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Inspection on 11/05/10 for Speakers Court

Also see our care home review for Speakers Court for more information

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

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

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

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

What the care home does well

The vast majority of all the written and verbal feedback we received from the customers who live at Speakers Court and staff that work there, was in the main very positive about the standard of service provided. Typical comments, included, - `its a great place to live, especially now we`ve got a new manager`, `I can do what I want when I want`, and `the staff are great here, I tend to get on with most of them`. It was also evident from all the comments we received, records we looked at, and staff practises observed that the service continues to be good at promoting independent living and enabling the customers to do to as much for themselves as they our willing and capable of doing safely. For example, customers we met all told us they are actively encouraged and supported by staff to take `reasonable` risks, such as travel independently on public transport and preparing their own meals. Finally, it remains clear the flats and their contents are the property of the customers and as soon as staff and/or visitors are given permission to enter there is no doubt you are in someones home.

What has improved since the last inspection?

The single biggest barrier to improvement Speakers Court has faced in recent years has been the long term absence of its registered manager. For reasons often beyond the providers control Scope ended up using four different managers over a nine month period as temporary cover for their absent manager. The different leadership styles and approaches of these generally very experienced and competent temporary managers, and the short periods of time they were in charge, ultimately meant none of them were able to significantly improve customer and staff morale, or the overall quality and consistency of the care and support provided at Speakers Court. It was therefore positively noted that as we had required in the services last inspection reports a new suitably qualified, competent and experienced manager is now in permanent day to day charge at Speakers Court. It was evident from all the comments we received from customers and staff that the new manager has had a very positive impact on the life and morale of all the people who both live and work at Speaker Court. Typical feedback we received, included -`the manager has turned Speakers around and put it back on its feet`, `the new manager is firm, but fair; and at least you know where you stand with him... Its definitely better`, `at last we`ve got someone in charge who is always around... about time too`, and `you can talk to Dan (the manager) about anything - he`s a good chap.. things are getting better here again.` All ten of the outstanding requirements made in the services previous two inspection reports have been met in full and the vast majority of good practice recommendations implemented: The services medication recording, administering, and monitoring arrangements have all significantly improved in the past six months to minimise the risk of medication errors reoccurring. The training and support staff receive in respect of their roles and responsibilities regarding the safe handling medication has also improved. The new manager has introduced health care action plans which staff use to record the health care needs, preferences, outcome of all the input each customers receive from various health care professionals they are in contact with. This ensures anyone authorised to inspect these records can determine whether or not a customers health care needs and wishes are being properly monitored and met. All the services moving and transferring equipment has been tested in the past six months in line with best health and safety practises. Staff are now carrying out weekly fire alarm checks and participating in fire drills at least once a quarter, and maintaining accurate records of the outcomes of these practises. The service has improved the support staff receive by increasing the number of opportunities they have to attend one-to-one supervision sessions with their manager and/or Team Coordinator, as well as group meetings with their fellow peers. The new manager has now carried out an appraisals of all his staff teams knowledge and skills and ensured they have all received up to date training in fire safety, first aid, food hygiene, safeguarding vulnerable adults, infection control, and the Mental Capacity Act. In addition to this training, the Team Coordinator has also received specialist training to help them understand their new role and responsibilities as a senior member of staff. As recommended in Speakers last inspection report the service has now reviewed its night time on call arrangements and clarified which staff and/or managers should be contacted on any given night and under what circumstances. All the staff we met demonstrated a good understanding of these night time on call arrangements and were confident they would work well if they were called upon to implement them. Care plans have been significantly improved in the past six months and are now much more person centred and contain far greater detail regarding the support customers require from staff to ensure their unique personal and social needs and wishes are always met. Finally, the services arrangements for ensuring customers are always consulted about and participate in the running of their home have been significantly improved. For example, the new manager has introduced monthly one-to-one meetings for customers to attend with their designated keyworkers; and, ensures customers views are always sought regarding the recruitment of new staff and new customers moving in.

What the care home could do better:

All the positive comments outlined above about all the improvements made by the new manager in the past six months the providers do accept the service remains far from perfect. We have made one new requirement for the manager to address and two good practise recommendations for him to consider implementing: A representative of the provider must carry out monthly unannounced inspections of the Speakers Court and compile a report on the conduct of the service. This will enable the providers to determine whether or not outcomes for customers are satisfactory and whether or not the service could improve its overall performance. The services Guide should be written in plain language and generally made easier to read to ensure customers and their representatives can access all the information they need to know about the services and facilities provided at Speakers Court, including fees charged for them. Person centred care planning training should be provided to all staff that work at the service. This will ensure support to customers is provided in a person centred way which meets their unique needs, strengths and preferences. This good practice recommendation was made in the services last key inspection report, but was not implemented.

Key inspection report Care homes for adults (18-65 years) Name: Address: Speakers Court St James`s Road Croydon Surrey CR0 2AU     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: Lee Willis     Date: 1 1 0 5 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 33 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 33 Information about the care home Name of care home: Address: Speakers Court St James`s Road Croydon Surrey CR0 2AU 02086650745 02086650745 laura.baker@scope.org.uk www.scope.org.uk SCOPE Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Ms Laura Charlotte Baker Type of registration: Number of places registered: care home 7 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 physical disability Additional conditions: The maximum number of service users who can be accommodated is: 7 The registered person may provide the following category of service only: Care Home Only (CRH - PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Physical disability ? Code PD Date of last inspection Brief description of the care home Speakers Court provides accommodation and personal support for up to seven adults with Cerebral Palsy and associated physical disabilities. The five self-contained flats that make up Speakers are owned by Croydon Churchs Housing Association, but are managed and staffed by the registered charity Scope. The services new permanent manager Dan Lipscoombe, who is also responsible for running another Scope service in the area, has been in operational day-to-day charge Care Homes for Adults (18-65 years) Page 4 of 33 Over 65 0 7 1 8 0 9 2 0 0 9 Brief description of the care home since being appointed in September (2009). Located in the Broad Green area of Croydon the service is relatively close to a wide variety of good leisure and community facilities. The service is also close to a number of very good bus, tram, and rail links with excellent connections to London and the areas surrounding Croydon. The five self-contained flats that make up Speakers all have there own front doors which open out onto a well maintained old converted church courtyard. Each flat has a large open plan lounge/kitchen area, separate bedroom, and en-suite toilet and bathing facilities. The flats have also been suitably adapted to meet the individually assessed needs and wishes of everyone who lives at Speakers Court, as well as maximise their independence. All the flats are wheelchair accessible. There is a separate office located within the complex, which has its own kitchen, toilet and shower facilities, and sleep-in room for staff. All the people who use the service, which we refer to as customers throughout this report, have all been provided with copies of a Statement of Purpose and Guide that tells them what services and facilities they can expect to be offered at Speakers Court and how much they will be charged for them. Fees currently range between £39,000£63,200 a year for each placement. Care Homes for Adults (18-65 years) Page 5 of 33 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 of life for the customers who live at Speakers court has significantly improved in the past six months since the appointment of a new permanent manager. As a result we have increased this services quality rating from one star adequate to two star good. From all the available evidence gathered during the inspection process it was clear Speakers Court now has more strengths than areas of weaknesses, and we our confident the new manager will continue to recognise where further improvement is required. We spent four and a half hours at the service, during which time we spoke at length to four of the customers, the new manager, and two support workers. Ten of our surveys were completed by four customers and six members of staff. We also looked at various records and documents, including the care plans, risk assessments, and health action plans for two customers we met. The remainder of the visit was spent touring the premises. Care Homes for Adults (18-65 years) Page 6 of 33 The services Annual Quality Assurance Assessment (AQAA) form was completed by the new manager and returned to us when we asked for it. The self-assessment was very clear and told us what the new manager believes they do well at Speakers Court, how it has been improved in the past six months, and what they are planning to do better in the future. We would like to thank all those people who took the time and trouble to participate in this inspection and feedback to us. Care Homes for Adults (18-65 years) Page 7 of 33 What the care home does well: What has improved since the last inspection? The single biggest barrier to improvement Speakers Court has faced in recent years has been the long term absence of its registered manager. For reasons often beyond the providers control Scope ended up using four different managers over a nine month period as temporary cover for their absent manager. The different leadership styles and approaches of these generally very experienced and competent temporary managers, and the short periods of time they were in charge, ultimately meant none of them were able to significantly improve customer and staff morale, or the overall quality and consistency of the care and support provided at Speakers Court. It was therefore positively noted that as we had required in the services last inspection reports a new suitably qualified, competent and experienced manager is now in permanent day to day charge at Speakers Court. It was evident from all the comments we received from customers and staff that the new manager has had a very positive impact on the life and morale of all the people who both live and work at Speaker Court. Typical feedback we received, included -the manager has turned Speakers around and put it back on its feet, the new manager is firm, but fair; and at least you know where you stand with him... Its definitely better, at last weve got someone in charge who is always around... about time too, and you can talk to Dan (the manager) about anything - hes a good chap.. things are getting better here again. All ten of the outstanding requirements made in the services previous two inspection reports have been met in full and the vast majority of good practice recommendations implemented: The services medication recording, administering, and monitoring arrangements have all significantly improved in the past six months to minimise the risk of medication errors reoccurring. The training and support staff receive in respect of their roles and responsibilities regarding the safe handling medication has also improved. The new manager has introduced health care action plans which staff use to record the Care Homes for Adults (18-65 years) Page 8 of 33 health care needs, preferences, outcome of all the input each customers receive from various health care professionals they are in contact with. This ensures anyone authorised to inspect these records can determine whether or not a customers health care needs and wishes are being properly monitored and met. All the services moving and transferring equipment has been tested in the past six months in line with best health and safety practises. Staff are now carrying out weekly fire alarm checks and participating in fire drills at least once a quarter, and maintaining accurate records of the outcomes of these practises. The service has improved the support staff receive by increasing the number of opportunities they have to attend one-to-one supervision sessions with their manager and/or Team Coordinator, as well as group meetings with their fellow peers. The new manager has now carried out an appraisals of all his staff teams knowledge and skills and ensured they have all received up to date training in fire safety, first aid, food hygiene, safeguarding vulnerable adults, infection control, and the Mental Capacity Act. In addition to this training, the Team Coordinator has also received specialist training to help them understand their new role and responsibilities as a senior member of staff. As recommended in Speakers last inspection report the service has now reviewed its night time on call arrangements and clarified which staff and/or managers should be contacted on any given night and under what circumstances. All the staff we met demonstrated a good understanding of these night time on call arrangements and were confident they would work well if they were called upon to implement them. Care plans have been significantly improved in the past six months and are now much more person centred and contain far greater detail regarding the support customers require from staff to ensure their unique personal and social needs and wishes are always met. Finally, the services arrangements for ensuring customers are always consulted about and participate in the running of their home have been significantly improved. For example, the new manager has introduced monthly one-to-one meetings for customers to attend with their designated keyworkers; and, ensures customers views are always sought regarding the recruitment of new staff and new customers moving in. What they could do better: All the positive comments outlined above about all the improvements made by the new manager in the past six months the providers do accept the service remains far from perfect. We have made one new requirement for the manager to address and two good practise recommendations for him to consider implementing: A representative of the provider must carry out monthly unannounced inspections of the Speakers Court and compile a report on the conduct of the service. This will enable the providers to determine whether or not outcomes for customers are satisfactory and whether or not the service could improve its overall performance. Care Homes for Adults (18-65 years) Page 9 of 33 The services Guide should be written in plain language and generally made easier to read to ensure customers and their representatives can access all the information they need to know about the services and facilities provided at Speakers Court, including fees charged for them. Person centred care planning training should be provided to all staff that work at the service. This will ensure support to customers is provided in a person centred way which meets their unique needs, strengths and preferences. This good practice recommendation was made in the services last key inspection report, but was not implemented. 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 10 of 33 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 11 of 33 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. The services Statement of Purpose has been improved to include all the information the customers need to know about the services and facilities provided at Speakers Court. The Guide should also be made more accessible by ensuring its written in easy to read and plain language. This will ensure existing and potential customers have all the information they need to help them and their representatives decide whether or not the Speakers Court is the right place for them. The services arrangements for managing new referrals reflect professionally agreed best practise in this area thus ensuring prospective new admissions, their representatives, and the home can be sure the placement is right for all concerned, which includes existing customers. Evidence: The new manager showed us a copy of the services Statement of Purpose, which as required in Speakers Courts last inspection report had been reviewed in the past six months and up dated accordingly to reflect changes made to the way the service is managed, staff qualifications, fees the provider charges, and the organisations Care Homes for Adults (18-65 years) Page 12 of 33 Evidence: complaints procedures. The services Guide, although contains all the information any potential and existing customers would need to to know about Speakers Court, it is not that easy to read or understand. Two customers we met told us they had copies of the Guide, but never read them. The Guide should be written in plain language and made more accessible for customers and their representatives. The new manager demonstrated a good understanding of what constituted best practice regarding assessing the suitability of new referrals. Speakers Courts most recent customers told us they had both been fully involved in the decision to move in on a trial basis and knew they could change their mind at anytime if they chose not to make the move a permanent one. Other customers we we during this site visit confirmed they had been consulted about the possibility of two new customers moving in and their views were taken into account. Care Homes for Adults (18-65 years) Page 13 of 33 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans have been significantly improved and are now far more person centred and detailed in respect of the support each customer requires to ensure their unique needs and wishes are met. The new manager has also introduced some excellent arrangements to enable the customers to be consulted on, and participate in, all aspects of their life at Speakers Court, and is committed to actively encouraging nd supporting people to do as much for themselves as they are willing and capable of doing safely. Evidence: Most staff who returned our surveys told us they are always given enough up to date information about the needs of the customers they supported. The new manager told us as required in the services last key inspection report the care plan format had been improved to include more detailed information about individual customers specialist and preferred methods of communication, the support they needed to achieve their personal goals, and maximise their independence. The two care plans we looked at in Care Homes for Adults (18-65 years) Page 14 of 33 Evidence: depth contained detailed information about the unique support these individuals required to communicate effectively with others and maximise their independent living skills. Staff we spoke to told us the new care plans were better working documents than the previous format. Both the care plans we looked at had been reviewed in the past six months and up dated accordingly to reflect changes in need and circumstances. All the staff we met confirmed they had not received training in developing person centred care plans, as we had recommended staff attend in the services last inspection report. The manager told us he was currently in the process of negotiating with senior representatives of Scope to arrange for this training to be given. This good practice recommendation is repeated at the end of this report and progress made to achieve this aim will be closely monitored by us. All the risk assessments and associated risk management strategies we sampled at random had clearly been developed with an individual customer in mind and were in no way generic. These assessments also contained lots of detailed information staff needed to take in order to minimise identified risks and keep the customers safe. The manager told us he has introduced monthly meetings for customers and their designated keyworkers to get together on a one to one basis. It was evident from the recorded minutes of these meetings and comments we received from customers and staff that they were being held every month and were proving to be more popular than the old customer group meetings. One customer told us the most significant thing that had changed since the arrival of the new manager was staff had become better at listening too you and taking what you said on board. All the customers who returned our surveys told us they could make decisions about what they did each day, in the evening, and at the weekend. It was also evident from all the feedback we received from the customers that the new manager is committed to actively encouraging and supporting them to take responsible risks and do as much for themselves as they were willing and capable of doing safely. Typical comments made by customers. included - I often go up to London on my own, I take myself to church... no need for staff to come with me, I always help the new manager choose new staff, I look after my own medication in my flat, I make a lot of my own meals, and since moving in I have started using public transport, which was a bit scary at first, but I think Im getting use to it now. Care Homes for Adults (18-65 years) Page 15 of 33 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. The customers have the right to choose what social activities they do, both at home and in the wider community, and when they do it. Customers can also choose what they eat and drink, and are actively encouraged and supported to shop for their own food and prepare their own meals. Evidence: The two care plans we examined in depth both contained details about the spiritual needs and preferences of the two individuals for whom the plans were intended. As previously mentioned in this report the two customers whose care we had decided to case told us they took them self to various places of worship whenever they chose to go. A third of the staff who completed our surveys told us there was not always enough staff on duty to take the customers out. Typical written comments some staff made, Care Homes for Adults (18-65 years) Page 16 of 33 Evidence: included -employ more staff so we can take the customers out more often to the cinema, seaside and concerts, and make more staff available to assist the customers to get out more. As previously mentioned in this report we are aware of the new managers commitment to encouraging the customers to do more for themselves. which includes accessing the wider community and using public transport without direct staff support. All the customers we met generally agreed it was a good thing they were being encouraged to take some positive risks and to go out when and where they liked. We agree with the comments made by the new manager that current staffing levels at Speakers Court are sufficient enough to ensure all the customers that currently reside there can pursue their community based social activities and interests. All the written and verbal feedback we received from customers was very positive about the freedom of choice they felt they all had to go out and do what they wanted whenever they liked. All the customers we spoke with about visiting times told us they were not aware of any restrictions placed on times their relatives and/or friends could visit them in their flats. We observed all the staff on duty during this site visit knock on the doors of customers flats to ask their permission to enter their home before doing so. A number of customers we met told us they did their own food shopping, either with staff or on their own, and were helped by staff to cook a lot of their own meals. We agree with the new managers comments that planned menus setting out an individuals meal choices for the forth coming week were no good for the customers as they were encouraged to choose what they what food they ate on a meal by meal basis. Staff maintain up to date daily records of all the meals customers consume each day which showed us the food and drink they have reflects their individual tastes and choices. The manager also told us that while staff respect customers rights to decide what they eat and drink each day they also ensure people are always made aware of healthy eating options. Care Homes for Adults (18-65 years) Page 17 of 33 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. Suitably robust arrangements are in place to ensure customers who use the service receive personal support in the way they prefer and require, and that their unique health care needs and preferences are continually recognised and met. The services medication recording, handling, and monitoring arrangements have significantly improved in the past year and are now sufficiently robust to keep the customers safe. Evidence: All the customers we met were suitably dressed in well maintained clothes that were both age and seasonally appropriate for the time of year. One customer told us they always bought their own clothes and choose what they wore each morning. The new manager has introduced health care action plans for each of the people who Ive at Speakers Court as we had required in the services last key inspection report. These new plans contained detailed information regarding the dates and outcomes of all the appointments customers had attended with various health care professionals in the past six months. It was evident from the comments made by the staff we met and the information continued in the new health care plans that customers remain in regular contact with their GP, district nurses, physiotherapists, speech and language Care Homes for Adults (18-65 years) Page 18 of 33 Evidence: therapists, dentists, and opticians. The manager told us all the mobile hoists and other mobility equipment used in the various flats at Speakers Court had been checked and tested by the manufactures in April 2010 and any faults rectified. We carried out a follow up random inspection visit on Speakers Court in September 2009 and were able to conclude from all the evidence available to us that the services medication handling arrangements had significantly improved since its last key inspection. Similarly, no recording errors were noted on any of the Medication Administration Record sheets we sampled at random which had been used in 2010. The manager told us as he had stated in the services AQAA that no medication handling errors had occurred within the service in the since July 2009. The new manager has also assigned a senior member of staff to oversee the services medication handling practises and staff continue to carry out regular audits on their own practice. Two members of staff we spoke to about medication handling practises within the service told us the new recording and monitoring arrangements were working well. The manager also told us he carries out his own routine unannounced spot checks on his staff teams medication practises. It was positively noted that all those customers who are willing and capable of looking after their own medication are actively encouraged to do so. Care Homes for Adults (18-65 years) Page 19 of 33 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 services arrangements for dealing with complaints are sufficiently robust and understood by the customers to ensure they feel any concerns they may have about Speakers Court and Scope in general will be taken seriously and acted upon. Customers are kept safe because staff understand what constitutes abuse and know what to do if they witness or suspect it and all staff have received safeguarding training in the past six months. Evidence: One hundred percent of the customers who completed our surveys told us they knew who to speak to if they were not happy, and knew how to make a complaint. One customer told us they were satisfied with the way the service had handled a concern they had recently raised, which they confirmed the manager had taken seriously and dealt with promptly. All the staff who completed our surveys also told us they knew what to do if someone had concerns about the home. The two staff we met demonstrated a good understanding of what constituted abuse and knew who they needed to notify without delay if they suspected or witnessed it. These same staff both confirmed that as required in the services last key inspection report they had recently completed an approved E-Learning training regarding safeguarding. The manager told us that in addition to all his staff team receiving safeguarding training in the past six months both he and the services Team Care Homes for Adults (18-65 years) Page 20 of 33 Evidence: Coordinator had recently attended Scopes own advanced safeguarding course. The two safeguarding incidents involving the services customers which have occurred since the last inspection have been dealt with in a very prompt, open, and professional manner in accordance with locally agreed safeguarding protocols. It was positively noted that appropriate risk assessments had been carried out to minimise the likelihood of similar incidents of abuse reoccurring, while still respecting the rights of individual customers to make their own decisions about how they live their life. Care Homes for Adults (18-65 years) Page 21 of 33 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 standard of the interior decoration, soft furnishings, fixtures, and fittings in all three of the self-contained flats we viewed was good ensuring the customers who occupied them lived very homely, comfortable, and generally well maintained environments. The services arrangements for controlling infection are sufficiently robust to ensure customers also live in a very clean and safe environment. Evidence: One customer we met told us their flat contained everything they need and had recently been fitted with a new wheelchair accessible shower, which they preferred to their old bath. The manager confirmed this individual had been fully involved in the decision making process to replace their old bath with a new shower unit. All the customers we spoke with at length agreed their flats were decorated to a good standard and in a style that reflected their unique tastes. All the flats we viewed looked extremely personalised. All the customers who returned our surveys told us their home is always kept fresh and clean. All the flats we viewed looked clean and smelt fresh. The manager told us he is currently negotiating with the Housing Association who own Care Homes for Adults (18-65 years) Page 22 of 33 Evidence: the building to establish a time specific rolling programme to continually redecorate and maintain all the flats at Speakers Court. Progress made by the provider to establish this maintenance and redecoration programme will be assessed at the services next inspection. Care Homes for Adults (18-65 years) Page 23 of 33 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 service ensures enough suitably competent staff are on duty at all times who are familiar with the customers unique needs and wishes, listen to what they have to say, and keep them safe. The training and supervision the staff receive has significantly improved in the past six months ensuring the team has the right mix of knowledge, skills, and on going peer and management support to meet the customers needs and wishes. The services arrangements for recruiting and assessing the suitability of new staff are sufficiently robust to ensure it continues to employ the right sort of people who are fit to work in social adult care. Evidence: Half the customers who completed our surveys told us care staff and managers always treat them well and listen to what they say, while the rest wrote this was usually the case. Typical feedback we received from customers about staff, included - the staff are always keen to help us, the staff here are very good, the staff are the best thing about the place, and i havent got a problem with any of the staff at Speakers Court. All the staff we met told us there was either always or usually enough staff on duty to meet the needs of all the customers who use the service. On arrival we noted two care staff on duty, which excluded the manager. The manager confirmed that a minimum Care Homes for Adults (18-65 years) Page 24 of 33 Evidence: of two staff always work across the day, which he assured us was sufficient to meet the needs of all the customers, keep them safe, and promote their independent living skills. As recommended in Speakers last inspection report the service has reviewed its night time on call arrangements and clarified which staff and/or managers should be contacted on any given night and under what circumstances. All the staff we met demonstrated a good understanding of these night time on call arrangements and were confident they would work well if they were called upon to implement them. All the staff who completed our surveys said their employer had carried out satisfactory checks, such as Criminal Records Bureau and references, before they started working at Speakers Court. Customers we met all told us they believed the new manager would ask their opinion about the suitability of new staff before appointing them. The manager confirmed that as stated in the services AQAA he had not been required to recruit any new staff since being in charge because he continued to have a full compliment of staff. As a consequence the service does not have to relay on any temporary agency staff, which the duty rosters we sampled at random indicated. Most staff who completed our surveys told us their induction had mostly covered everything they needed to know about their job before they started. Furthermore, one hundred percent wrote the on going training they received was relevant to their role, helped the understand and meet the needs of the customers, and kept them up to date with new ways of working. As required in the services last inspection report the manager provided us with evidence that showed us all staff that worked at Speakers Court had received up to date training in fire safety, first aid, food hygiene and infection control. Staff training records also showed us one hundred of the current staff team had either achieved a National Vocational Qualification in care (Level 2 or above) or were enrolled in a suitably NVQ course. Staff we met told us the training they received had improved in the past six months. Other training courses staff had recently attended included Scopes complaints resolution training and understanding the mental Capacity Act. As recommended in the service last report the manager has assessed all his staff teams training needs and established an action plan to address any identified gaps in their knowledge and skills. All the staff who completed our surveys told us they always got enough support from their manager who they regularly met to discuss how they we getting on. One member of staff told us it was good they now had a permanent manager on site they could talk to if they were not happy about anything at Speakers Court. Staff records we looked at random indicated these individuals had each received three one-to-one supervision sessions with either the relatively new manager or Team Coordinator during 2010. Minutes of the services last two staff meetings also showed us these Care Homes for Adults (18-65 years) Page 25 of 33 Evidence: were now being held approximately once every two months or so, and were being well attended by staff. Care Homes for Adults (18-65 years) Page 26 of 33 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 customers now benefit from living within a service that is well run by a very experienced and competent new manager. Overall , the quality assurance systems the providers developed ensure the customers and their representatives to have their say and affect the day-to-day running and future develop of Speakers Court. However, Scopes own internal monitored arrangements are currently falling short of what is required and need to be carried out a more frequent intervals as a means of assuring the quality of the service delivered. The services fire safety arrangements have significantly improved, and its health and safety measures remain sufficiently robust to safeguard the welfare of the customers, their guests, and staff. Evidence: As required in the services last inspection report the providers appointed a new suitably experienced, qualified, and competent person to be in operational day-to-day Care Homes for Adults (18-65 years) Page 27 of 33 Evidence: control of Speakers Court in September 2009. As mentioned throughout this report all the feedback we received from the customers and staff about the new managers style and leadership approach was in the main very positive. Typical comments, included the manager is very helpful and always on hand to offer his advice and support, Dan (the manager) has got the place on its feet again, and its great to have someone in charge again who you can speak to anytime you want. The new manager has had an extremely positive impact on the service as a whole since being appointed and has played a pivotal role in improving outcomes for customers and staff morale. The new manager is clearly good at delegating and sharing responsibility for running the service among his staff team. As mentioned previously in this report we positively noted that various members of staff have been given greater responsibility to monitor the services medication handling practises, supervise their colleagues, participate in team meetings, and being on-call at night. Furthermore, as we recommended in the services last report the role and responsibilities of the senior Team Coordinator post has been made much clearer and these staff are now expected to receive similar training to that received by service managers. Staff we met told us the service continues to be well run even when the manager is away because they are more aware of their roles and responsibilities and can always relay on the Team Coordinator for advice and support. As mentioned throughout this report all the customers we met told us the new manager and staff always listened to them and took on board what they had to say. The manager was able to provide us with a copy of the last report compiled by a representative of Scope following an inspection they carried out in January 2010. However, the manager conceded that contrary to the Care homes Regulations these inspections we no longer being undertaken by Scope on a monthly basis. The requirement is made that these internal quality assurance visits are re-instated by the provider. As required in the services last inspection report the manager provided us with documentary evidence on request that revealed staff are now maintaining up to date records of all the fire drills and fire alarm tests conducted within Speakers Court. These records revealed the fire alarm system is tested on a weekly basis and fire drills undertaken approximately once a quarter in line with good fire safety guidance. Staff we met demonstrated a good understanding of the services fire evacuation procedures. The manager showed us an up to date fire risk assessment of the building when we asked for it. The manager stated in the AQAA that the services electrical circuits, portable electrical Care Homes for Adults (18-65 years) Page 28 of 33 Evidence: tests, fire detection and alarm systems, fire fighting equipment, emergency call bell system, water heating, and gas installations had all been serviced as recommended by the manufacturer or regulatory bodies. Care Homes for Adults (18-65 years) Page 29 of 33 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 30 of 33 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 39 26 A representative of the provider must carry out monthly unannounced inspections of the Speakers Court and compile a report on the conduct of the service. This will enable the providers to determine whether or not outcomes for customers are satisfactory and whether or not the service could improve its overall performance. 21/06/2010 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 1 The services Guide should be written in plain language and generally made easier to read to ensure customers and their representatives can access all the information they need to know about the services and facilities provided at Speakers Court, including fees charged for them. Page 31 of 33 Care Homes for Adults (18-65 years) 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 2 6 Person centred care planning training should be provided to all staff that work at the service. This will ensure support to customers is provided in a person centred way which meets their unique needs, strengths and preferences. This good practice recommendation was made in the services last key inspection report, but was not implemented. Care Homes for Adults (18-65 years) Page 32 of 33 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. 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