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Inspection on 11/01/10 for 109 Higham Road

Also see our care home review for 109 Higham Road for more information

This is the latest available inspection report for this service, carried out on 11th January 2010.

CQC found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Records show that where they are able to people sign their care plans to show that they agree with what has been written. The majority of people living at the home told our expert by experience that they had been involved in putting together their care plans. People told us that they were involved in the running of the home. Staff told us that people usually go on holiday twice a year with their main holiday in May and a short break in the winter. People told expert by experience that they can chose whether they have a male or female staff member to help them with their personal care. One person told us "It is alright living here - you can have what you like in your bedroom." One person told us ""staff are helpful, they know what I like."

What has improved since the last inspection?

A risk assessment has been completed for the steps at the front of the property. Records show that the necessary pre recruitment checks have been completed for staff prior to the working in the home. A new kitchen has been fitted and the carpets on the hall, stairs and landing has been replaced.

What the care home could do better:

Assessments of risk do not consistently detail the actions staff should take to minimise the risk. Some of the information in people`s individual plans of care is not dated. The home does not have any facility to store controlled drugs safely in line with the latest requirements of the Misuse of Drugs Act Amendment 2007. Our expert by experience noted that there was an unpleasant odour in parts of the home. There was no record of satisfaction surveys being carried out in 2009 for the people who live at the home, their relatives or staff members.

Key inspection report Care homes for adults (18-65 years) Name: Address: 109 Higham Road 109 Higham Road Rushden Northants NN10 6DS     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: Catherine Perrins     Date: 1 1 0 1 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 27 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 27 Information about the care home Name of care home: Address: 109 Higham Road 109 Higham Road Rushden Northants NN10 6DS 01933358429 01933358606 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: www.caremanagementgroup.com Care Management Group Ltd (trading as CMG Homes Ltd) care home 6 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: To include 2 service users over the age of 65 years LD(E) Date of last inspection Brief description of the care home 109 Higham Road is a care home providing accommodation and personal care for six adults with a learning disability. It is owned by Care Management Group Ltd and is situated close to Rushden and to Higham Ferrers town centres. It is in close proximity to all local amenities, with good transport links by bus to Wellingborough and Northampton. Higham Road is a detached house in a residential street with a pleasant rear garden. All residents are accommodated in single bedrooms. Communal areas consist of a lounge, a pleasant dining room overlooking the garden, and a kitchen. The garden is enclosed and used during the summer for barbecues and other outside activities. Current fees range from 570.97 to 1066.06 pounds per week and exclude the cost of chiropody, hairdressing, clothing and personal items such as toiletries. 2 1 0 1 2 0 0 9 6 Over 65 0 Care Homes for Adults (18-65 years) Page 4 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is two star. This means the people who use this service experience good quality outcomes. This was an unannounced key inspection which means that we focused on the key national standards. The key standards are those considered by the Commission to have the most impact on outcomes for people using the service. As part of the preparation for this inspection a period of three hours was spent reviewing the information that CQC has about this service. We looked at all the information that we have received, or asked for, since the last key inspection. This included: The annual quality assurance assessment (AQAA) that was sent to us by the service. Care Homes for Adults (18-65 years) Page 5 of 27 The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. Information we have about how the service has managed any complaints. What the service has told us about things that have happened in the service, these are called notifications and are a legal requirement. The previous key inspection and the results of any other visits that we have made to the service in the last 12 months. Relevant information from other organisations. The inspection visit lasted six hours during the morning and afternoon of a weekday. During the inspection two people were case tracked. This involves looking in detail at all aspects of their care and experiences at 109 Higham Road, including looking as their individual plans of care and other records, talking to them and talking to their care staff. Because people with learning disabilities are not always able to tell us about their experiences we also used observations of peoples state of well being and how they interacted with staff members and others. A sample of staff files were also viewed as part of the inspection. The registered manager was present for the inspection. An expert by experience assisted with the inspection. Experts by experience are people who have experience of using social care services. The expert by experience spoke to people who live at the home and their relatives and spoke to staff. She also made observations based on her experience. Comments made by the expert by experience have been included throughout this report. Care Homes for Adults (18-65 years) Page 6 of 27 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. Care Homes for Adults (18-65 years) Page 7 of 27 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 8 of 27 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 9 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are given good information and their needs are assessed before they move to 109 Higham Road to make sure that it is the right move for them. Evidence: The home has a statement of purpose and service user guide which give people good information about the home and the services it offers. The service user guide contains pictures and is written in a way that makes it easier for people with learning disabilities to understand. Records show that peoples needs are assessed before they move to 109 Higham Road to make sure that the home is right for them. The manager explained that people are able to visit the home before they move in to help them decide if it is the right move for them. No-one new has moved to the home since the last inspection. Care Homes for Adults (18-65 years) Page 10 of 27 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. People have their support needs met and have opportunities to make everyday choices and decisions. Evidence: Each person who lives at the home has an individual plan of care. This contains their care plans and other information that staff need to care for people in the right way. Care plans seen covered areas such as health needs, psychological support, communication, daily living and self care skills, relationships, employment and education, recreation, cultural and spiritual needs and finances. They contained some detail about peoples preferences such as what time they liked to get up and go to bed. There was evidence of people being helped to make choices such as what clothes they wanted to wear. Records show that where they are able to people sign their care plans to show that they agree with what has been written. Each area of the care plan contains a section where the person can note any comments that they might have about the plan. One of the people that we case tracked had made several comments Care Homes for Adults (18-65 years) Page 11 of 27 Evidence: in their care plan. The majority of people living at the home told our expert by experience that they had been involved in putting together their care plans. Individual plans of care contained assessments of the risks people living in the home face from the environment and the various activities that they do. There was evidence of these being reviewed and update since the last inspection, but although records show that staff are given some guidance within these assessments on how to reduce the risks, this is not always comprehensive. For example the risk assessment for one person detailed that they are at risk of falling. It stated that staff received training in first aid and that they had a good awareness but did not state what other measures were in place to help prevent the person from falling. The manager stated that the shift times of the early morning shift had been altered in order to reduce the risk to this person but this was not recorded in the risk assessment. Some of the information in peoples individual plans of care is not dated. For example one person had a daily profile A day in my life which contained information about how they liked to be supported but as it was not dated it was not possible to determine from the records whether the information was current. As well as their individual plan of care file each person has a diary. Staff use these to record detailed daily notes such as what the person has been doing, any changes to their routine and any other significant information. This helps staff to monitor peoples well-being and to ensure that important information is accessible to all staff members. People told us that they were involved in the running of the home. One person who lives at the home explained that, Staff help me go to Iceland - I like going there, I push the trolley and put food in. another person told us that everyone takes turns to cook. On the day of inspection people were seen dusting and cleaning the house. People told us that they have a key worker who they have a meeting with once a month so they can discuss their care plans and the support that they receive. People said that their key workers also help them to buy clothes and other personal items. Care Homes for Adults (18-65 years) Page 12 of 27 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at 109 Higham Road are encouraged to be independent and have various activities available that enable them. Evidence: The manager explained that between ten oclock in the morning and three oclock in the afternoon people living at the home can take part in various activities which are usually done in the dining room. On the day of inspection a group of people went out to a local cafe for a drink. One person told us that they Sometimes go out on mini bus which the home has. Another person told us that they like to go the Salvation Army for a cooked breakfast. Another person commented that I like listening to pop music in my room. One person told our expert by experience that there was nothing to do at night. Menus were seen and looked varied and nutritious. One person told us that the food Care Homes for Adults (18-65 years) Page 13 of 27 Evidence: is good - I help cook. Staff explained that people take it in turns to cook the main meal of the day. Staff told us that people usually go on holiday twice a year with their main holiday in May and a short break in the winter. One person told us that they go on holiday on an aeroplane to the beach. Care Homes for Adults (18-65 years) Page 14 of 27 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have their health and personal care needs met. Evidence: Records show that people have access to a range of different health and social care professionals such as general practitioners, psychiatrists, dentists, opticians and chiropodists. People told expert by experience that they visit the doctors and dentist. People told expert by experience that they can chose whether they have a male or female staff member to help them with their personal care. The administration of medication is generally well managed with all entries on the medication record being signed to show that people are receiving their medication as prescribed. The home does not have any facility to store controlled drugs safely in line with the latest requirements of the Misuse of Drugs Act Amendment 2007. This specifies how care homes should store controlled drugs. Controlled drugs are prescribed medicines which some people abuse them by taking them when they have not been prescribed, there are laws and regulations about how these drugs should be stored and administered. Care Homes for Adults (18-65 years) Page 15 of 27 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are protected by the procedures in place for handling complaints. Evidence: The home has a complaints procedure which outlines what people should do if they wish to raise a concern about the home and the response that they can expect. This was available in an accessible format to help the people living at the home understand the information about how to raise any concerns that they may have. People told us that they would raise concerns with their key worker or with the manager of the home. Records show that the home has received one complaint since the last inspection, this was dealt with by the home in line with their procedures and resolved to the satisfaction of all. One person indicated to our ex by ex that they were not happy with the staff support that they receive. This was discussed with the registered manager. There have not been any referrals made about the home to the Local Authority under the locally agreed safeguarding adults procedure. Staff spoken to had a good knowledge of how to safeguard adults and their responsibilities under the locally agreed procedures. Care Homes for Adults (18-65 years) Page 16 of 27 Evidence: The home have not made any applications to the Local Authority under the deprivation of liberty safeguards and observations made during the inspection suggest that people are able to move around the home freely and do not have any restrictions placed on them. Care Homes for Adults (18-65 years) Page 17 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have a safe and comfortable place to live. Evidence: 109 Higham Road is a detached property in a residential area with a range of facilities in the local area. Communal areas include a lounge and dining room both of which have pictures, ornaments and plants to give them a more homely feel. A number of holiday photographs of the people living at the home were displayed in the lounge. All of the bedrooms in the property are single and have a wash basin in. Bedrooms seen had been made personal with photographs, posters, ornaments and other personal items. One person told us It is alright living here - you can have what you like in your bedroom. Our expert by experience noted that there was an unpleasant odour in parts of the home. The manager explained that the were plans to replace the floor covering in one persons bedroom. Radiator covers were noted to be in place for the majority of radiators in the property Care Homes for Adults (18-65 years) Page 18 of 27 Evidence: to ensure that people do not burn themselves on the hot surfaces. The radiator on the first floor landing was observed not to have a cover. The home has an enclosed rear garden with an outhouse which is used as a laundry room. The property appeared generally well maintained with adequate furnishings and facilities. Care Homes for Adults (18-65 years) Page 19 of 27 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. Suitably trained staff in adequate numbers ensure peoples needs can be met. Evidence: One person told us staff are helpful, they know what I like. The recruitment of staff is well managed with all of the necessary pre recruitment checks being carried out to ensure that staff are suitable to work with people with learning disabilities. Staff told us that they had an induction when they first started working at the home which included working alongside an experienced colleague to make sure that they had all of the information that they need to do their job in the right way. Staff explained that they attend training courses such as food hygiene, safeguarding of adults, dementia care, infection control, fire safety and moving and handling. Staff explained that they do some training by e learning which they can do on their computers at home. Staff explained that they are tested after they have completed the e learning to ensure that they have understood the main points of the training. One person indicated to our ex by ex that they were not happy with the staff support Care Homes for Adults (18-65 years) Page 20 of 27 Evidence: that they receive. This was discussed with the registered manager. Care Homes for Adults (18-65 years) Page 21 of 27 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management arrangements at the home ensure that the people living in the home have their needs met. Evidence: The registered manager has worked at the home for a number of years and discussions with her showed that she has a good understanding of the needs of the people who live at 109 Higham Road. Records show that the necessary safety checks such as fire checks, checks on the water system and portable appliance testing have all been carried out recently. Hoists and lifting equipment has been serviced as per manufacturers recommendations. Records show that the risks posed by the steps at the front of the property have been assessed. Records show that the people who live in the home have a monthly meeting facilitated by staff where they can discuss the running of the home. Care Homes for Adults (18-65 years) Page 22 of 27 Evidence: There was no record of satisfaction surveys being carried out in 2009 for the people who live at the home, their relatives or staff members. Care Homes for Adults (18-65 years) Page 23 of 27 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 24 of 27 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 1 20 13 The storage of medication must be reviewed to ensure that the home is able to store any controlled drugs safely and to ensure compliance with the latest requirements of the Misuse of Drugs Act Amendment 2007. To ensure that all medication can be stored safely. 30/05/2010 2 30 16 The home must be kept free from offencive odours. To ensure good hygiene and a pleasant living environment. 31/03/2010 3 39 24 A quality review system must be maintained which includes consultation with the people who live at the home and their representatives. 31/03/2010 Care Homes for Adults (18-65 years) Page 25 of 27 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 To ensure that the service is meeting peoples expectations. 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 9 Risk assessments should be further developed to ensure that all the measures in place to reduce any risks are documented and to give staff clear instructions of how to keep people safe. Care Homes for Adults (18-65 years) Page 26 of 27 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. 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