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Inspection on 19/03/09 for 26 Henley Way

Also see our care home review for 26 Henley Way for more information

This inspection was carried out on 19th March 2009.

CSCI 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.

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

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: 26 Henley Way 26 Henley Way West Hallam Derby DE7 6LU two star good service The quality rating for this care home is: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Anthony Barker Date: 1 9 0 3 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. They reflect the things that people have said are important to them: 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 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 Commission for Social Care Inspection aims to:  Put the people who use social care first  Improve services and stamp out bad practice  Be an expert voice on social care  Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 03000 616161 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Internet address www.cqc.org.uk Information about the care home Name of care home: Address: 26 Henley Way 26 Henley Way West Hallam Derby DE7 6LU (0115)9441946 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): henley.way@unitedresponse.org United Response Name of registered manager (if applicable) Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 3 Number of places (if applicable): Under 65 Over 65 3 0 learning disability Additional conditions: Date of last inspection A bit about the care home 26 Henley Way is a detached house in a small village development. People living here are provided with adequate accommodation and single rooms. There is a reasonably-sized rear garden. The Service offers personal and social care to people with a severe learning disability with associated conditions that include autism and sensory disability. Activities are planned to meet individual needs. 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 How we did our inspection: This is what the inspector did when they were at the care home This key inspection was unannounced and took place over one day. The last key inspection at this service was on 7th February 2007. The Commission had requested the Service to complete an Annual Quality Assurance Assessment (AQAA) before this inspection. Survey forms were sent to staff, befrienders and external professionals but no completed ones were returned. The people living at the Service all had high levels of dependency and therefore were not able to contribute directly to the inspection process, though they were observed working with and being cared for by staff. One particular persons experience of the quality of the service was focussed on, through their personal records and discussion with staff. The Acting Manager and one support worker were spoken with at this inspection and records were inspected. There was also a tour of the premises. The weekly fees at the time of this inspection ranged from £950 to £1300. What the care home does well Individual written needs assessments and plans of care were in place showing that peoples health, personal and social care needs were being met. The Service provided activities, personal support and other services that were valued by people and promoted their independence in a person centred way. Good procedures for handling complaints and abuse were in place ensuring people were fully protected. People were living in a homely, comfortable and safe environment. The Service had a group of well-recruited, and generally well trained, staff to ensure that people living here were safe and their needs were met. The Service was well managed so that people living there were protected and their best interests were promoted by the systems in place. What has got better from the last inspection The kitchen had recently been refurbished to achieve an attractive and safe environment. New carpets had been fitted in most areas and several rooms redecorated. Decoration at the premises reflected the preferences of the people living at the Service. There had been improvements to several recording systems at the service. What the care home could do better If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Tony Barker CSCI CPC1, Capital Business Park Fulbourn Cambridge CB21 5XE Tel: 01223 771300 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 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 - 03000 616161 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 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 . Individual written needs assessments were in place before people were admitted to the Service so that their diverse needs were identified and planned for. Evidence: The Acting Manager confirmed that the three people, living at the Service, had been admitted some years ago. A full assessment of their needs was made prior to their admission, as confirmed by detailed examination of care records at a previous inspection. Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People who use the Service had comprehensive and individual plans of care which demonstrated that their health, personal and social care needs were being met and they were enabled to make decisions about their lives. Evidence: The care plan of the person case tracked was examined. It was well worded, holistic and person centred and included Active Support Plans worded in the first person. This document was a valuable guide to staff and ensured that peoples needs were being met. Annual reviews of peoples care plans were taking place at person-centred review meetings. The Acting Manager described how she and another United Response manager facilitate the annual review meetings for those people living at each others services. She spoke of plans to introduce pictures into the review meeting notes in future. She also said that key workers spend two hours weekly quality time with the people living at the Service, going through their care plan files. These processes ensure that regular, independent monitoring of the needs, and preferences, of people living at the Service, is taking place which fully involves the people themselves. All care plan entries were being signed and kept up to date. Information supplied by the Acting Manager before the inspection stated that, We have discussion forms to enable people we support to be involved in the running of their home and in changes around their home. At the time of this Inspection these forms were being replaced with Decision Making forms. The form relating to the case tracked person had had the Decision Making Profile part of the form completed: this described how to support the person to make a decision. There were several other examples of people being involved in day to day matters as well as in significant Evidence: events in their life. One of these was of a person attending monthly self advocacy conferences. The Service is commended on the ways it is enabling people to make decisions about their lives. There was a good range of up to date, recorded risk assessments. These showed that the Service was aware of potential risks to which people were exposed and indicated ways of managing these risks. The support worker spoken with showed an understanding of the concept, and use, of responsible risk taking in order to increase peoples independence. For instance, the person case tracked at this Inspection is at some risk when walking on uneven ground and the staff member spoke of there being a risk assessment to address this matter. The Services Health and Safety file includes pages with symbols that are used by staff to improve the awareness of risks, and the need for weekly Health and Safety checks, for discussion with people who live at the Service. 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 Service provided activities and services that were age-appropriate and valued by the people who live here, and promoted their independence. Evidence: The people living at the Service were either receiving an external day service, were attending college or were involved in voluntary work. One person had just been offered a paid job delivery the Thompson Directory. Information supplied by the Acting Manager before the inspection indicated that one person has attended training courses around their voluntary work. This voluntary work involved the person in creating a leaflet for a local voluntary organisation, photocopying and delivering them to houses in the community - with support from care staff. We saw the large alphabetical keyboard, large mouse and touch screen monitor used by this person, and one other, in conjunction with a computer. Activity Plans were examined. These used widget symbols to enable the people who live at the Service to be involved in the planning of their days activities. The Acting Manager spoke of changing these symbols for photographs and increasing the format from A4 to A3 to help further understanding. Further evidence of the activities people are involved in was seen on the dining room walls. Here there were three mounted canvas board displays of each persons paintings. The support worker spoken with was also able to provide evidence of people being involved in valued and fulfilling activities. He said that one person likes to feel involved in day to day activities within the Service and likes lots of praise. He added Evidence: that the person has a beaming smile on their face while doing tasks (they like). This member of staff was heard, at this Inspection, praising the same person for drying their lunch plate after the meal. These examples show how the Service is making good efforts to find valued work and activities within the premises, and in the community, for the people living here, and this is commendable. None of the three people living at the Service had any contact from relatives. Information supplied by the Acting Manager, before the Inspection, stated that, The people we support have regular contact with their friends... and have made new friends in the community. The support worker, who was spoken with, said that one person is friends with someone living at a nearby care home who shares a cookery course at college. The Acting Manager explained that new friendships also included those made at college. The support worker gave examples of how routines, at the Service, are flexible to meet peoples individual needs and circumstances. As an example, he said, morning routines are, personalised to each individual and take account of their own way of working. Staff informed us that they were due to go to the local bowling alley on the morning of this Inspection, with two people they support. However, one person indicated, by shaking their head, that they did not wish to go bowling. When staff suggested a trip to Ikea and a walk in the local park this was met with approval, through a nod of the head. It was also clear to us that routines at the Service promote peoples independence. All were involved in food shopping and clearing the table after mealtimes. The Services four week rolling menu indicated that people were being provided with a varied and nutritious diet. One person living at the Service had been involved in updating the Services menu in June 2008 and in creating one for their own use. Peoples food preferences were recorded on file. Food stocks were found to be at a satisfactory level and the Acting Manager said that people living at the Service are enabled by staff to make regular trips to local food shops. Each person living at the Service had their own kitchen cupboard, which gave them added independence and confidence within the kitchen. A board was displayed in the kitchen with three photographs depicting the days three meals. These were taken from a box of photographs each showing a different meal and so provided people with a more easily recognisable pictorial menu. 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 . The Service was providing people with personal support in the way they preferred and required and was meeting their physical, emotional and health needs. Evidence: At this Inspection we observed positive interaction between staff and the people living here - with their dignity needs clearly being recognised. The support worker spoken with gave examples of how staff meet the dignity and privacy needs of people living at the Service. For example, staff knock on doors, cover people with towels if they are walking to the bathroom and tell people what you are doing rather than just doing it. He spoke of people having their own space - for example, taking time out in their bedroom. There was evidence of equipment in place that maximised peoples independence. For instance, there were grab rails on landing and hall walls for one person who was unsteady on their feet as well as a frame attached to their bed to help them stand. Information supplied by the Acting Manager before the inspection referred to communication boards with pictures of activities, staff and menus. From observation and discussion with the Acting Manager it was clear that peoples communication needs had been assessed and, wherever possible, were being met. The Acting Manager said that she had had training in the Mental Capacity Act (MCA), including the new Deprivation of Liberty Safeguards legislation, and would be cascading this training to the staff group. She said she also intends to speak to staff, in individual supervision sessions, to enable them to analyse their role in the context of the MCA. Additionally, she will be giving staff information on the Independent Mental Capacity Act Advocate (IMCA) service. The Acting Manager spoke of links being recently set up with the Southern Derbyshire Advocacy Service and two people, living at the Service, were to attend a meeting in Bakewell about advocacy. Evidence: Care plans provided evidence of each persons health care needs being met. There was evidence on the case tracked persons records of involvement of a range of external health professionals, including psychiatrist, GP, dentist and optician. There was a new Active Support Plan on Personal Care that included a section on How I Manage my Continence. Small format ring files called My Health File were in place for each person living at the Service. These were worded in a person centred way and taken to health appointments, the Acting Manager said. Files contained a body map dated 12/1/09 showing a graze on the case tracked persons head and the Acting Manager had recorded on the daily logs that staff should monitor and record any changes. However, there were no future records to confirm whether this monitoring had taken place - a significant omission in respect of a head injury. The Medication Administration Record (MAR) sheets, of the people who live at the Service, were examined. Attached to these were photographs, a list of the prescribed medication and a record of staff signatures/initials, to ensure that signatures can be cross-referenced against staff names. The standard of recording on the MAR sheets was generally satisfactory. However, there was one handwritten change of dose of amitriptyline that had not been signed, in order to provide an audit trail. The Acting Manager showed that she was aware of the need for double signatures in these circumstances and provided evidence that this was normally done. Medicines were securely stored. No controlled drugs were prescribed. Most staff had received training in the safe use of medicines within the past year. 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 . Good procedures for handling complaints and abuse were in place ensuring that people were fully protected. Evidence: The Services complaints procedure was displayed in the hall, as a poster, in a pictorial style, for the benefit of the people living here. It was headed, Are you happy with the support we give you? Reference was still being made to the National Commission for Social Care - an organisation that no longer exists - in this poster, and in a separate sheet on how make a complaint. The Acting Manager stated that one complaint had been received, from a person living at the Service, within the previous 12 months. We examined a satisfactory complaints log which was kept in the persons own file. The Acting Manager said that United Response was planning a system, of responding proactively to the concerns of people they support. Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People were living in a comfortable, homely and safe environment. Evidence: The Services environment was homely and well furnished and decorated. The kitchen had recently been refurbished. This included an induction hob with a locking safety feature and resultant removal of a safety gate. This meant that all the people living at the Service could safely enter the kitchen without staff help. The kitchen was in an attractive red and black decor that reflected the favourite colours of two people living at the Service. This colour scheme was also reflected in the newly bought lounge furniture. Most communal areas had been re-carpeted. There was also evidence of other decoration of the premises. The Acting Manager spoke of plans to change around several rooms so as to provide a third bathroom. This would mean each person would have their own bathroom so addressing some incompatibility issues relating to usage of bathrooms. The plans would also lead to moving the laundry downstairs and this would address the needs of the person who is accommodated on the ground floor. Two bedrooms were viewed and were found to be personalised. One room was particularly colourful and visually stimulating - reflecting that persons needs. From the tour of the premises there was evidence of good standards of cleanliness and hygiene throughout, with no unpleasant odours. The support worker spoken with described good practice regarding the transportation of soiled articles of clothing and bedding within the premises. The laundry room had one washer, with a sluicing programme, and one dryer. The questionnaire completed by the Acting Manager referred to the majority of staff having completed Infection control training. 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 had a group of well-recruited, and generally well trained, staff to ensure that people living here were safe and their needs were met. Evidence: None of the five care staff had achieved a National Vocational Qualification (NVQ) in Care to level 2 or above. This did not meet the National Minimum Standard to maintain a staff group with at least 50 qualified staff. The Acting Manager stated, in the pre-inspection questionnaire, that people who live at the Service are involved in staff interviews. Recorded evidence of this was seen at this Inspection. The Acting Manager said that two of the people had chosen a smiley face over sad and unsure faces when asked about their views on the staff member. Job descriptions had been compiled from discussions with the people who live at the Service. The file of a member of care staff appointed three weeks prior to this Inspection was examined. It was found to contain all of the elements, required by current Regulations, regarding recruitment practices. There was recorded evidence of this same staff member being provided with induction training to Skills for Care Common Induction Standards. His training booklet had been appropriately signed and dated in the sections completed. He said he had shadowed another staff member during the first two weeks of his work at 26 Henley Way and was booked on courses with United Response. Training records confirmed that staff had been provided with all mandatory training except that sleep-in staff had not received six-monthly interim fire safety training since the external training undertaken in March 2008. The Acting Manager said that staff had been provided with training on the topic of epilepsy. 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 Service was well managed so that people living here were protected and their best interests were promoted by the systems in place. Evidence: The Acting Manager had worked with people with learning disabilities for 20 years, with nine years spent with United Response. She had achieved the Registered Managers Award and had satisfactorily completed the NVQ in Care at Level 4. She was on a six-month contract, as Acting Manager of this Service, from August 2008. Monthly independent audit visits to the Service, on behalf of the Registered Provider, as required by Regulation 26, were now taking place - an improvement from the last inspection. The Services current annual Service Plan was on a flip chart in the dining room. This was well laid out and included target dates, to monitor progress. Quality assurance questionnaires were being sent to staff and external professionals, for their views on the quality of service provided - though none had been returned by the latter group. The Acting Manager said there were plans to compile questionnaires for the people living at the Service. She had stated, in the pre-inspection questionnaire, that, people we support are involved in team meetings. Evidence of this was seen on team meeting minutes. Good food hygiene practices were noted including the regular daily recording of refrigerator and freezer temperatures. The safe storage of cleaning materials was observed, along with the product data sheets required by the Control Of Substances Hazardous to Health (COSHH) Regulations. The pre-inspection questionnaire, completed by the Acting Manager, indicated that equipment at the Service was being maintained and good Health and Safety practices followed. Fire alarm tests were Evidence: carried out weekly and fire drills were held monthly. The Acting Manager said that monthly Health and Safety hazard checks were being made of each room in the premises. The Services environmental risk assessment had been appropriately reviewed. No Health and Safety hazards were found at this inspection. Are there any outstanding requirements from the last inspection? Yes  No  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 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 Description 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 Description 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 19 Following a potentially serious injury, to a person living at the Service, a record should be kept of how this is monitored. Any handwritten change of prescribed medicine should be signed and counter signed on the MAR sheet. The Services complaints procedure should include the name and current contact address and telephone number of the Commission. At least 50 of the care staff should achieve an NVQ in Care at level 2. Sleep-in staff should be provided with six-monthly interim fire safety training. 2 3 20 22 4 5 32 35 Helpline: Telephone: 03000 616161 or Textphone : or 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) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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