Inspection on 08/06/09 for Drayton Wood

This inspection was carried out on 8th June 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Drayton Wood 09/06/08

Drayton Wood 14/06/07

Drayton Wood 21/06/06

Drayton Wood 04/01/06

Drayton Wood 26/07/05

Drayton Wood 18/01/05

Drayton Wood 24/05/04

Extracts from inspection reports are licensed from CQC, this page was updated on 06/08/2009.

Key inspection report Care homes for adults (18-65 years) Name: Address: Drayton Wood Drayton High Road Drayton Norwich Norfolk NR8 6BL 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: Judith Last Date: 0 8 0 6 2 0 0 9 This report is a review of the 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 stars – excellent  2 stars – good  1 star – adequate  0 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. 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 Care Homes for Adults (18-65 years) Page 2 of 45 Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by:  Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice  Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983  Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services.  Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 45 Information about the care home Name of care home: Address: Drayton Wood Drayton High Road Drayton Norwich Norfolk NR8 6BL 01603409451 01603426568 office@benellcare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Benell Care Services Limited care home 36 Number of places (if applicable): Under 65 Over 65 36 0 learning disability Additional conditions: In total thirty six (36) people of either sex, who have a learning disability, may be accommodated. Nine (9) people, of either sex, with a learning disability may be accommodated in Drayton Wood main house. Seven (7) people, of either sex, with a learning disability may be accommodated in Holly Lodge. Seven (7) people, of either sex, with a learning disability may be accommodated in Honeysuckle Lodge. person accommodated in Honeysuckle Lodge will be no more than 25 years. Seven (7) people, of either sex, with a learning disability may be accommodated in Spruce Lodge. Six (6) people, of either sex, with a learning disability may be accommodated in Cedar Lodge. Care Homes for Adults (18-65 years) Page 4 of 45 Date of last inspection 0 9 0 6 2 0 0 9 A bit about the care home Drayton Wood is registered to provide care and support to people with learning disabilities. It is set large landscaped gardens and woodlands. In the grounds there are pens for pygmy goats and chickens and there is an aviary. There are five separate houses. Drayton Wood is the original building and dates back to Victorian times. There are four more recent purpose-built houses known as Holly Lodge, Cedar Lodge, Care Homes for Adults (18-65 years) Page 5 of 45 Honeysuckle Lodge and Spruce Lodge. They are registered as one home, but have separate staff teams and groups of people with different needs. Nine people live in the main house, Drayton Wood. There is one double bedroom that is used for couples wishing to share, and seven single bedrooms. Seven of the eight rooms have en-suite facilities. There is a large lounge and dining area and a separate day care centre. Care Homes for Adults (18-65 years) Page 6 of 45 Honeysuckle Lodge, Spruce Lodge and Holly Lodge provide accommodation to 7 people, in single rooms with en-suite facilities. Cedar Lodge accommodates 6 people. Each home has its own kitchen and dining facilities, and living rooms. Spruce Lodge has a lift to help people get up to the first floor People can get into Norwich by bus or one of the homes cars. There are also used for people to go to other nearby towns and villages. Care Homes for Adults (18-65 years) Page 7 of 45 Drayton Wood has the Investors in People Award and this was been renewed in December 2007. This is given for commitment to staff training. It costs from, £460.00 to £1004.86 per week to live at the home, dependent upon peoples needs. There are additional charges - for example for hairdressing, chiropody, transport and personal spending. Care Homes for Adults (18-65 years) Page 8 of 45 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 Care Homes for Adults (18-65 years) Page 9 of 45 How we did our inspection: This is what the inspector did when they were at the care home Before we went to the home we looked at all the information we have about it. This includes the form we asked the manager to fill in and send before we went. We also had surveys posted to us by 4 relatives, 9 staff and 26 of the people living in the home. Some people needed help to complete these. Care Homes for Adults (18-65 years) Page 10 of 45 We also looked at the history of the home, and any information that has come to us since we last looked at how well it was being run. We visited the home without telling the manager we were going, and spent just over 8 hours there. During our visit, the main way we did the inspection was by case tracking. This means we look at records to see what they say about peoples needs, then try to find out from talking to people, looking and listening, how well their needs are being met Care Homes for Adults (18-65 years) Page 11 of 45 We used all the information we gathered and the rules we have, to see what outcomes there are for people in their daily lives. What the care home does well People have lots of opportunities to socialise and to do things in and out of the home. They can go out on their own if they are able to and wish to do so. They can also choose holidays. Care Homes for Adults (18-65 years) Page 12 of 45 People can help out around the home and gardens if they want to. Staff try to find ways of communicating with people who find this difficult. People say the food they have is good. Care Homes for Adults (18-65 years) Page 13 of 45 They also say they like their rooms and can keep them how they like. This includes choosing the colours and how they are decorated. People who were able to express their views clearly, say they know who to go to if they have concerns or want to complain. They say they can go to Sonja (the top one) to get things sorted out. Care Homes for Adults (18-65 years) Page 14 of 45 What has got better from the last inspection The staff have had some more training in managing medicines and records have improved. This means we are more confident that medicines are managed safely. The management team can more easily see if there are problems with tablets that need sorting out. The manager as continued to improve the decoration in different parts of the home. Care Homes for Adults (18-65 years) Page 15 of 45 What the care home could do better There are three things that need to happen by law. One of these is to do with health care. Sometimes people who need support to eat in a healthy way are gaining a lot of weight. This means that the way staff are supporting and advising them is not working and that they may need extra advice to help some people to stay well. The manager must look at the way staff have to provide support if there is an emergency in another part of the home. She must write down her findings and make sure that Page 16 of 45 Care Homes for Adults (18-65 years) people would not be at risk if staff had to leave them on their own while they helped others. The manager needs to get all the information the law says is needed before staff start work at the home and make sure she keeps this available. This is so she can show she has done everything needed and everything she can to make sure unsuitable people do not work at the home. There are other things that the manager could think about doing that would be good practice. We would encourage her to do these to improve things even more. If you want to read the full report of our inspection please ask the person in charge of the care home Care Homes for Adults (18-65 years) Page 17 of 45 If you want to speak to the inspector please contact Judith Last CQC East National Correspondence Centre Citygate Gallowgate Newcastle upon Tyne NE1 4PA Tel: 03000 616161 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 - 0870 240 7535. Care Homes for Adults (18-65 years) Page 18 of 45 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 19 of 45 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. People, or their representatives, have access to information about the home, and their needs are assessed, so they can be sure they will be met if they decide to move in. Evidence: When we arrived at the home, Mrs Serruys had not complied with the requirement we made last time. This was to do with providing people or their representatives, information about fees. While we were there she put this right and made another page for the information to go in the guide to the home. People (or more likely their representatives) need this if they are to use the information to make fully informed decisions about moving to the home. Surveys sent to us before we visited showed us that 81 of people (21 out of 26) felt that they did have enough information before they decided to move in. All of the relatives who answered the question in our survey, feel that they do have enough information to help them in making decisions. One person we spoke to told us they did not feel they had enough information about the home, but then went on to say that they had been to visit, looked round and talked to Care Homes for Adults (18-65 years) Page 20 of 45 Evidence: people about it before making the decision to move in. They say, Someone showed me where I would sleep. This shows that people are able to find out what the home is like before they decide to move. We could see from records that peoples needs were assessed before they moved to the home. We know from our other visits as well as this one that information is gathered by the management team either directly or from other professionals. This means that staff will know what someones needs are and how they should support them, before they move in. Care Homes for Adults (18-65 years) Page 21 of 45 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 are involved in decisions about their lives so far as possible and efforts are made to encourage them to play an active part in planning their care. Evidence: We looked at support plans for 5 people. A computer programme is used for maintaining the records and keeping them up to date. When needs change a new set of guidance about what support staff should offer is printed off so they should be clear what is expected of them. We could see that additional information is incorporated into plans where relatives have raised concerns about how people are supported. This means that efforts are made to incorporate the views of others who are important to people and who can help them get the right support. If there are no changes, information is not necessarily reprinted, but we could see from computer records that it is kept under review. Where people are able to they have signed their records. One person we spoke to says staff write things down, they talk to me about it. Care Homes for Adults (18-65 years) Page 22 of 45 Evidence: 88 (seven out of eight) of the staff who wrote to us say they always have up to date information about peoples needs in their care plans. The remainder felt this usually happens. We received a comment that On some occasions keyworkers forget to update care plans. We saw evidence of this. There had been a delay in updating information for one person where their family circumstances had changed. Although this had been documented in an updated personal history, the care plan itself had not been altered. However, the person told us staff are very good, they come and talk to me. They said they felt staff helped them come to terms with things that upset them. This means that staff are aware of the change and how to support the person effectively, even though the specific information is not set out in their care plan. Care plans set out objectives for care and associated risks, together with what staff are to do to minimise these. However, one persons file contains risk assessments that have not been reviewed for some time. These show they are not to be left unsupervised in one part of the home. Review notes show this has happened. We were told this is no longer considered to present a risk but written information has not yet been updated and agreed so it is clear. One person we spoke to is aware of risks like falling or having a seizure when they are out in the community. They continue to choose to travel independently and know they must have information with them in case of emergencies. They say that staff do discuss things with them and sometimes they take advice. If I dont feel too good I dont go. Most people would find it difficult to understand their written plans, but records show they are present at reviews and supported by keyworkers who can help them understand what is going on and to get their views across. Our survey asks people whether staff listen to them and act on what they say. This is so we can see if people feel they can express their views about how they want to be supported and decisions they want to make. 81 who wrote to us feel staff always do this and 15 feel it happens usually. One person told us I get on better with some staff than others as I dont think they listen to me. When we asked them about this they told us that it is all sorted out now because they had been to speak to the top one, and its better. We asked staff about guidance they have to support people in making informed decisions within the latest rules about mental capacity and deprivation of liberty. A team leader confirmed they had some guidance and discussed some areas where it would impact on the way decisions are made. Another staff member says they had not guidance or training. The manager is aware of the need for further training so that staff can support people more effectively with informed decision making. Two people told us how staff support them with their money. Individual plans include information about how people are to be supported with this. One person was not able to speak to us about this and needs a lot of help. Their care plan shows an update showing what checks staff must make before supporting the person with withdrawals, to avoid Care Homes for Adults (18-65 years) Page 23 of 45 Evidence: incurring bank charges. One person says they I would like to learn more about my money and their care plan shows how staff are to support them with this. These things show people are offered varying degrees of support to manage their finances, based on their individual needs. Information about peoples care is held securely within locked offices in each unit. Computers are linked to a stand alone network within the service and the manager says personal information is only accessible via these on site when computers are on the network. Two laptops are in use but the manager says again that these are not used to store personal information. She says they can only access personal information when they are connected to the network at the home. This shows peoples personal information is held confidentially. Care Homes for Adults (18-65 years) Page 24 of 45 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported with a fulfilling lifestyle that suits their needs and preferences. Evidence: We spoke to people about what they like to do and we asked them in our surveys. We had comments like: I like reading and I go to the library. I watch television in my room and listen to music. I am able to go out into the city when I choose on my own using the bus. I am happy with my routine and like the fact I can go out into the city if I choose. Im still liking it here and Ive got my own laptop. We get the choice where we go on holiday. I go to the church every Sunday. I go to exercise class on Monday. I enjoyed going to the Theatre Royal. I also have my pet goldfish in my room. A relative wrote to us that they feel the range of social events in the evening is also very good. These things show people have opportunities to engage in social, spiritual and recreational opportunities using the local community. Care Homes for Adults (18-65 years) Page 25 of 45 Evidence: One relative suggests the timing of activities could be looked at so the person they visit is are able to do their shopping at times when the city is not so busy. Another feels there could be more organised trips at weekends. A third relative feels that sometimes staff do not always offer appropriate advice or guidance on shopping trips and that the person sometimes buys clothing that is too small and has buttons which are very awkward for the person to manage. Two people are supported as a couple and others are supported with guidance about relationships as situations demand. Staff were able to tell us about the support they have been offering and how they try to clarify issues or involve other professionals if this is needed. Half of the relatives who wrote to us feel the person they visit is always supported to keep in touch with them. 25 (one relative) feel this happens sometimes. (One did not answer.) Two people we spoke to told us about keeping in touch with relatives and friends by telephone or visits and some people have their own telephones to help with this. One person told us that they are in touch with friends they made before moving to the home and support plans set out that this is to be encouraged. These things show people are supported to maintain friendships and relationships. People we spoke to told us that they help to keep their rooms clean. One says I do the dusting, another that I tidy my own room. One person says that they keep their bedroom clean but that staff do the bath for me. One person says that they like to cook when I feel like it. However, one relative commented to us that they felt sometimes staff did housework on behalf of the person they visit, instead of supporting them to do as much as possible for themselves. Records, and discussion with people as well as staff, show that service users are supported to participate in daily routines. While we were in the home we heard staff interacting with people in the home, talking to them about what they had been doing during the day and any plans for the evening. We also heard that staff knocked on peoples doors before they came in. We asked two people about this and they say staff always knock. However, during our visit, one persons privacy was compromised by another who lives in their home and they were upset about this. People sign an agreement, where they are able, to say whether they wish staff to assist Care Homes for Adults (18-65 years) Page 26 of 45 Evidence: them with their post. We also saw records to show that people had been supported to apply for postal votes where they wanted to exercise their right to vote. Menus we saw in three different houses, show people can make choices about their meals. One person told us that if they did not feel like eating what was on the menu I can always have something else. A staff member told us about the process of involving people whose communication is limited, using pictures to help them make choices about the food they eat. People are also able to go out for meals and say they enjoy this. However, two relatives have commented to us about the amount of money people spend going out for meals or buying in takeaways when food is included in the charges for the accommodation. Each unit has its own dining area where people can eat their meals. One relative told us that the person they visited had a special diet that is well catered for. Care Homes for Adults (18-65 years) Page 27 of 45 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 health and personal care people receive is based on their individual needs and the manager has plans to address any shortfalls. Peoples medicines are managed safely. Evidence: The support that people need with their personal care is set out in their individual plans. These show where they may need supervision or assistance because of their abilities or risks (such as from epilepsy). This means staff should be aware of how people wish their personal care needs to be met and what they need to do to ensure personal care is delivered safely. People wrote to us about staff and made comments like they are kind to us, and that when I moved to Drayton Wood I got the support I needed. While we were present we did not hear staff use any expressions that led to concerns about peoples dignity. However, one relative did tell us that they had heard people referred to as the menagerie. Records show that people are referred to other professionals for assessment and assistance if they need this or require special equipment. Care Homes for Adults (18-65 years) Page 28 of 45 Evidence: People told us they can go to bed when they like and one says they go earlier in the week because of doing things during the day time. This means there is some flexibility of routine for people. Preferred routines are set down in support plans. Each person has a health plan which records and sets out who else is involved in keeping them well - community nursing staff, dentist, optician, consultants etc. One person told us about a problem they had with their foot and that this makes it difficult for them to walk far because it becomes uncomfortable. The persons care plan says that staff should check for recurrence of the problem but this is not clearly set out and consistent in the health plan - which says occasionally walking can be uncomfortable but this is rare. This is not consistent with the care plan and what the person told us about their needs. Records show where peoples weight is to be monitored because of potential impacts upon their health (including mobility). However, the records of weights do not show staff intervention is wholly successful in supporting people in this area and some significant weight gains are recorded. The manager is aware of this as a problem and has plans to deliver nutrition training as well as looking at portion control. We heard staff talking to one person about appointments, explaining what was going to happen about a dentists appointment the following day and also a hospital appointment. This shows staff make efforts to discuss and inform people about their health care so they are supported with decisions about it. Further training for staff is planned in this area, so they understand better how to support people to make informed decisions and what to do if this is not possible. We looked at the way medicines are managed. Last time this presented concerns as it was not possible always to see from records that medicines had been administered as they were prescribed. The medication administration record charts have been reviewed following discussion with the local pharmacy. This means that balances not used at the end of a month and not in the monitored dosage system can now be recorded as carried forward. This enables the management team to monitor and audit procedures to make sure staff are following them appropriately. Storage of medicines is in locked cabinets within offices that are normally kept locked. However, these would not be adequate to allow storage of controlled drugs in individual units if these are needed. We looked at stocks of medicines and records and did not find anomalies. While we were there we saw a staff member administering medicines to people. This was done by checking against medication administration records and labels before preparing drugs to Care Homes for Adults (18-65 years) Page 29 of 45 Evidence: give to people, one at a time. This represents an appropriate process for ensuring medicines are administered safely. There were no gaps in records seen where it would not be possible to determine whether medicines had been given as prescribed. Where medicines are needed for occasional use there is now guidance in medication records to show why and when it may be needed so that staff can be clearer about when to give it, the maximum amounts in a set period and the intervals between doses. This means that the processes for ensuring safe administration of medicines have improved. Care Homes for Adults (18-65 years) Page 30 of 45 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. People have access to a complaints procedure (although verbal expression of concerns may not always be taken up as robustly), and there are measures in place to help protect them from abuse. Evidence: People who completed our surveys say that they know how to complain. However, it is clear from the level of assistance some people needed from staff, and the comments they make, that sometimes people would have to rely upon staff to interpret behaviour in order to identify a concern. There is a simplified complaints procedure on each persons file although these are held in the office. People we spoke to say they would talk to staff or the manager if they had any concerns. One person told us about a concern they had and how this had been addressed. They say they spoke to the top one and its sorted out now. This means that people are confident their concerns will be addressed. All of the staff who wrote to us say they know what to do if someone living at the home, or their representative, raises concerns about care. Relatives were asked in our surveys if they knew how to complain and whether the home had always responded appropriately. 75 (three out of four) knew how to complain and Care Homes for Adults (18-65 years) Page 31 of 45 Evidence: one could not remember but said they had never needed to. Of the people who did know, two say the home has always responded appropriately. One feels that verbal complaints are not always followed up and do not have much effect, although written ones are. However, we could see that concerns raised at a review had resulted in an update to one persons support plan so staff had guidance about how to avoid giving rise to similar concerns in the future. Staff have training in the protection of vulnerable adults and records and discussion with the manager show that any concerns about issues or conduct are referred appropriately. We looked at financial records and saw that records of withdrawals from banks corresponded to relevant deposits into personal allowances. Receipts also corresponded to items purchased where staff support people with their monies. Care Homes for Adults (18-65 years) Page 32 of 45 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 live in a homely, clean, comfortable and safe environment. Evidence: People say that they like living in the home. Three people who were able to talk to us told us that they had chosen the colour of their rooms and were very happy with them. Two other people signed to us about having their rooms painted and one that they had chosen the colours from a book. People can have their own possessions and own furniture around them. Some parts of the home are adapted to provide accommodation and access for people who have mobility problems. Records show that there are regular tests on fire safety within the individual units and that staff have training so that they know what to do to promote the safety of service users and themselves if there is a fire. Two people told us they have keys and one other says they dont but would like one. All areas of the home that we visited were clean and free from unpleasant odours. Staff records show that there is training available for infection control and food safety so that they will know how to minimise the spread of any infection and how to prevent cross Care Homes for Adults (18-65 years) Page 33 of 45 Evidence: contamination when they prepare food. This contributes to peoples safety in the home. Care Homes for Adults (18-65 years) Page 34 of 45 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported by a generally competent staff team but recruitment procedures are not sufficiently robust in all cases. Evidence: We looked at the training matrix for staff working in the home and at a sample of training records. The manager wrote to show 16 out of 35 care staff have National Vocational Qualifications in Care. The training coordinators list shows that a further 12 people have been registered for the qualification. This will help ensure that the vast majority of the staff team have the qualifications and learning opportunities they need to support people effectively. We could see that a range of other training is on offer to ensure staff understand their roles and how to work safely. This includes awareness of abuse, promoting safer and therapeutic services and safe holding techniques(to help deal with behaviour that challenges safely). All of the staff (9) who wrote to us felt that they are given training that is relevant, keeps them up to date and helps them to understand and meet different needs. We had additional comments such as some courses are reviewed annually, and this takes into account any changes in legislation. The internal training has been taken over by a new Care Homes for Adults (18-65 years) Page 35 of 45 Evidence: lady and since then information has been much easier to access and training has been more organised, less random. However, surveys also indicate that training in relation to meeting the needs of people with diverse needs could be improved. Our survey asks whether staff feel they have the right support, experience and knowledge to meet different needs such as those relating to disability, age, gender, race, ethnicity, sexual orientation and faith. 56 (five out of nine) feel they always have this, 33 (3)feel they usually have this and 11 (one person) feels they sometimes. One commented specifically that they felt that some of the aspects relating to older age care, rather than support, are lacking in my training. We asked whether relatives felt that staff had the right skills and experience to meet peoples needs effectively. One person did not answer. The remaining three gave a range of views - one feeling staff always had this, one that they usually have it, and one sometimes. Because we could see, and staff tell us, that training is now more organised, we have not made a requirement about this. We are aware from contact with anonymous complainants, that they feel sometimes staffing levels have not been as they would wish and that this has compromised care on occasions. A staff member wrote to us that as two people they supported need full care this sometimes took support away from others living in the house. One wrote to us that two people they worked with were very dependent. They say this means when assisting one of these service users it is very time consuming and sometimes others have to wait for the required support. Of the 9 staff who wrote to us, 11 (only one) was able to confirm they felt there were always enough staff to meet peoples needs. 78 say this is usually the case and 11 says sometimes. Three out of four relatives feel that the staff team usually is able to meet the needs of the person and one says I feel at times they could do with more staff on duty. The manager says in information that she sent, no shifts had needed to be covered by agency staff and that the staff team is very flexible about covering extra shifts. However, she also acknowledged that they had made agreements with another agency so that they had additional resources to call on when staffing levels fall occasionally due to sick leave at short notice. We asked about the staffing arrangements at night and what happens in an emergency. There is an expectation that staff from other houses would assist in the event a fire breaks out in one of the units. However, the staffing levels in each unit at night are based on the needs of people living there. For example, we were informed that two people in one unit potentially have bad seizures and so staffing is arranged accordingly. There is no Care Homes for Adults (18-65 years) Page 36 of 45 Evidence: separate assessment of risk associated with fire and how this should be managed to that these people are not placed at risk should staff not be available to them because they are attending another unit. Induction training is offered and staff recognise that this has also improved. One person who says it only partly covered what they needed at the point they started work at the home, adds that I feel this area has dramatically changed at the company since I started. We looked at recruitment records for three staff taken on since our last visit. These were incomplete. Once person had no written reason for a gap in their employment history. One person had a reference requested from a previous post in care work but this was not on file. One person had only one reference on file although the manager, deputy manager and administrator confirm a second and very good one was received. They felt this may have been misfiled. The first reference was dated by the sender for a date after the person had started work on induction at the home - although we were told this is a classroom exercise and that staff are not then working with people who live at the home. This means that record to not currently show that the recruitment process fully complies with the law. However, staff do have checks against the list which prohibits them from working with vulnerable adults before they start work at the home, and this is followed up with full disclosures kept on file. Care Homes for Adults (18-65 years) Page 37 of 45 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. People benefit from a service that is run effectively and where their views, safety and welfare are taken into account. Evidence: The manager is qualified and experienced in her role. She undertakes training from time to time in order to help her continue to run the home effectively. She has the support of a deputy manager as well as team leaders in each of the smaller units. There is also a training coordinator and an administrator who provide support and input into the effective running of the home. This means there are clear lines of accountability in the day to day running of the service. Staff say that they see the manager more regularly than they used to as she goes round to the individual units to meet people. All of the residents we spoke to know who the manager is and say that they can speak to staff or Sonja if they need to. There are systems in place for surveying people about the quality of the home and what they think about it. However, when we visited, only the results of the surveys of people living there had been compiled into a report to suggest how things might improve. Care Homes for Adults (18-65 years) Page 38 of 45 Evidence: Relatives are surveyed but there was no overview of findings or action points to improve the service. During our visit the findings from relatives were analysed. This means the manager can now see more clearly what actions may be necessary to make further improvements. Staff are not surveyed (anonymously or otherwise) as part of the process. The manager says no responses were received from other visiting professionals. The training coordinator undertakes visits to the individual units to look at individual groups of standards and to see where things could be improved. There are written reports of her findings for the management team to follow up. The information that was sent to us was more fully complete than that supplied last year and showed us where she has made improvements and the plans she has for the future. We could see from checks against part of the information that she had given us evidence of what had improved. We looked at a sample of records to do with safety of the home - for example testing of lift equipment, which show these are mainatined safely. Fire detection systems are also tested and serviced regularly. Staff have access to training in moving and handling, responding to challenging behaviour, fire safey, food hygiene, first aid and health and safety. This helps them to understand how people are to be supported effectively and their safety is to be promoted. Care Homes for Adults (18-65 years) Page 39 of 45 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 Care Homes for Adults (18-65 years) Page 40 of 45 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 1 19 12 Where interventions 24/07/2009 identified as necessary in respect of maintaining health (specifically weight), are unsuccessful, the situation must be reviewed and additional advice sought if appropriate. If support is not being successful, the way it is being delivered must be reviewed to see how peoples health needs can be met more effectively. Regulation 12 of the Care Homes Regulations 2001 requires that the home promotes and makes proper provision for the health and welfare of service users. 2 33 18 The manager must review how staff are to provide support in emergencies. 10/07/2009 Care Homes for Adults (18-65 years) Page 41 of 45 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 She must write down her findings and make sure that people would not be at risk if staff had to leave them on their own while they helped others. There may not be adequate staff to ensure peoples safety in an emergency. People may be placed at risk of harm if the support identified as needed for them is not available when staff have to assist elsewhere. Regulation 18 of the Care Homes Regulations 2001, requires that, having regard to the size of the home, number and needs of service users, there are always competent staff in such numbers as are appropriate for peoples health and welfare. 3 34 19 The necessary checks on 10/07/2009 staff must be completed before they start work at the home. This is so people are protected from unsuitable workers by implementation of a robust recruitment policy. Care Homes for Adults (18-65 years) Page 42 of 45 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 Regulation 19 of the Care Homes Regulations 2001 as amended, sets out what information and checks must be completed before workers start at the home. Schedule 2 of the same regulations as amended, sets out the information that must be obtained and records kept in the home in relation to staff. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 6 Where support needs are unchanged between reviews and so information is not reprinted, hard copies should be signed and dated by the staff member responsible for maintaining the record. This is so it is easier for people (or their representatives) to see their records are kept up to date. Where handovers take place when there are people present in the individual units, the process should be reviewed so that people who need it can have staff with them. Where particular actions and close support is no longer considered necessary to keep people safe, risk assessments should be clearly updated to show the progress made and to clarify what support staff must provide to promote safety. Given that meals are included in fees, the arrangements for people buying meals out or takeaway food should be reviewed to ensure the system is fair and reasonable. Where people have an identified religion they wish to Page 43 of 45 2 9 3 9 4 17 5 19 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 practice, care should be taken that this is reflected in health plans so staff are clear what spiritual support people might wish to have should they become seriously ill or subject to a health emergency. 6 19 A review of health plans and support plans should take place to make sure information about problems and needs is consistent in both locations so everyone can be aware of what is the most up to date and the support that is needed. Specimen signatures and initials of staff who are administer medication should be retained in individual units. This is good practice in helping to identify easily who has been responsible for administering the medicines and - if initials appear similar to coding - that they are proper signatures and will not be confused with other lettering used on the charts. References should be date stamped and initialled on receipt as confirmation of the date they were received and to show they were obtained before someone started work, to show they were suitable. The management team should explore with staff the additional training they feel they need to meet peoples diverse needs. The quality survey should provide for consultation (anonymously if necessary) with staff working in the home. This would help identify where those working on the front line of service delivery have constructive suggestions and ideas for improvement. 7 20 8 34 9 35 10 39 Care Homes for Adults (18-65 years) Page 44 of 45 Helpline: Telephone: 03000 616161 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) Care Quality Commission (CQC). 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