disabilities. Twenty-four hour care is provided. All service users have single en-suite bedrooms. There is a garden at the rear and a patio area at 1st floor level. The premises are about 15-20 minutes walk from the centre of Gravesend and there is easy access to public transport and to a range of amenities. The Owner/Manager is nurse trained, has a diploma in management studies and has Care Homes for Adults (18-65 years) Page 4 of 29 Over 65 0 8 Brief description of the care home achieved the Registered Managers Award. He manages the home on a daily basis and is supported by a Deputy Manager. The current fee structure at the time of inspection was #581.00; there are additional charges for hairdressing, clothes, toiletries, activities and holidays. Care Homes for Adults (18-65 years) Page 5 of 29 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: This report is based on an unannounced site visit, which was used to inform this years inspection process; to check progress with matters raised for attention at the last inspection visit (March 2008) and to review findings on the day-to-day running of the home. The inspection took just over eight hours. It involved meetings with the proprietor/manager, the deputy manager, two support workers and the cleaner. We also met with three service users during the course of the day, and interactions between staff and service users were observed throughout the visit. We sent a selection of feedback questionnaires for distribution to service users, their advocates or relatives, staff and visiting professionals (health and social care). Feedback was not obtained in time for the issue of this report, but any responses will be used to inform the Commissions intelligence in due course. Care Homes for Adults (18-65 years) Page 6 of 29 Consideration was given to the Annual Quality Assurance Assessment (AQAA) submitted by the the proprietor/ manager in January 2010. The AQAA is a selfassessment that focuses on how well outcomes are being met for the people using this service. It also gives some numerical information about this service. The inspection also involved an examination of records, and the selection of one service users case files, to track their care. We looked at three personnel files, representing appointments within the past 12-18 months. And we looked at some staff training records. Six bedrooms were checked for compliance with the provisions of the National Minimum Standards, along with communal areas. Care Homes for Adults (18-65 years) Page 7 of 29 What the care home does well: What has improved since the last inspection? The AQAA told us about a range of improvements: Assessments and risk assessments have been looked at and are service user led. More input from service users has led to them going out unescorted and more input from relevant specialists. Service users have become more involved in daily routines /skills development. They have been on a holiday of their choice, and have been accessing local clubs, discos, bowling, leisure centre, swimming, snooker, pubs i.e. good community access. They have also been encouraged to vote. In terms of health care, service users have been supported to attend hospital appointments and with emergencies. Staff have ensured hospital staff are aware of their individual needs. The home has developed good liaison with local pharmacy. One service user has been supported with diet/weight control to good effect. The homes complaints procedure is now available in a pictorial / easy read format and it is also available to relatives. Service users receive ongoing support with managing money / shopping. The property is subject to an ongoing refurbishment programme. Carpets are being replaced and some service users rooms have been redecorated. The lounge furniture has been replaced and a large screen TV installed, along with Wii for exercises / entertainment. And a part time cleaner has been employed. The exterior has been repainted. Garden trees have been treated to admit more light. The home has new patio furniture and a BBQ. Service users have been encouraged to become more involved in gardening - vegetables, flowers, hanging baskets. In terms of the homes staffing arrangements, the AQAA told us that the staff team has been increased to include another senior support worker to take lead on supervising staff, service user care so as to allow manager to concentrate on strategic planning, innovation and staff training. Recruitment has been tightened and two new staff are NVQ3 qualified. Five staff are currently undertaking Learning Disability Qualification training to levels 2 and 3 Staff told us, I think its a homely atmosphere to work in. The clients feel they can come and tell us anything. This is a really good, open staff team. You can praise and criticise without Care Homes for Adults (18-65 years) Page 8 of 29 offence being taken. The service users are put first. The home is for them. It is service user led. 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 29 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 29 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. Prospective service users can feel confidant that their needs will be properly assessed, before or upon admission, and that they will be offered the opportunity to visit and try out the home before their placement is confirmed Each placement is confirmed by contracts, which are intended to tell everyone involved what to expect. But they are not user friendly. Evidence: This home has produced a handbook to provide current and prospective service users with the information they might need about the home. Previous inspections (October 2005 and March 2008) judged the scope of this information fully compliant with the provisions of this standard, so we did not assess it again. The admission dates of seven of the services users predate the emergence of the National Minimum Standards, and one other was at least 2-3 years ago and subject, therefore to inspections thereon. So this element of the National Minimum Standards was not inspected on this occasion, other than to establish that the existing service Care Homes for Adults (18-65 years) Page 11 of 29 Evidence: users were content with their placement. Previous inspections have also established that this home has procedures in place for the assessment of any prospective service users. We saw good evidence of this in the file we spot checked. We understand that prospective service users and their representatives (e.g. relatives or advocates) are encouraged to visit the home before any admission is confirmed. This helps to ensure that they will settle in. See section on Individual Needs and Choices for our findings on the way this home reviews and meets any ongoing or changing needs thereon. The placement of seven service users is funded by Kent County Council, which has its own contractual arrangements. This is outside the scope of this inspection. But each placement is also subject to the homes own contract. This will require updating in some respects, which we discussed with the proprietor/manager. Although it is written in plain language, it is not in pictorial or easy read format, so as to be meaningful to the service users. See section on sections on Environment, Health and Personal Care and Staffing for other key findings. This home can demonstrate its capacity to meet the needs of residents. Care Homes for Adults (18-65 years) Page 12 of 29 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. Services users can be confident that the care they receive, is based on person-centred assessments of their individual needs, and that their perspective will be central to this process. Services users can confidently expect to be treated with respect, dignity and privacy. Evidence: See section on Choice of Home for our findings in respect of pre-admission assessments. The scope of the care planning processes used by this home properly identifies a range of health, personal care and social needs. We were also shown About Me assessments carried out be the service users themselves, with support, to identify their preferences and where they felt they needed support. And these are intended to be read in combination with on-going monitoring checks, Care Homes for Adults (18-65 years) Page 13 of 29 Evidence: assessments (including risks) and records of contact with health care professionals to provide a rounded picture of each service users care needs. Care plans are written in a pictorial format, and signed off by the individual service users, so as to remain meaningful to them. And the aims and methods identified in each case are being reviewed by meetings between service users and their key workers to keep them up to date. More formal reviews are lead by care managers from the funding authority on an annual basis, and we saw good evidence of review reports from other agencies, such as education or day services, produced as part of this process. The AQAA told us that work has been carried out to produce communication passports, which allow anyone meeting individual service users for the first time (e.g. in hospital settings) to understand how to speak to them and what kind of language to use. This should help empower service users. All the bedrooms in this home are used for single occupancy, which means support with health and personal care can be given in privacy. We observed interactions between the staff and the service users and judged them appropriately familiar and respectful. The AQAA told us how service users were being supported to become more involved in the day-to-day running of the home - this included light household tasks like laundry, tidying up, preparing meals, menu planning and shopping. This is evidence of an inclusive and empowering approach. This home has made arrangements for keeping information confidential. Storage facilities are lockable and computerised information is restricted. Confidentiality features in each member of staffs contract of employment. Care Homes for Adults (18-65 years) Page 14 of 29 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 supported to make decisions and choices about their daily routines. The social, cultural and recreational activities being offered by the home are tailored to the preferences of the service users. Service users can be confident the home will support them to keep in contact with family and friends. Service users can be more confident that they will receive a healthy, varied diet according to their assessed requirements and choice. Evidence: The home maintains a programme of activities for each service user. We looked at records, and spoke to staff on duty, and all these sources showed a range of Care Homes for Adults (18-65 years) Page 15 of 29 Evidence: opportunities, separately tailored for each service user. Staff told us about activities on site such as painting, colouring. All the service users have their own TV in their rooms, so there is always a choice of viewing. But the installation of a large screen communal TV (linked to Freeview, with a video and CD) has proved very popular, particularly for those service users with visual impairment, as has the installation of Nintendo Wii exercise programmes. As reported earlier, activities also include service users being supported to take on some responsibilities like laundry, tidying up. Service users are involved in the choice of decor in their bedrooms and throughout the home. The deputy manager told us that throughout the summer the service users had cultivated a range of fruit and vegetables (tomatoes, beans, aubergines) and were delighted to see where their meals were coming from. Activities off site include trips to cinemas, restaurants, pubs etc, though we were told motivation could be variable. Their choice is respected. Other examples included access to a Mencap club,and the Social Education Centre in Gravesend. Service users are supported to attend services at a local church. And one told us about his voluntary work in charity shops. The home has its own car. We were assured that service users are able to have visitors at any reasonable time, but on-site car parking facilities are limited (4 spaces - see section on Environment) and the busy road outside is subject to parking restrictions. The home is reasonably well placed for links with the community. The nearest bus routes are just five minutes walk away. There is a cordless communal telephone in the hallway and in the office, both of which can be taken into bedrooms for privacy. Although the homes contract states that charges for its use are made, this is not the practice. Some service users also have their own mobile phones. We were assured that all mail is delivered to service users unopened, though staff can assist them to open and read the contents if they wish. Catering needs are properly identified as part of the admissions process and are updated or amended thereon. The home is committed to healthy eating and can cater for a range of diets. We were shown a menu book which is used to detail what each service user eats, as required, and this also details key guidance notes, so that staff remain vigilant. We were satisfied they were given a choice. We sat and had lunch with the service users and were told how much they liked the meals. One told us how he prepared his own meals and told us about the dishes he particularly liked and didnt like. One other has been supported effectively with their diet and weight. Care Homes for Adults (18-65 years) Page 16 of 29 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. Service users receive the personal and health care they need, and can be confident that their preferences will be taken into account as far as possible. Evidence: Service users can choose when to go to bed or get up, as far as they are able, and they were observed being supported to make some choices and decisions during our inspection visit. All of the service users in this home have bus passes and we were told that four can travel independently to shops and other community activities. One service user told us about his visit to a market and other outings he was able to make on his own. Records confirm that service users have access to a range of medical services, generic (e.g. GP, dentist, chiropodists, district nursing etc), and specialist (e.g. behaviour, continence management). We were told how one service users potassium intake had been monitored and managed so that changes to their medication were not warranted. The home maintains a medication file, which is prefaced with critical information about Care Homes for Adults (18-65 years) Page 17 of 29 Evidence: each service user, for use in an emergency. Although the drugs directory we saw was out of date, we were shown where the home keeps useful information about each individuals medication and things to look out for such as side effects, to keep people safe. None of the current service users manages their own medication. The medication administration records (MAR) we looked at showed no gaps or anomalies. The AQAA also told us about the information the service users have helped produce about their communication needs - all of which is intended to inform other agencies such as hospital staff, should they become involved in their care. Records confirmed that all support staff receive training in medication administration, and regular competency assessments are carried out, to keep people safe. The homes medication was being kept properly secured when not in use. The AQAA told us about the useful liaison it has with a local pharmacist for advice. But the homes arrangements are not subject to independent inspections by a pharmacist - this is recommended, as a precaution against practice becoming variable, and to keep people safe. Care Homes for Adults (18-65 years) Page 18 of 29 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. Service users can be confident that their concerns and complaints will be properly addressed, whether or not they use the homes formal complaints procedure. Service users can feel confident that they will be protected from abuse and will have their legal rights protected. Evidence: This home has a complaints procedure, which is detailed in the service users handbook and is available in an accessible format for service users. The homes AQAA told us that there had been no formal complaints raised in the past twelve months. We spot checked one service users petty cash arrangements. Their day to day financial transactions were being carefully recorded, and were properly supported by receipts. Balances are checked on a daily basis. This home has a procedure to ensure that service users are protected from abuse in all its forms. And this is underpinned by staff training. Care Homes for Adults (18-65 years) Page 19 of 29 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. Service users benefit from living in a generally well-maintained, homely and comfortable environment. Some matters have been raised for attention to ensure the bedrooms full compliance with the National Minimum Standards. Evidence: This home is in an urban setting, with good transport links to a range of the community resources (shops, dentists, GP and banking services etc). There are four parking spaces on a steep frontage to the site, which must include the homes own vehicle as well as a member of staffs own car. There are parking restrictions along the busy one way road outside the site. Measures are in place to keep the premises secure against unauthorised access, and the exterior of the property is well lit. None of the service users has a front door key but four have been assessed as able to come and go without an escort. Two of this homes service users are of pensionable age and two others are approaching pensionable age, and they are showing some mobility impairment. The home is partially adapted for this. There is a ramp and handrail to the front and rear Care Homes for Adults (18-65 years) Page 20 of 29 Evidence: access doors, and an adapted bathroom on the ground floor. One service user was assessed by an Occupational Therapist in respect of their seating provision, another has a hearing aid which has digital adjustments for TV and telephone use. And service users have benefitted by the installation of a large screen TV. Most furniture is domestic and of good quality. There were homely touches everywhere. The AQAA told us about a number of improvements to the property since the last inspection visit. The exterior has been repainted. Garden trees have been treated to admit more light. The home has new patio furniture and a BBQ. Inside, carpets have been replaced, with more in prospect and some service users rooms have been redecorated. The lounge furniture has been replaced and a large screen TV installed, along with Wii for exercises / entertainment. The home has benefitted by the recruitment of a part time cleaner. The home was clean and odour free in all areas inspected. There is one communal lounge and a separate communal dining room, both of which are reasonably spacious. The furniture is domestic in each case and there is a choice of seating. Although one service users own arm chair was showing signs of wear, the furniture was otherwise of good quality. This home is currently registered to provide care for up to eight service users, and all the bedrooms are single occupancy and have en suite WCs and wash hand basins, which means access and privacy can be assured. Six bedrooms were inspected on this occasion, and each had been personalised and generally well maintained, accepting two carpets in particular were scheduled for immediate attention / replacement. None of the service users had locks / keys to their bedroom doors, but two expressed a wish to have this. And only two had lockable facilities within their bedrooms. We did not see this documented or reviewed in the file we looked at, so we could not be sure how choice, independence or privacy was being promoted. This home has two communal WC/bathrooms (one of which includes an adapted bath) i.e. reasonably close to bedrooms and communal areas. One had been refurbished to a high standard. The other did not fully comply with expected standards of health and safety (see schedule of recommended action for detail) but we were assured that it Care Homes for Adults (18-65 years) Page 21 of 29 Evidence: was scheduled for refurbishment. The AQAA told us that, with one exception (electrical installation - last certificated in 2004), all the property maintenance checks were up to date. Care Homes for Adults (18-65 years) Page 22 of 29 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. The numbers of staff on duty at any given time reliably meet the aims and objectives of the home, and the emerging needs of the service users. Service users benefit from the staff training investments. Evidence: This homes staffing arrangements are designed to ensure that(excluding the manager): - from 7.30am till 2.30pm there should be one senior support staff and two support staff. - from 2.00pm till 9pm there should be one senior support staff and one or two support staff Overnight there should be one member of staff who sleeps on site but is available oncall. We were told that waking staff can be arranged in the event of any service users health issues. And the proprietor/ manager is also on-call in the event of emergencies. Since our last inspection visit (March 2008) a part time cleaner has been recruited. Otherwise there are no additional staff to cover the cleaning, laundry, or cooking duties - support staff are responsible for this, and are to be congratulated for the standards seen. Care Homes for Adults (18-65 years) Page 23 of 29 Evidence: Since the last inspection, there have been no concerns raised with the Commission about the homes capacity to maintain the staffing levels described, but we understand from the AQAA that although staff turnover had improved it had not done so as much as was hoped, so some planned improvements were delayed. The home has tried to reduce the impact of these barriers by tightening up recruitment, investments of staff training and incentives, and records confirmed this. Records confirmed that this home has a systematic recruitment process to comply with the key elements of the standard, including references, criminal records checks to account for individual employment histories, to keep people safe. The homes AQAA told us that four of the homes six staff have NVQ accreditation to Level 2 or above. In discussions with us, staff described a comprehensive list of mandatory training opportunities, designed to keep people safe. They confirmed receiving supervision from their line manager to comply with expected standards and said they felt well supported and invested in. Staff told us, I think the team works very well. We are very close. You dont feel left out. When I started I felt Id been working here for ages. I felt this was a place Id like to stay in. I havent had a problem with anyone. When I came here first I was wondering how it would work our. I feel I fit in with the team. Everything is good so far. I dont regret applying for this job. We have a manager you can talk to. I am happy to get out of bed and come to work! Everyone is nice. They talk to everyone. I enjoy it. Care Homes for Adults (18-65 years) Page 24 of 29 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 home is run for the benefit of service users in that it is based on a culture of openness and respect. Evidence: The Commissions registration process has established that Mr Hosanee has the relevant qualifications, training and experience for his role as proprietor and manager of this home. There are clear lines of accountability within the home, which means the registered person has been able to demonstrate sufficient presence to keep people safe. Feedback obtained on the day of our inspection indicated that interactions between the proprietor / manager and staff and service users was appropriately familiar and respectful. There was good evidence of day to day feedback influencing the way services were being delivered. There were, however, no records available to evidence any formal quality assurance feedback exercises carried out by the home among the service users, staff or other Care Homes for Adults (18-65 years) Page 25 of 29 Evidence: interested parties. The proprietor/manager had only a rudimentary action plan for for the current year, but told us about the changes he had been making to the staffing arrangements to allow him to take on a more strategic role in future. We wanted to know how well this home catered for the diversity of its service users group. The AQAA told us that two service users are female, the rest are male, and all the service users are white British. The AQAA also told us that the staff group shows more ethnic diversity. Two staff are male and five are female. This should mean that there is some scope to offer same gender support with personal care if that is a service users preference. We noted that service users files did not, however, document whether each service users had a preference. No diversity issues were identified for attention. Regular training on equality and diversity issues, should keep this aspect of the homes operation an active consideration. The home makes provision for the proper storage and accounting of personal effects and small sums of pocket money. But, as reported earlier, none of the bedrooms had a lockable facility. This needs to be justified. The AQAA indicates that all this homes property maintenance certificates were, with one exception (electrical installation) up to date. We found some potential hazards, (see section on Environment for details) which will need attention to keep people safe. It is accepted that the proprietor / manager has plans to address them. Care Homes for Adults (18-65 years) Page 26 of 29 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 34 (19) (11) (c) Where a registered person 30/04/2008 permits a new worker to start work pursuant to paragraph (9) the registered person shall? (c) Ensure that the new worker does not escort service users away from the care home premises unless accompanied by the staff member. Care Homes for Adults (18-65 years) Page 27 of 29 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 5 The homes contracts require updating in respect of the process for investigating complaints, the provision of bedroom furniture, and charges for telephone calls. The homes contract should be available in a user friendly format. The electrical installation should be inspected and certificated at 3-5 year intervals to keep people safe. Each bedroom should have a lockable door and a lockable facility as standard. Non provision must be justified with documented risk assessments or opt out consultation. 1st floor bathroom - the following matters are raised for attention: - it should have impermeable flooring, capable of being easily cleaned. - The door should have double acting locks capable of being opened from outside in an emergency. - The radiator should be guarded. 2 3 24 26 4 27 Care Homes for Adults (18-65 years) Page 28 of 29 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. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 29 of 29 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!