Inspection on 27/04/10 for Saint Elkas Care Home

This is the latest available inspection report for this service, carried out on 27th April 2010.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

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Extracts from inspection reports are licensed from CQC, this page was updated on 18/06/2010.

Key inspection report Care homes for adults (18-65 years) Name: Address: Saint Elkas Care Home 75 Hill Top Bolsover Chesterfield Derbyshire S44 6NJ     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: Rose Moffatt     Date: 2 7 0 4 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 28 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 28 Information about the care home Name of care home: Address: Saint Elkas Care Home 75 Hill Top Bolsover Chesterfield Derbyshire S44 6NJ 01246241519 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Ms Pauline Waddoups Name of registered manager (if applicable) Mrs June Thorpe Type of registration: Number of places registered: care home 6 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of service users who can be accommodated is 6 The registered person may provide the following category of service only Care Home only PC To service users of the following gender Both Whose primary care needs on admission to the home are within the following category Mental disorder, not including dementia or learning disability Code MD Date of last inspection Brief description of the care home Saint Elkas is a large, detached house set in its own grounds in Bolsover, Derbyshire. The home provides accommodation and support for up to 6 adults with mental health needs. The home provides a spacious and comfortable environment with a lounge, dining Care Homes for Adults (18-65 years) Page 4 of 28 Over 65 0 6 Brief description of the care home room, games room and small conservatory/quiet room. People living in the home each have their own bedroom. 5 of the bedrooms have en-suite facilities and 1 has a bathroom adjacent for the exclusive use of the person occupying that room. Information about the home, including CQC inspection reports, is available in the main entrance hall or from the manager. The fees at the home range from £985 - £1264 per week. This information was given by the provider on 27th April 2010. Care Homes for Adults (18-65 years) Page 5 of 28 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 star. This means the people who use the service experience good quality outcomes. The focus of our inspection is on outcomes for people who live in the home and their views on the service provided. The inspection process looks at the providers ability to meet regulatory requirements and national minimum standards. Our inspections also focus on aspects of the service that need further development. We looked at all the information we have received, or asked for, since the home was registered in November 2009. This included: the annual quality assurance assessment (AQAA) that was sent to us by the service. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also has some numerical information about the service; surveys returned to us by people using the service and from other people with an interest in the service; information we have Care Homes for Adults (18-65 years) Page 6 of 28 about how the service has managed any complaints; what the service has told us about things that have happened - these are called notifications and are a legal requirement; the previous key inspection and the results of any other visits we have made to the service in the last 12 months; relevant information from other organisations; and what other people have told us about the service. We carried out an unannounced inspection visit that took place over 4.5 hours on 27th April 2010. The inspection visit focused on assessing all the key standards. We sent out surveys to people living in the home and received 3 completed responses. We sent out surveys to the relatives or representatives of people living in the home and received 5 completed responses. We sent out surveys to staff employed at the home and received 3 completed responses. There were 5 people accommodated in the home on the day of the inspection visit. People who live in the home, visitors and staff were spoken with during the visit. The manager and the provider were available and helpful throughout the inspection visit. Case tracking was used during the inspection visit to look at the quality of care received by people living in the home. 2 people were selected and the quality of the care they received was assessed by speaking to them and / or their relatives, observation, reading their records, and talking to staff. Care Homes for Adults (18-65 years) Page 7 of 28 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. 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 28 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 28 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. There was a satisfactory assessment and pre-admission process so that people were confident their needs would be met at the home. Evidence: People told us their needs were met at the home. They said Since living at the home I feel happy and settled and I get all the support I need here. A relative told us We can relax and know his care and needs are in the best hands. A visiting healthcare professional told us the homes manager and provider were realistic about the support they could provide and the needs that could be met at the home. The healthcare professional said they had seen improvements in the physical and mental health of people admitted to the home. We looked at the records of 2 people in the home. Each had an assessment of the persons needs carried out before admission to the home. Both people had visited the home several times before deciding to live there. The admission process included an assessment of the persons capacity to make decisions about their care. There was no recorded detail of whether the person had a Lasting Power of Attorney (LPA), Care Homes for Adults (18-65 years) Page 10 of 28 Evidence: Independent Mental Capacity Advocate (IMCA), or advanced directive/living will. The manager informed us soon after the inspection visit that this information would be included on all future admissions. Staff told us they usually had up to date information about the needs of people in the home. They had the opportunity to get to know prospective residents during visits to the home. Staff said they had relevant training to understand and meet the needs of people in the home. The AQAA described the pre-admission processes and gave all the information requested about the needs of people in the home. Care Homes for Adults (18-65 years) Page 11 of 28 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. There was a consistent, person centred approach to care planning so that people received care and support to meet their individual needs and preferences. Evidence: People told us they can make decisions about what they do each day. They said that staff listen to them and act on what they say. They said they knew who their keyworker was and that they had been involved in care planning and review. The 2 care records we looked at each had a care plan covering the persons assessed needs. There were good details of the action required by staff to meet individual needs. There were relevant risk assessments in place and details of any restrictions on choice and freedom. The care plans and other documents were signed by the person to indicate their involvement and agreement. The care plans had been regularly reviewed. There was information available about an advocacy service, though no people in the Care Homes for Adults (18-65 years) Page 12 of 28 Evidence: home were currently using this. The AQAA said the home had improved by providing staff training in person centred planning, equality and diversity, and about the Mental Capacity Act 2005. Care Homes for Adults (18-65 years) Page 13 of 28 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 were supported and encouraged to live fulfilling lives by accessing activities and opportunities in and out of the home. Evidence: People told us they could do they wanted to each day. They said the home had a family environment, I can do what I like, and, food is top quality. We found that there were good details of each persons family/social history in their care records, together with details of their likes and dislikes, and what was important to them. We found that people were supported to maintain contact with relatives and other people important to them. We saw the weekly programme of activities displayed in the entrance area. People told us they enjoyed the activities provided, such as aerobic exercises and arts and crafts. Care Homes for Adults (18-65 years) Page 14 of 28 Evidence: Some people in the home regularly attended local churches. Some people attended local adult education classes. People were encouraged and supported to use local shops, cafes, pubs, and to use public transport. Most of the people in the home were on the electoral roll, 1 person had chosen not to be. People and visitors told us there was a relaxed atmosphere in the home and people were able to follow their preferred routines. All of the people in the home had a key for their bedroom door. They were encouraged and supported to take responsibility for keeping their rooms clean and for doing their own laundry. A visitor commented that staff were part of the family... no them and us differentiation. Staff did not wear uniform and sat with people in the home for meals. People in the home made their own breakfast and lunch, with support from staff if required. The main meal was at tea-time and this was prepared by staff with help from people in the home. The menu showed the choices available at each mealtime and appeared varied and well balanced. There was food and drink available at anytime. There was a pleasant dining room with one large table so that people could all eat together if they wanted to. The AQAA said that people were supported to make use of community resources and activities, and to join in with activities in the home. Care Homes for Adults (18-65 years) Page 15 of 28 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 were encouraged and supported to access appropriate healthcare services and care and support was provided to meet their needs and preferences. Evidence: People told us the staff always treated them well, listened to them and acted on what they said. They told us its always good to talk to the staff who are always ready to talk to, and said the staff were very understanding in peoples welfare. We saw that the care plans included some details of the persons preferences regarding how they were supported by staff. There was no indication that the person had been asked about their preferred gender of staff to support them. The manager told us this because none of the people in the home currently required assistance, (other than prompting), with personal care. We saw from the care records that any health problems were monitored and appropriate medical help sought as necessary. People were supported to visit their GP at the surgery. Care Homes for Adults (18-65 years) Page 16 of 28 Evidence: We observed positive interactions between staff and people in the home that showed respect for peoples privacy and choices. Medication was stored securely. All staff who administered medication had received relevant training. 2 people in the home managed their own medication with minimal support from staff. The medication records seen were correctly and fully completed. The AQAA emphasised the focus on promoting independence of people in the home. The AQAA said that people in the home have regular one-to-one time with their keyworker to discuss any concerns. Care Homes for Adults (18-65 years) Page 17 of 28 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. There were satisfactory policies and procedures in place and good staff awareness to ensure that people were protected and their concerns were appropriately addressed. Evidence: People told us they knew who to speak to informally if they were not happy about anything, and how to make a formal complaint. A relative said they could discuss any concerns about the person with staff and we know it will be sorted. The complaints procedure was displayed in the main entrance area of the home. There was also a comments box for people and visitors to use. There were no recorded complaints or comments. No complaints about the home had been received directly by CQC. There were relevant polices and procedures in place about safeguarding vulnerable adults. Staff had received training and were aware of procedures to follow if abuse was suspected or alleged. We found satisfactory procedures in place for managing the personal money of people in the home. Some people managed their own money and some needed more support from staff. Money was kept securely with records of all transactions. The records and money balances were checked by the manager and provider every week. Care Homes for Adults (18-65 years) Page 18 of 28 Evidence: The AQAA showed that no complaints had been received at the home and no safeguarding referrals had been made since the home opened in November 2009. Care Homes for Adults (18-65 years) Page 19 of 28 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. The home was clean, well maintained and suitably furnished and equipped so that people lived in a safe, pleasant environment that met their needs and preferences. Evidence: People told us the home was always fresh and clean. They said they had chosen their own bedrooms and were pleased that they could bring in their own furniture and other possessions. People told us they were responsible for keeping their bedrooms clean and had help from staff with this if necessary. People had the use of a large lounge with television, a games room, a small conservatory/quiet room, a dining room, and a smoke room. The gardens were well maintained and private with a greenhouse and raised beds. The manager said people in the home were planning to grow their own flowers and vegetables. We found that the first floor windows were not fitted with restrictors. The manager told us this work was planned and confirmed to us soon after the inspection visit that the work had been carried out. The laundry was equipped with a domestic style washing machine and tumble dryer. People were responsible for their personal laundry with support from staff. The kitchen Care Homes for Adults (18-65 years) Page 20 of 28 Evidence: was spacious and in a domestic style. We found the home was clean and free from offensive odours on the day of the inspection visit. Staff had received training about the control of infection and were aware of current good practice. The AQAA showed that the maintenance of all equipment and systems in the home was up to date. The provider told us they were currently advertising the position of maintenance person to cover Saint Elkas and their other care home. Care Homes for Adults (18-65 years) Page 21 of 28 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. People were supported by competent, well motivated staff in sufficient numbers to meet their needs. Evidence: People told us there were always enough staff available when needed. People and their relatives told us the staff were supportive, and said I think all the staff are brilliant, and, The staff are very friendly and go the extra mile to ensure that service users and their families are made to feel very welcome and nothing is too much trouble. Staff told us they had the training they needed to understand and meet the needs of people in the home. Staff said they enjoyed working at the home as there was a good atmosphere and the staff team worked well together - Its not like coming to work!. We found there were usually 2 or 3 support workers on duty from 8.45am to 5pm, plus the manager. There was 1 support worker on duty from 5pm who slept-in to provide any help needed during the night. Staff told us they were very rarely needed during the night. There was a domestic assistant working from 5pm - 7pm on 3 days per week. Care Homes for Adults (18-65 years) Page 22 of 28 Evidence: We looked at the records of 2 members of staff. Both records had all the required documents and information. We saw that the Criminal Records Bureau (CRB) disclosure for each one had been obtained before the member of staff started working in the home. People in the home were encouraged to be involved in the recruitment process and one member of staff confirmed that a person in the home was involved in their interview. All staff had received an induction to Skills For Care standards. Training records showed that staff were mostly up to date with all required training, such as fire safety, safeguarding vulnerable adults, and food hygiene. In addition, staff had received training about specific needs of people in the home. 4 out of 5 support workers had achieved a relevant National Vocational Qualification (NVQ) at level 2. This exceeded the national minimum standard of 50 of staff with NVQ at level 2 or above. Staff told us they regularly had supervision sessions with the manager and we saw records to confirm this. There were also records of annual appraisals and monthly staff meetings. The AQAA said they planned to improve by supporting staff to achieve NVQs at level 3. The AQAA showed there had been no turnover of staff since the home opened in November 2009 and no use of agency staff. Care Homes for Adults (18-65 years) Page 23 of 28 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home was well managed so that people had a consistent, reliable service that met their needs and promoted their health, safety and welfare. Evidence: The registered manager was suitably qualified and experienced to run the home. People in the home, visitors and staff told us the manager was approachable and they had confidence in her to sort out any problems. A visitor told us This is a well organised home. The manager was supported by the provider who also had relevant qualifications and experience. The AQAA was completed by the manager and was returned to us by the due date. The self-assessment section had enough information to give a reasonable picture of the current situation in the home. There was a lack of detail of where the home needed to improve and how they were planning to do this. The data section of the AQAA was mostly completed. There were 3 relevant policies not noted in the AQAA. 1 of these was found during the inspection visit and the manager provided evidence of the other 2 soon afterwards. Care Homes for Adults (18-65 years) Page 24 of 28 Evidence: The quality assurance system included surveys of people in the home, visitors and staff. The manager had not yet produced a report of the analysis of surveys with details of action taken to address issues raised. There was a comments box in the main entrance area, though the manager said this had not been used so far. There were regular meetings for people in the home and separate meetings for their relatives/representatives. We saw records of the monthly reports by the provider which included improvement and action plans. There were regular internal audits in the home. There were relevant policies and procedures in place regarding health and safety in the home and staff had received relevant training. As noted in the Environment section of this report, we found there were no window restrictors to the first floor windows. This was addressed soon after the inspection. Care Homes for Adults (18-65 years) Page 25 of 28 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 26 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 39 The results of quality assurance surveys should be made available to people,in the home, their relatives/representatives, and other interested parties, including CQC. This will ensure that people in the home are confident their views underpin review and development in the home. Care Homes for Adults (18-65 years) Page 27 of 28 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. 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