Inspection on 20/05/10 for Andlaw House

This is the latest available inspection report for this service, carried out on 20th May 2010.

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

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Andlaw House 20/06/07

Andlaw House 10/11/05

Andlaw House 26/01/05

Andlaw House 02/08/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 17/07/2010.

Random inspection report Care homes for adults (18-65 years) Name: Address: Andlaw House 126 Bartholomew Street West Exeter Devon EX4 3AJ three star excellent service The quality rating for this care home is: The rating was made on: 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 review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Judith McGregor-Harper Date: 2 0 0 5 2 0 1 0 Information about the care home Name of care home: Address: Andlaw House 126 Bartholomew Street West Exeter Devon EX4 3AJ 01392490366 01392490399 Telephone number: Fax number: Email address: Provider web address: www.sense.org.uk Name of registered provider(s): Name of registered manager (if applicable) Mr Nicholas Stephen Banwell Type of registration: Number of places registered: Conditions of registration: Category(ies) : Sense, The National Deafblind and Rubella Association care home 10 Number of places (if applicable): Under 65 Over 65 0 0 0 learning disability physical disability sensory impairment Conditions of registration: Age Range:- 18 to 50 years Date of last inspection Brief description of the care home 10 6 10 Andlaw House is a two-storey purpose built home, close to the centre of Exeter. It is divided into two flats with separate staff teams. However it is registered as one home. There are also garden areas that are accessible to people living at the home. Please contact the provider for the current range of fees. Care Homes for Adults (18-65 years) Page 2 of 11 Brief description of the care home Care Homes for Adults (18-65 years) Page 3 of 11 What we found: This was a routine random inspection carried out on one day by one inspector. As part of this inspection we reviewed the requirement made at the last key inspection in 2007. We focused the remainder of our inspection on viewing records in relation to assessment and admission of people moving into the home, on-going and changing care needs, risk assessment of the individual, medication management, staff recruitment, the homes environment, management of the home and health and safety measures. Choice of home. We discussed admission and transition processes for people who come to live at Andlaw House with the manager and we looked at two current care and support plans. We saw that the home takes clear and reasoned steps in assessing people fully before they move into the home, so that the staff and service facilities can meet peoples assessed needs. Introductory visits are planned as part of the transitional process. Individual needs and choices. We looked closely at the plans of care for two people living at the service. There was a great deal of detail about peoples abilities and staff requirements for additional support where people are unable to act for themselves. There was also recorded regular review of peoples needs. We saw that care plans were written in the first person, as though the person had written or dictated their plan of care. We discussed with the manager whether this was an accurate reflection of the amount of input people had contributed toward their plans of care. We recommend that in order to demonstrate a person centred approach to care plan recording that plans avoid being written in the first person unless this accurately captures instruction from the person and that their agreement with the plan of care is duly recorded. When touring the home we noticed that staff use listening monitoring devices for people who are at risk of epilepsy and/or sleep apnoea. The manager assured us that the use of listening devises had been considered in terms of affecting a persons right to privacy and that such considerations had been recorded. We saw that on-going and detailed best interest assessments were being maintained for some people. These had not, however, been preceded by assessments of mental capacity, as they must be. Lifestyle. On the day of the inspection some people had gone away on a short-break camping holiday. Other people were coming and going from the building with staff assistance accessing local services and facilities. The atmosphere at the home was relaxed and welcoming. The service has vehicles for transporting people to access community events; transport includes facilities for wheelchair users. Care Homes for Adults (18-65 years) Page 4 of 11 Personal and health care support. Prior to the inspection we received feedback in surveys about the service from five visiting health and social care professionals. The tone from all responses was positive and praiseworthy regarding how the service is managed and how staff care for people living at Andlaw House. One professional (and one staff survey respondent) raised a query to whether there could be better use of new technologies to enable communication at the service to facilitate promoting choices for people. We raised this with the manager and we were able to see that the service has invested in equipment to assist communication and that this has been set up for use. We also received two survey responses from two families of people living at the service. These survey returns told us that the families were very happy with the care provided to their relative living at the home. We looked at two peoples plan of care regarding their physical health. We saw that the plans had a lot of detail and were regularly reviewed in consultation with community based specialists. We saw that community nurses had delegated some tasks to staff and had assessed the staff as competent for performing duties such as, for example, administering enemas. The health care plan was kept in a separate file from the other plans of care for people. We put the suggestion to the manager for his consideration that a holistic plan of care would not separate health care from a persons general care and support plan. We looked at medication management in the home and medication records. Generally they were maintained well. We saw that for two people the variable dose of their as required medications had not been recorded. This is recommended in order to establish a therapeutic dose of medicine. We raised this with the manager who said that he would arrange for variable doses to be included in the care plan review of as required medicines. This would constitute good practice. Concerns, complaints and protection. The Annual Quality Assurance Assessment (AQAA) submitted to us prior to the inspection told us that the service has received no complaints in the last 12 months. We have not received any complaints about the service directly during this time frame. The service has demonstrated in the last 12 months that it appropriately instigates safeguarding processes in order to protect people who live at the home. Environment. We toured the home and saw that it was clean. We looked at communal spaces. We saw that bathroom and shower rooms had suitable equipment to support people with mobility difficulties. We noticed that some bathroom lights were positioned such as they shone above where peoples faces would lie in baths. We suggested that the home investigate Care Homes for Adults (18-65 years) Page 5 of 11 this further to whether this detracted from the relaxing experience of bathing. We saw that the home was decorated as to provide colour contrasting schemes for people with impaired vision to enable them to better appreciate their location within the home surroundings. We asked if specialist advice had been sought regarding the colour schemes used. We were told it had not and we suggested that further research/advice would assist the service in promoting best current practice in this respect. We discussed with the manager how soiled linen is handled in the home and laundered and we saw the laundry facilities in the home. We recommended to the manager the use of red alginate bags for soiled laundry and, wherever possible, the ceasing of the practice of hand sluicing of soiled laundry, in order to minimise the risk of cross infection at the service. We acknowledge that during the inspection the manager was able to locate some red alginate bags for immediate staff use. We noticed that a clinical waste bin was situated by the main entrance. We suggested that an alternative place for its storage would be preferable to visitors. The home has taken appropriate action to comply with a fire notice issued in 2009. Staffing. At the last key inspection for this service a requirement was made with regard to staff recruitment processes. We checked two staffing files at random and saw that action had been taken to meet the requirement fully. We saw that robust processes were followed to prevent people who are unsuitable to work with vulnerable adults from gaining employment at the service. Prior to the inspection we had received six survey returns from staff working at the home. All respondents told us that they had undergone background checks before starting work at the home. We also looked at staff training records and the staff training plan. The AQAA acknowledged that there were some areas where staff need staff training or training updates. We could see that progress is being made to address such gaps. We saw that some training carried out from the home was not included in the training plan excel spread sheet. We suggested that it could be useful to record all such training on the computerised record for ease of access and to facilitate future training needs planning. We discussed comments received from staff surveys and we agreed with the manager that we will recommend that there be staff training arranged to explore ways in which communication can be further improved between hearing staff and staff with hearing loss. We could see how such training would reap the additional benefit of improved communication between staff and people living at the home who have hearing impairment. We were informed that almost three quarters of staff who work at the home hold a care qualification to at least level 2 NVQ. In the AQAA the manager accepted that scheduled staff supervisions had not been taking place as often as he would like. He has developed plans, however, to remedy this. Staff survey returns echoed the patchy nature of supervisions. Care Homes for Adults (18-65 years) Page 6 of 11 Conduct and management of the home. The manager completed and submitted an AQAA to us prior to the inspection. It gave us the information we asked for and it was completed in a way as to reassure us that the manager is aware of what the strengths of the service are and, importantly, where the service needs to further improve. We looked at accident recording in the home and we could see that staff are aware of the process to follow should someone have an accident. We noted that in one entry the language used to describe an accident was inappropriate. The manager said this would be followed up and staff reminded of the need for appropriateness of language in official documents. Accidents are monitored to assess for patterns or trends so that remedial action or care planning changes can be made. What the care home does well: 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 2. Care Homes for Adults (18-65 years) Page 7 of 11 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 8 of 11 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, 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 7 12 Mental Capacity Act assessments must be completed prior to best interest assessments being commenced. In order to demonstrate that you have considered a persons ability to make a decision themselves before involving other people in taking decisions on their behalf. 27/08/2010 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 6 Care plans should avoid being written in the first person unless this accurately records verbal instruction from the person and that their agreement with the plan of care has been recorded. Variable doses of medicines should be recorded on the medicine administration record in order to establish a therapeutic dose of the medicine. 2 20 Care Homes for Adults (18-65 years) Page 9 of 11 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 3 30 Hand sluicing of soiled linen should be avoided and the use of alginate laundry bags should be considered as an alternative practice to hand sluicing. We recommend that staff training be arranged to explore ways in which communication can be further improved between hearing staff and staff with hearing loss. 4 35 Care Homes for Adults (18-65 years) Page 10 of 11 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or got 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 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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