Care Home: York Lodge

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What the care home does well Residents continue to live in a clean, well decorated and maintained home with their personal accommodation individualised to reflect their lifestyle. Central to the aims of the home is the promotion of independence with services and practices designed to enable residents to live independently and to develop and maintain living skills. Resident`s lives are enriched by excellent practices in the promotion of meaningful occupation, leisure pursuits, choices and being enabled to live chosen lifestyles. Residents spoke positively about their experiences at the home with a sample of their comments included "best bit is being able to be independent and go out myself and go into Horley" "I like living here". Relatives commented "allows him to live a very free and easy life with support when needed". He is very settled there it is a great place we are very lucky to have such a good place for him to live". Excellent person centred care plans helps to ensures that residents support needs are thoroughly assessed enabling the staff to provide individual support with residents actively engaged in the development and review of their plans. Residents are active participants in the running of the home, this includes being involved in the recruitment process for staff, cleaning of the home and maintenance of the grounds. Resident`s benefit by being supported to maintain relationships with their families and friends. A relative said "we can phone or call at any time if there is problem they contact us immediately we always feel welcome". Mealtimes and arrangements for eating are determined by residents with evidence of the promotion of healthy eating. A residents said "I cook for myself I decide what I would like at the beginning of the week and then go and do the shopping but usually I just buy what I fancy". Resident`s benefit from a well-motivated and knowledgably manager who promotes good practices in independent living, strong leadership and runs the home in the best interest of residents. The home regularly reviews aspects of its performance through an excellent program of self-review and feedback. Staff make a positive contribution in residents lives as residents benefit from a supervised, well trained and enthusiastic staff team that know them and who are robustly recruited and employed in sufficient numbers as is necessary to meet their needs. A sample of comments made about staff included "all the staff are caring helpful and supportive especially if I am unwell" "very nice Staff are all very good" and "the support is very good speak regularly to staff on the phone who are very knowledgeable"There are currently plans to convert the home into self contained supported accommodation flats in the near future, despite this uncertainly over the long term future of the home staff and management continue to demonstrate much commitment towards residents achieving their individual aims and goals of independent living. What has improved since the last inspection? All of the shortfalls noted at the previous inspection have now been addressed this has resulted in safety being improved through more robust recruitment practices. Further improvements have been made the environment with the redecoration of more bedrooms lounge and kitchen, creating a pleasant environment in which to live. What the care home could do better: There are no shortfalls in practices that have lead to requirements being made at this inspection. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: York Lodge York Lodge 129 Balcombe Road Horley Surrey RH6 9BG     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Jane Jewell     Date: 2 9 0 5 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 31 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI 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 31 Information about the care home Name of care home: Address: York Lodge 129 Balcombe Road York Lodge Horley Surrey RH6 9BG 01293785235 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Welmede Housing Association Ltd care home 8 Number of places (if applicable): Under 65 Over 65 0 learning disability Additional conditions: 8 The maximum number of service users who can 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 York Lodge is a care home registered for the provision of personal care and support for up to eight adults whose primary support need is a learning disability. Service users may have a secondary mental health disorder or sensory impairment. The Registered Provider, Welmede Housing Association specialises in care and support of adults with learning disabilities. York Lodge is part of a group of care homes operated in Surrey by this organisation. Hyde Housing Association owns this property and is responsible for its parts of the maintenance. The service aim is to enable service users to lead as independent and fulfilled life as Care Homes for Adults (18-65 years) Page 4 of 31 Brief description of the care home possible, providing support that maximises skills to the fullest potential. The property is a large, detached building situated on a main road in a residential area. The home is presented across three floors with access to all floors via stairs. Horley town centre is within walking distance and community facilities and services are accessible. At the front of the building is a large garden and car parking facilities and an enclosed garden is available at the rear. Communal accommodation is arranged on the ground floor, comprising of a spacious lounge and smaller, second lounge. There is a large dining room, a well equipped kitchen, separate utility room and combined staff office/ sleeping in facility also on this floor. Bedroom accommodation is arranged on the first and second floors, accessible by stairs . All bedrooms are single occupancy and are situated near to toilet and bathing facilities. There are currently plans in place to convert the home into self contained supported accommodation flats in the near future. Care Homes for Adults (18-65 years) Page 5 of 31 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: three star excellent 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 information contained in this report has been comprised from an unannounced inspection undertaken over five hours and information gathered about the home before and after the inspection. The manager had comprehensively completed an Annual Quality Assurance Assessment form and the information contained in this document has been used to inform the inspection process. The inspection was facilitated in part by the Mr lee Mather (Registered Manager). The focus of the inspection was to look at the experiences of life at the home for people living there. The inspection consisted of being shown around the communal areas by a residents, examination of the homes documentation and observations of residents daily routines and in their interactions with staff. Four residents, four staff and three Care Homes for Adults (18-65 years) Page 6 of 31 relatives were consulted as part of the inspection process. Feedback surveys were sent to the home for distribution in order to obtain the views on the quality of the services and facilities being provided. Fourteen were returned in total, six from residents, four from staff, two from advocates and two from health care professionals. Their feedback is included in this report. There were six residents living at the home at the time of the inspection. What the care home does well: Residents continue to live in a clean, well decorated and maintained home with their personal accommodation individualised to reflect their lifestyle. Central to the aims of the home is the promotion of independence with services and practices designed to enable residents to live independently and to develop and maintain living skills. Residents lives are enriched by excellent practices in the promotion of meaningful occupation, leisure pursuits, choices and being enabled to live chosen lifestyles. Residents spoke positively about their experiences at the home with a sample of their comments included best bit is being able to be independent and go out myself and go into Horley I like living here. Relatives commented allows him to live a very free and easy life with support when needed. He is very settled there it is a great place we are very lucky to have such a good place for him to live. Excellent person centred care plans helps to ensures that residents support needs are thoroughly assessed enabling the staff to provide individual support with residents actively engaged in the development and review of their plans. Residents are active participants in the running of the home, this includes being involved in the recruitment process for staff, cleaning of the home and maintenance of the grounds. Residents benefit by being supported to maintain relationships with their families and friends. A relative said we can phone or call at any time if there is problem they contact us immediately we always feel welcome. Mealtimes and arrangements for eating are determined by residents with evidence of the promotion of healthy eating. A residents said I cook for myself I decide what I would like at the beginning of the week and then go and do the shopping but usually I just buy what I fancy. Residents benefit from a well-motivated and knowledgably manager who promotes good practices in independent living, strong leadership and runs the home in the best interest of residents. The home regularly reviews aspects of its performance through an excellent program of self-review and feedback. Staff make a positive contribution in residents lives as residents benefit from a supervised, well trained and enthusiastic staff team that know them and who are robustly recruited and employed in sufficient numbers as is necessary to meet their needs. A sample of comments made about staff included all the staff are caring helpful and supportive especially if I am unwell very nice Staff are all very good and the support is very good speak regularly to staff on the phone who are very knowledgeable Care Homes for Adults (18-65 years) Page 8 of 31 There are currently plans to convert the home into self contained supported accommodation flats in the near future, despite this uncertainly over the long term future of the home staff and management continue to demonstrate much commitment towards residents achieving their individual aims and goals of independent living. 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 following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 31 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 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides both prospective and existing residents with an excellent range of accessible information about what services are provided and what to expect when living at the home. The home is able to identify and meet the needs of residents. The way in which prospective residents would be assessed ensures that the home admits only those residents whose needs can be met by living at the home. Evidence: The homes statement of purpose, which is a book that tells people who the home is for and the service users guide, which is the book that tells people how the home works, is comprehensive and provides a wide range of information about the home and the services it provides. Care Homes for Adults (18-65 years) Page 11 of 31 Evidence: Both documents are in a format which aids residents understanding and includes pictures and easy read formats. The service users guide was developed by the residents at the home with a resident commenting that they had all the information they needed to help make up their mind whether to move to the home or not. Information about the home would be sent to prospective residents and their representatives to help make informed choice about the homes suitability. It was previously required that the service user guide clarify the fee structure. Although this had not been completed due to the managers misunderstanding of what was being asked they did agreed to now add in the correct information immediately. There are plans in place to convert the home into self contained supported accommodation flats in the near future. Therefore there has not been any new admissions to the home in some time in order to avoid instability for new residents. Therefore, this standard was assessed in respect of the admission procedure should the home decide to further admit residents. The manager was aware of the admission criteria for the home and knowledgeable about admissions practices that would ensure a comprehensive range of information is gathered about prospective residents. This would then inform their decision whether a prospective residents needs could be met at the home. There are also policies to ensure an effective pre-admissions process and moving in plans. The age range of residents at the home is from late twenties to early seventies with all residents being male. The majority of residents are assessed has having low needs with two residents assessed as requiring more support from staff in their daily lives. Most residents have lived at the home since it opened eighteen years ago. The home is able to clearly evidence that it is meeting the needs of residents. Residents spoke positively about their experiences at the home with a sample of their comments included best bit is being able to be independent and go out myself and go into Horley I like living here. Relatives commented Allows him to live a very free and easy life with support when needed, he is very settled there it is a great place we are very lucky to have such a good place for him to live and He is really happy there does best get to know him really well and have a good measure of him and have worked hard to get to know him. Residents spoke of being provided with the opportunity to visit the home in advance to assess the quality, facilities and suitability of the home with their family and representative. A resident commented I stayed for a few weekends before moving in to find out if I liked it I also met the staff and other residents. Care Homes for Adults (18-65 years) Page 12 of 31 Evidence: Each resident has a tenancy agreement with the home. This details the terms and conditions of residency and clarifies mutual expectations around rights and responsibilities whilst staying at the home. This document is also provided in a pictorial format to help aid the understanding of its contents. Care Homes for Adults (18-65 years) Page 13 of 31 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from an excellent person centred care planning process, that provides clear, up to date and accurate information about their individual needs and goals and the support needed to achieve them and which are presented in an innovative way with residents actively involved . The home balances well the rights to residents to take reasonable risks as part of an independent lifestyle. Residents are actively involved in the running and in daily live at the home. Evidence: Three individual plans of care were inspected and were found to contain comprehensive, detailed and up to date information on residents needs and the appropriate guidance for staff on how to support residents to meet these needs. Person centre planning is an established and embedded practice at the home with Care Homes for Adults (18-65 years) Page 14 of 31 Evidence: residents actively participating in the development and review of their plans. A resident invited the inspector to view their plan with them which included an electronic version. Their plan reflected their lifestyle, included humour and their personal achievements and was clearly owned by the individual who took much interest in the accuracy of its contents. Staff consulted with were very knowledgeable about the individual support needs of each resident. Any changes in residents needs and preferences are identified promptly through the regular review of care plans. Respecting residents rights to make decisions about their lives is integral to the ethos of the home. Much feedback was received from residents on how they make decisions about what to eat, how to spend their day and what leisure activities to undertake. Any potential restrictions on a residents freedom of choice have been dealt with appropriately through new legislation (Mental Capacity Act) which effects residents rights to make decisions in their lives. The home has a developed system in place for enabling residents to take responsible risks as part of an independent lifestyle. For example core risks faced and posed by residents are assessed and any measures to reduce or mange the risk is recorded for staff to follow. A resident spoke the contents of their risk assessment and was knowledgeable about the actions they take to reduce the assessed risks they faced. A range of ways was seen of how well residents are actively involved in the running of the home with regular meetings and consultations, all of which was confirmed in records and discussions with residents. Residents spoke of how they are responsible for various chores including communal cleaning and maintaining the garden. Staff demonstrated an awareness of good practices about confidentiality, ensuring that sensitive information is kept secure and knowledgeable about the circumstances under which information must be shared with management and others. Staff are also aware that residents have the right to ask that some information not be shared with family or others. Care Homes for Adults (18-65 years) Page 15 of 31 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents lives are enriched by excellent practices in the promotion of independence, meaningful occupation, leisure pursuits, choice and being enabled to live chosen lifestyles. Residents benefit by being supported to maintain relationships with their families and friends. Mealtimes and arrangements for eating are determined by residents with evidence of the promotion of healthy eating Evidence: Central to the ethos of the home is the promotion of residents personal development with a view to enabling an independent lifestyle. Many good examples were noted Care Homes for Adults (18-65 years) Page 16 of 31 Evidence: where residents have the opportunity to maintain and develop social independence, communication and living skills. This includes one to one literacy sessions, college courses and residents actively being supported to maintain their independent lifestyles. Two residents are assessed as needing support in the community and two residents undertake voluntary work in the local community. Residents spoke of the wide variety of community facilities they use including local shops, transport and leisure facilities. To promote independence the home does not provide transport but instead uses local public transport. As part of an independent lifestyles residents largely organise their own leisure pursuits. The organisation employs an activities team who ensures that the home has information about a range of activities and events which residents can organise their own participation in or access with support from staff. Residents spoke of a wide range of leisure activities they undertaken including, water sports, computer gaming, bowling and cinema visits. A residents fedback I tell the staff what I am doing for the week and the staff ensure I have enough money and support for this. For those residents that choose they are enabled to organise various holidays throughout the year, which was clearly an important part of their life. Arrangements are in place to meet residents cultural and spiritual needs, with staff knowledgeable about any residents individual needs. Relatives commented upon how welcomed they are made to feel when they visit, this included being offered beverages or meals and staff being friendly and approachable. A relative said we can phone or call at any time if there is problem they contact us immediately we always feel welcome. Residents spoke about visiting their relatives at their houses with most residents having their own mobile phones in which to keep in contact with their friends and relatives. Residents present as a close cohesive group with some close friendships between the group. One resident spoke of cooking meals for their friends at the home. All residents consulted mentioned flexibility in the daily routines and respect for personal freedom and lifestyles. Several residents spoke of the importance of being able to live an independent lifestyle and how the home enabled them to do this. To enable independence residents plan, buy and cook their own meals with various levels of support from staff depending the individuals capabilities. A resident said I cook for myself I decide what I would like at the beginning of the week and then go and do the shopping but usually I just buy what I fancy. Staff spoke about the support they provide to promote healthy eating and have developed recipe cards to Care Homes for Adults (18-65 years) Page 17 of 31 Evidence: help increase the range of meals being cooked. Care Homes for Adults (18-65 years) Page 18 of 31 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. Residents benefit from personal and health care support that is individual, respects their privacy and dignity and encourages them to remain as independent as possible. The medication systems are well managed promoting good health. Evidence: Staff sated that no residents require any direct personal care, instead, they provide prompting and encouragement to residents to maintain their personal appearance and support residents in accordance with the individuals care plan to achieve their goals. A staff member fedback that the best bit about the home is the independence of residents and the confidence they have to go out on their own. Throughout the course of the inspection staff were consistently observed providing support in a dignified and sensitive manner whilst encouraging the resident to remain as independent as possible. Residents are supported to access a range of health care services, to meet their Care Homes for Adults (18-65 years) Page 19 of 31 Evidence: individual needs and their health action plans. Residents spoke of input in their lives from Gps, specialist nurses, dentists, psychologist and opticians which they would normally attend independently. It was clear that where there are concerns regarding the health or welfare of residents they are encouraged to seek medical advice and intervention promptly or is sought on their behalf by staff with a resident commenting I can call GP whenever I want. The system for the administration of medication are good with clear and comprehensive arrangement being in place to ensure residents medication needs are met. As part of an independent lifestyle residents are actively promotion to self medication which is supported through a risk assessment process to ensure they remain safe to do so. Care Homes for Adults (18-65 years) Page 20 of 31 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. An effective complaints procedure and appropriate adult protection policies helps to protect the rights and interests of residents. Evidence: There is an accessible complaints procedure for residents, their representative and staff to follow should they be unhappy with any aspect of the home. No formal complaints has been received or recorded by the home since the previous inspection. All residents consulted with felt confident to approach any member of staff with any concerns and felt that it would be dealt with promptly. Two relatives stated that where they have had to raise minor concerns in the past these have been dealt with promptly by the manager with one relative saying we had to raise minor niggles in the past and Lee will address them or at least explain why he ca n not, we do not always agree but staff always ensure that any decisions are in the residents best interest. The home has written policies covering adult protection and whistle blowing. These make clear the vulnerability of people in residential care, and the duty of staff to report any concerns they may have to a responsible authority for investigation. Staff have received formal training in safeguarding adults and prevention of abuse and the staff consulted with showed a good understanding of their roles and responsibilities under safeguarding adults guidelines. Care Homes for Adults (18-65 years) Page 21 of 31 Care Homes for Adults (18-65 years) Page 22 of 31 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. Residents live in a clean, homely environment, which has been decorated and furnished to a good standard with their bedrooms furnished and decorated according to their individual lifestyles. Evidence: The inspector was shown around the communal areas of the home by a resident. The home is ideally located near to Horely town centre and transport links, several residents indicating how important this closeness was to being able to maintain their independence. The home is generally well decorated and maintained, the manager confirmed that repairs and maintenance are usually done fairly promptly by the housing association that owns the building. Much effort is made to create a relaxed homely feel, some further redecoration has been undertaken since the last inspection this has included redecoration of further bedrooms, lounge and kitchen area. The home is set in its own grounds with a large garden at the front and smaller garden at the rear which residents are responsible for maintaining. Residents spoke of enjoying sitting out in the garden and having barbeques during the summer. Residents invited the inspector to view their bedrooms, which had all been Care Homes for Adults (18-65 years) Page 23 of 31 Evidence: individualised to reflect their lifestyles, with all residents consulted confirming that their bedrooms had everything they needed. Residents spoke about choosing to have double beds and cable television. All residents are provided with locks for their bedroom doors, with staff only entering into residents bedrooms upon invitation. Residents are responsible for cleaning their own bedrooms, the lifestyles of some residents and the promotion of independence and the level of respect and privacy afforded means that some bedrooms were not always cleaned by the resident to an acceptable standard. Staff were however mindful of issues effecting health and safety and the point at which they would need to intervene to ensure safety. There are sufficient number of toilets and bathrooms located around the home. In one shower room there was some mould present, which the manager was aware off and agreed to address promptly. Communal areas of the home were clean with residents responsible for maintaining the hygiene and cleanliness of the overall home. The home is not designed to offer a service to people with a permanent physical disabilities and the stairs and other access arrangements would make it unsuitable for residents with significantly restricted mobility. Currently no residents need any specialist equipment or adaptations to promote their independence. Care Homes for Adults (18-65 years) Page 24 of 31 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 make a positive contribution in residents lives as residents benefit from a supervised, well trained and enthusiastic staff team that know them and who are robustly recruited and employed in sufficient numbers as is necessary to meet their needs. Evidence: It was observed through the inspection that staff understood their roles and had a good rapport with residents and planning skills. The tasks of the day appeared wellorganised and individual staff appeared confident in carrying them out. This helped ensure that residents knew who was available for support. Staff consulted with had a clear understanding of the aims of the home and how their individual role contributed towards achieving this. Residents felt that there was always sufficient staff around for them to get the support or advice they needed when they wanted it. Staff confirmed that there is some flexibility in the staffing hours should they need additional cover. There is a small stable staff team who have worked at the home for some time and who knew the residents well and were observed providing appropriate levels of support. Humour was Care Homes for Adults (18-65 years) Page 25 of 31 Evidence: observed to be used successfully in communicating with one resident, which promoted relaxed friendly interactions with staff. A sample of comments made about staff included all the staff are caring helpful and supportive especially if I am unwell very nice staff are all very good and The support is very good speak regularly to staff on the phone who are very knowledgeable The manager reported that there is little staff turnover and therefore limited recruitment. The organisation has a recruitment panel where residents are invited to be a part of the panel. A resident was actively involved in the recent recruitment process for the deputy manager at the home. Two staff files where looked at which showed that robust recruitment practices are followed by the organisation to ensure that only staff who are safe to work with vulnerable people are employed. The home has been proactive in ensuring that all staff have undertaken a National Vocational Qualification (NVQ ) in Care. There is a commitment to improving staff skills through an ongoing training programme both in practical matters and the broader aspects of working with people who have learning disabilities. Staff spoke of selecting which courses they would like to attend from the range of course provided by the organisation. Staff consulted with confirmed that they had undertaken all of the mandatory areas of training needed to works safely with residents including medication, manual handling, safeguarding adults. A staff member spoke of undertaking some specialist training in epilepsy, bereavement and mental health conditions. The manager confirmed that new staff would undertaken a skills for care induction, which is the industry recommended minimum inductions standards. Staff confirmed that there is a formal programme of monthly supervision and direct supervision with the manager working along side support staff each shift. All staff consulted with felt well supported by the manager to undertake their roles. Care Homes for Adults (18-65 years) Page 26 of 31 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from a well-motivated and knowledgably manager who promotes good practices in independent living, strong leadership and runs the home in the best interest of residents. The home regularly reviews aspects of its performance through an excellent program of self-review and feedback. A range of regular health and safety checks helps to promote the health and safety of residents and staff. Evidence: The manager has been managing the home for four years and they hold the recommended management qualifications and have undertaken ongoing training to keep updated in best care practice issues and changes in legislation. They demonstrated much commitment and understanding of the promotion of independence Care Homes for Adults (18-65 years) Page 27 of 31 Evidence: and in the daily running of a care home. They provide a strong sense of leadership and direction which enables staff to then provide good individual support. A sample of comments about the manager included Lee very good is very much on top of things Lee very fair very supportive open to new ideas if we suggest he will try and Lee I like him he listens to me. There are several mechanisms in place for the manager to obtain feedback on the services of the home and whether it is achieving its aims and objectives. These include, annual placement reviews, residents and staff meetings, internal quality audits, written feedback from relatives and health care professionals. Tenants meetings are also held quarterly by an independent facilitator where residents confirmed they have the opportunity to discuss any issues that are effecting them or areas in which the home could improve. Examples were noted whereby improvements to the homes documentation, working practices and the environment have been made based on this feedback. Written guidance is available on issues related to health and safety. Records submitted by the manager prior to the inspection stated that all of the necessary servicing and testing of health and safety equipment has been undertaken. There are regular health and safety checks around the building. Systems are in place to support fire safety, which include: regular fire alarms and emergency lighting checks, staff training and maintenance of fire equipment and fire drills were reported to have been undertaken. The manager reported that a fire risk assessment has been undertaken by a fire safety officer. This records significant findings and the actions taken to ensure adequate fire safety precautions in the home. Care Homes for Adults (18-65 years) Page 28 of 31 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 29 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 30 of 31 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. 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