Inspection on 26/10/09 for Melbreck

This is the latest available inspection report for this service, carried out on 26th October 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Melbreck 20/03/07

Melbreck 22/06/06

Melbreck 25/11/05

Melbreck 04/04/05

Melbreck 17/01/05

Melbreck 01/10/04

Melbreck 04/08/04

Melbreck 28/04/04

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Southfields

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Extracts from inspection reports are licensed from CQC, this page was updated on 16/02/2010.

Key inspection report Care homes for adults (18-65 years) Name: Address: Melbreck Tilford Road Rushmoor Farnham Surrey GU10 2ED     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: Suzanne Magnier     Date: 2 6 1 0 2 0 0 9 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 34 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 34 Information about the care home Name of care home: Address: Melbreck Tilford Road Rushmoor Farnham Surrey GU10 2ED 01252793474 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: melbreck@robinia.co.uk Robinia Care Ltd care home 26 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability physical disability Additional conditions: The maximum number of service users who can be accommodated is: 26 The registered person may provide the following category/ies of service only: Care home with nursing - N 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 Physical disability - PD Date of last inspection Brief description of the care home Melbreck is a substantial detached property supporting 26 people who have a learning disability and or a physical disability aged between 18 and 65 years. The home is located in a rural area near Farnham. The accommodation has 24 single rooms with one double room. There is a large enclosed garden which has raised flower beds, fruit trees, lawns and pathways which are accessible for people to use in wheelchairs. Care Homes for Adults (18-65 years) Page 4 of 34 Over 65 0 0 26 26 Brief description of the care home There is a large hydrotherapy pool which at the time of the report needs to be refurbished and a greenhouse is avialbale for people to use. The home offers an on site physiotherapy department and an activities centre which is managed by a qualified occupational therapist. The home has two adapted vehicles for people to use with staff support. Adapted bathrooms and toilets contain specialist moving and handling equipment to support people safetly with their mobility. The home has two passenger lifts and a stairlift within the property. All people using the service have their own bedroom, apart from one shared room. Communal areas within the home include lounges and dining areas. Parking is available at the front and the rear of the building. Care Homes for Adults (18-65 years) Page 5 of 34 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. This inspection of the care home was an unannounced Key Inspection carried out by Ms S Magnier Regulation Inspector. The registered manager represented the service throughout the inspection. For the purpose of the report the individuals using the service are referred to as residents. The inspector arrived at the service at 08.30 and was in the home for eight hours. It was a thorough look at how well the home is doing and took into account detailed information provided by the home and any information that the commission had received about the service since the last inspection on the 14th November 2007. As part of this key inspection the commission invited an expert by experience and an Care Homes for Adults (18-65 years) Page 6 of 34 assistant from My Life My Choice to be part of the visit in order to be with and observe residents and staff in the home about their experiences of the home. The expert by experience and assistant have produced a report and the findings have been included within this document. The home had submitted the Annual Quality Assurance Assessment AQAA prior to the inspection, which was very well written to inform the commission about the service and some details of the document have been added to the report. The commission did not receive any completed surveys from residents. Three completed surveys from health care professionals and one survey completed by a staff member was received the comments of which have been included within the report. The inspector spent time touring the home with the registered manager which also included talking to and observing the body language of the residents living at the home and with staff members in order to gain their views and opinions about the service. The inspector looked at how well the service was meeting standards and has in this report made judgements about the standard of the service. Documents sampled prior and during the inspection included the homes Annual Quality Assurance Assessment AQAA, the Statement of Purpose and Service User Guide, care and person centred plans, risk assessments, medication procedures, a variety of training records, several staff recruitment files and several of the services policies and procedures including complaints and safeguarding. No complainant has contacted the Commission with information concerning a complaint made to the service since the last inspection and no safeguarding referrals have been made since the last inspection. From the evidence seen by the inspector and comments received, the inspector considers that the home continues to be able to provide a service that meets the needs of people who have diverse religious, racial or cultural needs. Care Homes for Adults (18-65 years) Page 7 of 34 What the care home does well: Prospective residents and their representatives have up to date information regarding the home so they can make an informed choice about using the homes services and facilities. The admission and assessment procedures ensure that residents needs are appropriately identified prior to moving into the home in order to ensure that the homes staff have the skills, abilities to meet the residents care and support needs. Residents benefit from being supported to maintain control in their lives and are given opportunity to demonstrate in their own way how they receive support and care from staff. The support and personal care that residents receive is based on their individual needs set out in their care plans and associated documents which are well managed and maintained. Residents care plans were up to date and the provision of personal care and support were robustly documented. The monitoring of risk assessments is well managed to ensure the residents safety and well being and promotes their rights to take risks in their daily lives. Residents are able to exercise some choice in their daily lives, maintain bonds with family and friends and take part in social, cultural, religious and recreational activities if they choose to. Residents are encouraged to maintain their daily living skills and a choice of a healthy diet is provided. Residents physical, emotional and health care needs are monitored and met. Choice, respect and dignity is consistently promoted. The homes medication procedures ensure that medication is administered to all residents in a safe and appropriate way. The homes complaints procedure is an accurate document for residents or people associated with the home to express any concerns or complaints. Procedures are in place to protect residents from abuse and harm. Staff receive safeguarding vulnerable adults training to promote residents rights to be safeguarded from abuse or harm. Areas within the home were clean and hygienic. The homes recruitment practises, induction and mandatory training of staff is consistent to ensure that residents needs are appropriately and safely met and staff have equal opportunities with regard to their own professional development. The home continues to be run in the best interests of the residents. Care Homes for Adults (18-65 years) Page 8 of 34 The management and administration of the home is consistent and robust. Residents welfare is promoted through the robust monitoring of health and safety in the home. 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. 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 34 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 34 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents and their representatives have up to date information regarding the home so they can make an informed choice about using the homes services and facilities. The admission and assessment procedures ensure that residents needs are appropriately identified prior to moving into the home in order to ensure that the homes staff have the skills, abilities to meet the residents care and support needs. Evidence: The Statement of Purpose and Service User Guide provided some evidence of the services and facilities offered to residents living in the home yet there was no indication when the document had been updated. The documents contained out of date information regarding Robinia and the Care Quality Commission and it was concluded that the documents were not accurate in informing prospective residents or their representatives about service. The registered manager was prompt in addressing the shortfall and has advised the commission following the inspection that the documents have been updated in order that prospective residents or their representatives have sufficient information to help Care Homes for Adults (18-65 years) Page 11 of 34 Evidence: them make an informed choice about living in the home. Three residents care plans were sampled who had been admitted to the home since the previous inspection. There was evidence to support that the registered manager had gathered written information prior to the prospective resident moving into the home in order to ensure that the home had the appropriate facilities, equipment and staff had appropriate skills and abilities to safely support the individual. The pre admission documentation was well written to detail the needs of the resident and included care needs assessments which had been developed whilst the resident had been supported in another care environment and included written assessments from other health care professionals. Care Homes for Adults (18-65 years) Page 12 of 34 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. Residents benefit from being supported to maintain control in their lives and are given opportunity to demonstrate in their own way how they receive support and care from staff. The support and personal care that residents receive is based on their individual needs set out in their care plans and associated documents which are well managed and maintained. The monitoring of risk assessments is well managed to ensure the residents safety and well being and promotes their rights to take risks in their daily lives. Evidence: The registered manager confirmed that each resident has a care plan and the home have maintained a system whereby each resident has a member of staff allocated as their key worker. The home have recently introduced a person centred planning approach and five care plans have been updated using the new documentation. Of the three care plans Care Homes for Adults (18-65 years) Page 13 of 34 Evidence: sampled one was partly completed using the new style of recording. The existing recording of two care plans demonstrated that the care provided to residents had been fully assessed, recorded and agreed working practises were in place to support the resident on a daily basis and which clearly informed the staff member how the resident liked or preferred to have staff support them in a predicable and consistent way. The care plans were thorough and clear and although based on a nursing model reflected the care to be provided to the resident in a way which demonstrated a holistic and person centred approach. Due to the complexities of the residents needs and communication staff had completed the care plans and agreed working practises on behalf of the residents. Some information had been obtained by the residents family and other health care professionals involved in the support of the resident. Where residents were unable to clearly demonstrate their views and opinions these had been interpreted by staff and each resident had a communication passport which assisted staff to understand the way in which the resident communicated and what specific tones or behaviours meant. The person centred plan sampled, taking into account it was not fully completed, was well assembled and evidence gathered had been transferred from an existing care plan. There was little difference between the information sampled from the existing care plan yet the person centred plan could be developed by use of photographs, significant events in the residents life, holiday memories and would help the reader in this format to get to know the resident and their life history, in a different way. Both systems included the residents likes and dislikes, documented choices in their lives for example getting up, going to bed, their daily routines, some goals and aspirations which had been interpreted by staff or family members of the resident, meaningful activities and people that are important to them in their lives. There was evidence to support that the staff were aware of residents rights to gender specific care, how they liked to be addressed and spoken to, their level of sensory awareness and their mobility and assistance needed with moving and handling. The home has incorporated written consent which is obtained from the residents representatives for the use of photographs within any of the homes documentation in order to ensure that residents rights to privacy and dignity are promoted and maintained. It was acknowledged that residents living at the home were unable to sign their care plans due to their individual limited abilities. This detail was not consistently recorded Care Homes for Adults (18-65 years) Page 14 of 34 Evidence: in the care plans sampled and should be recorded on each plan on behalf of the resident. It was noted that there was evidence within the residents care plans that a formal reviews of their care plan had been undertaken at regular intervals in order to ensure that the changing needs of the resident are identified and changes acted upon for the safety and welfare of the resident. It was confirmed that residents relatives remain involved in their loved ones care ans support and the home have made some enquiries regarding a local advocacy group to become involved in the support of residents when necessary. Residents daily notes covering a twenty four hour period were sampled and included the activities the resident had taken part in. The records were well recorded and were written in a way which respected the resident and considered as positive in promoting the residents rights to individuality and confidentiality. During the inspection it was noted that there was a calm atmosphere throughout the home and residents appeared to be generally content. One resident was distressed and staff were on hand promptly to support the resident and try to reassure them. Staff were observed to preserve and maintain residents dignity and privacy by knocking on their room doors prior to entry and supporting residents discreetly regarding personal care. It was noted that attention needs to be paid to the amount of notices within residents rooms and also in some communal areas of the home which may infringe residents rights to privacy and confidentiality. Where notices within rooms are deemed necessary to assist staff in supporting residents then, it has been suggested, these are displayed in a more tasteful manner in keeping with the homely atmosphere of the home. Whilst sampling the care plans it was noted that staff had completed individual risk assessments, which documented hazards in residents daily living for example mealtimes, use of adapted equipment, use of bed rails and bumpers, moving and handling, maintaining posture, choking and PEG feeding, support whilst receiving personal care, using the bath or shower. The risk assessments linked with the activities of the residents daily life and were evidenced as well recorded to ensure that any hazards that had been identified which affected the residents health and welfare had been identified and documented and so far as possible eliminated to ensure the residents well being and safety. Care Homes for Adults (18-65 years) Page 15 of 34 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. Residents are able to exercise some choice in their daily lives, maintain bonds with family and friends and take part in social, cultural, religious and recreational activities if they choose to. Residents are encouraged to maintain their daily living skills and a choice of a healthy diet is provided. Evidence: Within the care plans the daily records described the activities that a resident had participated in. The records were up to date and well written to describe the activities that had taken place and the reaction and response of the resident to the activities. The registered manager advised that during the year the majority of residents had been on hoilday to the south coast and it had been very successful and annual holidays for the coming year were starting to be planned. Care Homes for Adults (18-65 years) Page 16 of 34 Evidence: Two staff in the activity centre were observed developing a timetable for residents to attend planned activities and during the tour of the premises activities charts throughout the home were displayed on several notice boards which were designed to inform staff and others in the home what activities were planned in order to advise residents. Activities provided by the home include include drama, music, cookery, arts and craft, cookery and relaxation in the white room. During the tour of the premises it was noted within residents bedrooms that leisure activities such as TV, listening to music, soft toys, musical instruments, games, crosswords, board games, mobiles and sensory equipment, and having objects of interest were available. The registered manager confirmed that the home has an open door policy regarding visiting and there was evidence, through sampling the visitors book and talking to staff that that residents family members and friends are encouraged to visit the home and keep in contact with their loved ones and residents are supported, where possible to stay with their friends and relatives as much as possible. Photographs of family and friends and other personal items which reflected the residents family inclusion were seen in residents bedrooms and also included greeting cards and sentimental objects. The expert by experience and his personal assistant report about the homes inclusion of friends and family included that family and friends can visit the service users at the home and the service users can also visit their families when they want. Service users are encouraged to interact with one another and during the visit the expert by experience witnessed one service users talking to another one in the lounge after lunch. Written comments received by the commission on behalf of the residents were favourable about the home and the staff and some comments included that residents would like to have more recreational activities to take part in. The expert by experience and his personal assistant report about the homes activities and meaningful pastimes included that the home has five lounges, each with a large TV, which staff explained were used to give the service users person centred activities for example service users with same interests in activities could be in the same room with like service users. There are lists of activities on the notice boards for service users to see. The activities are planned with the staff to support them and staff are rostered around the service users activities. Service users are supported to enjoy activities like dog walking and animal farm. A former member of staff brings dogs to the home and the service users enjoy walking the dogs in the compound, as well as experiencing farm animals that are brought into the home. The home has a large garden where some service users get out to do gardening or play golf with an outside Care Homes for Adults (18-65 years) Page 17 of 34 Evidence: person who comes in to do this with them. The home has two vans which service users use when going out to the day centre and to other leisure activities like pantomime, cinema, days out and shopping. Staff give good support to the service users. The expert by experience witnessed staff in the activities centre supporting service users create Halloween decorations, other staff were doing physiotherapy and another was in the sensory room with a service user. The registered manager confirmed that some residents relatives have requested on behalf of their family member to participate in spiritual support. A member of the clergy visits residents yet the registered manager confirmed that as the majority of the residents do not have the ability to request to see a member of the clergy residents rights are taken into account yet where residents show an interest staff would promote their spiritual and religious beliefs by providing support. The pace of the day was unhurried and staff undertook residents daily routines in a quiet and professional manner. The inspector noted in records and also on the day of the inspection that residents preferences for example getting up and going to bed, having snacks and getting up through the night were accommodated by staff to reinforce the residents rights to making decisions and having choices in their lives. On arrival at the home some residents were being supported to have their breakfasts which included staff support and also some residents receiving nutrition via PEG feeds. There was evidence in the form of menu cards to show residents what was available in pictorial form for breakfasts and staff confirmed that some residents choose what they would like by pointing to the photo image. The homes menu was sampled and it was considered offered a nutritious diet. Records within residents care plans detail the supplements or food residents have had during the twenty four hour period. It was observed that the home provides a wide selection of specialist crockery for residents to use which assists in their maintaining independence and safety whilst having their meals. The expert by experience and their personal assistant observed the midday meal at the home and reported that service users have a choice of what to eat. The cook and staff normally meet and plan service user meals. A member of staff said that due to verbal communication with the residents, the cook makes three choices of food at every meal and this is physically taken to the residents to visually choose what they want to eat. This was witnessed at lunch and all residents seemed to enjoy their food. Care Homes for Adults (18-65 years) Page 18 of 34 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 care plans were up to date and the provision of personal care and support were robustly documented. Residents physical, emotional and health care needs are monitored and met. Choice and dignity is promoted and the homes medication procedures ensure that medication is administered to all residents in a safe and appropriate way. Residents right to dignity and respect is consistently promoted. Evidence: The homes system of recording health care appointments was found to be well managed. Records of health care appointments indicated that residents had attended medical appointments both inside and outside of the homes environment. Appointments included specialised health care professionals, general practitioners and access to chiropodists, opticians, district nurses, dentists, speech and language therapists and other hospital specialists. The home have their own physiotherapist on site who works alongside staff to support the resident to maintain their independence and potential. The physiotherapist and their attendant were seen to tour the home during the morning to check the moving Care Homes for Adults (18-65 years) Page 19 of 34 Evidence: and handling equipment within the home to ensure it was in good working order to promote the residents and staff safety and well being. It was noted within the care plans sampled that the physiotherapist had incorporated excellent photographic guidelines to support staff in the techniques to support resident in their daily lives. It was noted that some areas in the home did not fully conform to residents rights of confidentiality and this was addressed with the registered manager at the time of the inspection regarding printed guidelines adhered to various walls throughout the home detailing residents specific needs. The care plans contained body weight charts, regular records of meals taken and where necessary dietitian input had been sought to ensure the safety and well being of the residents with specific dietary needs. Assessments regarding residents continence management had been completed and advise and support from the continence adviser had been sought to ensure residents comfort and dignity. It was observed that the staff team consists of a multi racial mixed gender staff group who support gender based care in order that residents preferences are taken into consideration. The commission received written responses to questionnaires sent to health care professionals and comments included keeps in contact with the care manager, makes sure the service users health and social care needs are fully addressed, follows up on decisions, and excellent paper work. I am totally confident regarding this service. Good team leaders Very proactive for clients, seem to look at their needs as well as the families Could liaise with the day centre better as information is not always given or in much detail. From my many visits to Melbreck I have always found them very professional and upfront. They have always spoken with me regarding any concerns that may arise. updated training is provided and equipment to enhance the work is provided. What they could do better is to provide enough staff to meet the standard of care needed by service users.Support young people with learning and physical disabilities to live valued lives and access community activities and works well with families. The appears to provide adequate care to meet the needs of two substantially incapacitated residents and families provide regular contact by phone and visits. The inspector sampled the secured medication trolleys in the home. The trolleys were orderly and the inspector was advised that the local Pharmacist supplies the homes medication. The AQAA details that no residents are currently being supported with the administration of controlled medicines and no resident self medicates. The homes records evidenced that the ordering, returns and stock taking of medicines Care Homes for Adults (18-65 years) Page 20 of 34 Evidence: were robust. It was confirmed that only trained nurses undertake the medication administration in the home and whilst sampling the medication administration charts it was observed that there were no gaps in any of the sheets. The medication folder contained a section of information, which included the residents photograph, their general description, their GP, next of kin and known allergies, forms regarding the use of homely remedies and clear guidelines for staff in the event of a resident requiring as necessary medication in order to ensure that the medicines are administered in a manner which protects the resident from harm or abuse. Care Homes for Adults (18-65 years) Page 21 of 34 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. The homes complaints procedure is an accurate document for residents or people associated with the home to express any concerns or complaints. Procedures are in place to protect residents from abuse and harm. Staff receive safeguarding vulnerable adults training to ensure that residents are safeguarded from abuse or harm. Evidence: During the inspection the homes complaints procedure was sampled and it was noted that it was not up to date and included incorrect details regarding the commission. This was addressed promptly by the registered manager who following the inspection contacted the commission to advise that the policy and procedure had been updated and that the information was current in order that people associated with the home had information on how to make a complaint or raise a concern if they were dissatisfied. A pictorial complaints procedure was also sampled during the inspection. The homes complaints record contained information which indicated that following receipt of a complaint the home would detail the chronology of events for example the dates of the complaint, actions taken by the home, copies of correspondence with the complainant and the outcomes regarding complaints in order to ensure that there is appropriate evidence to support that peoples views, opinions and complaints are recognised and acted upon. It was evident that the majority of residents would not be able to tell of any Care Homes for Adults (18-65 years) Page 22 of 34 Evidence: dissatisfaction with the service provided, and would be reliant on staff recognising that they were unhappy. Staff confirmed that they and the residents families and friends would be aware of the residents ways of communicating and would understand any changes which may indicate the resident was not happy, such as changes in mood, behaviours and body language. The local authority multi agency procedures for safeguarding adults were dated 2005 and the registered manager was prompt to advise the commission following the inspection that the 2008 protocols had been downloaded and were within the homes premises. The home have not been subject to any safeguarding vulnerable adults referrals and the staff training matrix sampled that staff receive regular safe guarding vulnerable adults training in order to promote residents rights to be protected from harm or abuse. The home have a whistle blowing procedure which was sampled during the inspection. Care Homes for Adults (18-65 years) Page 23 of 34 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The security in the home needs to be strengthened, refurbishment of some areas in the home and replacement of carpets need to be undertaken, storage within the home needs to be reviewed and a risk assessment undertaken regarding the laundry area. Areas within the home were clean and hygienic. Evidence: Security of the home needs to be reviewed as the inspector walked into the home via an open fire exit door which should have been kept closed but it was observed with the registered manager that the door was being used for access to and from the physiotherapy and day centre by staff. It was also observed that residents and staff belongings could be at risk of theft as several individuals items of value were seen around the home and not securely stored. It has been required that arrangements must be made that the security of the home is reviewed in order to ensure the safety and protection of residents and staff and their personal belongings. The general atmosphere in the home was calm and orderly during the inspection. During the tour of premises it was acknowledged that the home has a high incidence of wear and tear due to the amount of adapted equipment used by the residents. The registered manager confirmed that the home is planned to have a refurbishment and redecoration which has been long awaited to brighten up the home for the benefit of Care Homes for Adults (18-65 years) Page 24 of 34 Evidence: the residents. During the tour of the premises it was noted that in one lounge the carpet was very soiled, despite a steam cleaning programme and a requirement has been made that arrangements be made for a replacement carpet or flooring to ensure that the residents lounge is hygienic and in good decorative order. The lounge areas were well equipped to provide residents with leisure activities and contained individualised ornaments and articles of specific interest for some residents. It was observed that there was a general lack of storage in one of the residents lounges as a number of large items were stored in the corner by the fire door which could be potentially hazardous in the event of fire due to the close proximity to the fire exit. Additionally it was noted that the pantry door was wedged open by a step ladder and bottles of milk shake. The door had a sticker which read fire door keep closed but this was not being taken into account by staff. It was observed that some doors in the home has electronic closures or magnetic doors guards and where some fire doors were not closing flush the registered manager took immediate action to rectify the concern. It has been required that the arrangements must be made for a review of the appropriate storage of items which may potentially be hazardous to the welfare and safety of residents in the home. Residents bedrooms were observed as spacious and personalised with the persons name on many of the doors. Comfortable and tastefully matching bedroom furnishings and decor were present and the rooms sampled contained the residents own items of furniture, personal possessions, leisure items including televisions, radios, musical instruments and books. The homes bathrooms and toilets were clean and contained specialist equipment and specific aids to support residents and records of safe bathing practises for example water temperature checks were well documented. The inspector observed that hand washing facilities were available throughout the home in order to ensure the control of infection in the home.The home has an infection control policy in place and staff confirmed they are trained and aware in infection control procedures. Staff were observed adhering to infection control measures for example wearing protective clothing and washing their hands to prevent the spread of infection in the home. The laundry area was sampled and it has been required that arrangements must be made for a risk assessment to be documented regarding the control of infection in the laundry area with particular attention being paid to the storage of soiled and clean linen in the laundry. Care Homes for Adults (18-65 years) Page 25 of 34 Evidence: The expert by experience and his personal assistant reported that the home has domestic cleaner. Though some places did not look very clean they were informed that the home will soon be refurbished and the stained carpets removed. The home is large and well equipped to support the service users who use wheelchairs. The home has two lifts, stair lifts and ramps to the different floor levels of the home. Care Homes for Adults (18-65 years) Page 26 of 34 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The homes recruitment practises, induction and mandatory training of staff is consistent to ensure that residents needs are appropriately and safely met and staff have equal opportunities with regard to their own professional development. Evidence: Staff were observed during the inspection to provide well organised support for the residents in a way which reflected the residents rights to dignity and respect. Three staff recruitment files were sampled and evidenced that the home undertakes safe vetting practises concerning the recruitment of staff in order to ensure the safety and protection of residents living in the home. The staff induction and mandatory training records were sampled and evidenced that staff receive induction to the home and mandatory training. Where two staff members had not undertaken mandatory training evidence was supplied to the commission to confirm that the training had been booked for staff to attend. The registered manager confirmed that the home is aware of and supports staff to receive training and awareness regarding Mental Capacity Act and Deprivation of Liberty safeguards. Care Homes for Adults (18-65 years) Page 27 of 34 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management and administration of the home is consistent and robust. The home continues to be run in the best interests of the residents and their views and opinions and those of others associated with the home are sought yet formalised procedures need to be strengthened. Residents welfare is promoted through the robust monitoring of health and safety in the home. Evidence: As documented within the report it was evident through observation that the pace of the home continues to be designed to meet the needs of the residents and the staff present during the inspection demonstrated a good knowledge about residents to ensure their safety and well being. The registered manager has been in post for sixteen years and has a nursing diploma, has achieved the registered managers award and is an NVQ assessor and NVQ internal verifier. In addition the registered manager has a teaching and assessing qualification which enables her to assess student nurses who undertake work placements within Care Homes for Adults (18-65 years) Page 28 of 34 Evidence: the home. Staff confirmed that the manager continues to conduct the home in the best interests of the residents and the management style is open and inclusive. The expert by experience and his personal assistant reported that the staff members spoken with said they were happy in the home and that the management values them, and offers good training for them to support the service users well. The home is well staffed and do not use agency staff. This gives the residents a choice of when to go to bed and get up in the morning depending on the days activities. During the inspection it was observed that the registered manager undertook her duties in a professional and calm manner and was very knowledgeable about the running of the home to benefit the residents and the staff. The registered manager confirmed that there are two registered nurses on duty each day and the nurses manage a team of eleven staff each day. The inspector sampled some Regulation 26 notification reports and was informed that the Regulation 26 visits are unannounced. The records sampled indicated that any shortfalls in the quality of the service would be noted by the organisation during the Regulation 26 visits, so that appropriate action could have been taken to rectify the shortfalls. The registered manager confirmed that the home does have a Quality Assurance policy and procedure in place yet the last quality assessments were conducted in 2006. The registered manager gave assurances that Robinia were undertaking a new Quality Assurance assessment process as part of the organisations review and appointments of new senior managers. Records indicated that health and safety checks are maintained, fire safety equipment and records were documented and equipment serviced. The sluice and laundry areas were noted to be clean and tidy. The home have maintained records relating to water and food temperature checks to ensure residents safety and well being. The home has the required gas safety and electrical certificates available in the home and a current insurance indemnity certificate displayed. The inspector re affirmed the procedures that the home must report any incidences to the commission under Regulation 37 notifications of any event that affects the well Care Homes for Adults (18-65 years) Page 29 of 34 Evidence: being and welfare of residents in the home. The homes policies and procedures promote the health, safety and welfare of people in the home. Care Homes for Adults (18-65 years) Page 30 of 34 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 31 of 34 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 24 13 Arrangements must be 19/02/2010 made for the review of appropriate storage of items in the home which may potentially be hazardous to the welfare and safety of residents. In order to ensure the safety and well being of residents. 2 24 23 Arrangements must be made for a replacement carpet or flooring to the residents lounge. ensure that the residents lounge is hygenic and in good decorative order. In order to ensure that the lounge flooring is hygenic and in good decorative order. 19/02/2010 3 24 13 Arrangements must be made that the security of the home is reviewed. 19/02/2010 Care Homes for Adults (18-65 years) Page 32 of 34 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 In order to ensure the safety and protection of residents and staff and their personal belongings. 4 30 13 Arrangements must be 19/02/2010 made for a risk assessment to be documented regarding the control of infection in the laundry area with particular attention being paid to the storage of soiled and clean linen in the laundry. In order to ensure the control and spread of infection in the home. 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 39 The Quality Assurance procedures of the home need to be strengthened in order that the views and opinions of residents and those of others associated with the home are sought and responses formalised. Care Homes for Adults (18-65 years) Page 33 of 34 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 34 of 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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