Inspection on 20/05/09 for First Row, 31

This inspection was carried out on 20th May 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

First Row, 31 05/06/07

First Row, 31 08/06/06

First Row, 31 10/01/06

First Row, 31 19/03/05

First Row, 31 18/01/05

First Row, 31 15/11/04

First Row, 31 16/03/04

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

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: First Row, 31 31 First Row Linton Morpeth Northumberland NE61 5SH The quality rating for this care home is: Two star good service 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: Carole McKay Date: 2 0 0 5 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 Inspection report CSCI Page 2 of 33 Care Homes for Adults (18-65 years) Audience Further copies from Copyright General public 0870 240 7535 (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. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 33 Information about the care home Name of care home: Address: First Row, 31 31 First Row Linton Morpeth Northumberland NE61 5SH 01670861690 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) : coley@eldcare.fsnet.co.uk Mr John Thomas Cole,Mrs Delia Cole care home 3 Number of places (if applicable): Under 65 Over 65 3 0 learning disability Additional conditions: Date of last inspection 0 5 0 6 2 0 0 7 A bit about the care home 31 First Row Linton is an ordinary terraced house. Care Homes for Adults (18-65 years) Page 4 of 33 The house has a large private garden. Three men live at the house. The fees range from £622.79 to £675.44. Information about the home and inspection reports are available. Care Homes for Adults (18-65 years) Page 5 of 33 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: Two star good service Care Homes for Adults (18-65 years) Page 6 of 33 How we did our inspection: This is what the inspector did when they were at the care home We visited the service on 20 May 2009. We sent out surveys. We talked to people. Care Homes for Adults (18-65 years) Page 7 of 33 What the care home does well People can get out and about in the local community. And they are supported to have an active lifestyle. And to keep in touch with family and friends. Care Homes for Adults (18-65 years) Page 8 of 33 The home keeps people safe. People who live at the service are encouraged to stay well. What has got better from the last inspection Arrangements for supporting the staff are better. Care Homes for Adults (18-65 years) Page 9 of 33 And staff have had more training. What the care home could do better Make the service user guide easier to understand. Develop service user plans so that service users can be more involved in producing these. Care Homes for Adults (18-65 years) Page 10 of 33 Keep information more secure. Manage medicines more safely. 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 Carole McKay St Nicholas Building St Nicholas St. Newcastle upon Tyne NE1 1NB 0191 2333300 Care Homes for Adults (18-65 years) Page 11 of 33 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 12 of 33 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 13 of 33 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. Before coming to the home people receive some information about the service. But a fully comprehensive information pack is not ready for people to ensure that they have all the information they need to make an informed decision. Evidence: The service has information about the home that it can hand to new service users, or people who are considering the home. Since the last inspection the manager and staff have worked to produce this in a more accessible format by using DVD materials. But this work is not yet completed. No new admissions have been made to the service since the last inspection. But the home has the assessments carried out by the Care Managers for each service user and these, along with reviews of care, are kept on file. In surveys the service users confirmed that received enough information about the service and one person wrote that they had taster days, overnight stays. The home carries out a risk based assessment of need. These are typed accounts of the risks as perceived by the home and detailed written management plans. As such Care Homes for Adults (18-65 years) Page 14 of 33 Evidence: these are not as person centred as they could be i.e. focusing on the wishes and aspirations, accessible to the service users themselves and do not demonstrate how service users have been supported and encouraged to be involved in the assessment process. In surveys the staff showed that they feel they always have sufficient information about the needs of the people they care for. Care Homes for Adults (18-65 years) Page 15 of 33 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The service plans care for service users and makes decisions with service users that are in service users best interests. The records do not yet demonstrate the process in a clear and comprehensive way that reflects service users diverse needs. Evidence: Each person living at the home ( service user) has a service user plan. These are divided into separate files. One file is to do with important legal documents and correspondence. The main file is about the care needs of each person and includes care plans. The on going daily records of progress are kept in an individual diary for each person. The care plans are written on a risk assessment basis. An identified risk is described and a management plan is written out for staff to follow. This keeps service users safe from harm. However these do not necessarily look at all aspects of a persons life, including all the positive aspects, and do not use a variety of ways of to help individuals make a contribution. Care Homes for Adults (18-65 years) Page 16 of 33 Evidence: Staff account for how they follow these by writing in the hard back diary. But this sometimes includes loose leaf additions. For example one loose leaf piece of paper had been added to a diary describing how staff had followed a plan for responding to the behavioural needs of a person. This important information could get easily lost and diary information could be difficult to audit over a period of time. The service user plans include the aims and objectives of care and an individual activities plan for each person. Some of this information is presented in a timetable format so that it is easy to follow. But other care plans are written from the staff perspective and are typed documents. Where decisions are reached to address risk these are accounted for, and are in the best interest of the service user, but involvement of the service user in the decision, and their views about this are not always clearly demonstrated by the record keeping. But in a survey a care manager reported that the service usually supports service users to live the life they choose. And that the only exceptions to this are if there is agreement that it would be unacceptably risky and This is only done in exceptional circumstances, with all involved in an agreement and with the individual concerneds knowledge. Decision making by service users as a group is supported by house meetings. The records show that these take place as necessary, rather than with regularity. But brief minutes are kept and show that service users are consulted about holiday arrangements and changes to the house. Care Homes for Adults (18-65 years) Page 17 of 33 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Service users are supported to have an active and healthy lifestyle with varied activity, social and family contact being encouraged. Evidence: None of the service users are employed, however daytime activities are offered. One person attends the day care activities arranged by the provider of this service. Other people attend a horticultural skills unit or college every week. The service users are encouraged and supported to take part in community life, within their abilities. For example a service user regularly goes shopping independently to a nearby town, using public transport. Another person has been supported to go to the local shop and to use public transport. One service user regularly goes to the local pub at weekends for a social drink with local people from the community. Staff provide the level of support that is suited to Care Homes for Adults (18-65 years) Page 18 of 33 Evidence: the persons needs. Support for people to go out of the home is part of the daily activity plan. A car is available and extra staff are provided to enable individual activities to take place. Holidays are planned for later in the year. For one person this means supporting them to go on holiday with close family, taking into account a dislike of long travel times. Relationships with family are encouraged. Two people regularly spend time with relatives. Service users were spending time in all areas of the home according to their own choice during our visit. Routines were relaxed and staff were interacting with the service users. People are encouraged to become involved in household tasks according to their capabilities. Menus are varied and are planned on a day to day basis to take account of preference and provide choice. Service users also enjoy meals out at local pubs and restaurants. Mealtimes are flexible to suit the individual schedules of the service users. Care Homes for Adults (18-65 years) Page 19 of 33 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. The service users will have their personal care and health needs met. There are some gaps in the recording of this and in the medication records. Evidence: Each person has a service user plan that takes account of health care needs, but only one person has a health action plan. In surveys the staff confirmed that they have up to date information about the needs of the service users. The service user plans show that regular appointments are made for routine health checks such as the dentist and optician. And the service makes referrals to service users GPs for access to other specialists. For example one service user has had a referral to a dietitian in 2008. Other referrals have been made with good outcomes for a service user who has had some complex health care needs. Where necessary, health care is reviewed by health specialists and special teams. Care Homes for Adults (18-65 years) Page 20 of 33 Evidence: One recent visit to a well man clinic had positive outcomes for one service user and staff are now following instructions for supporting the person with self examination. The staff record this in the diary rather than the service user plan file. The home has not generated a care plan specific for this but follow the easy to read leaflet issued by the clinic. In a survey a health professional described the service as holistic, proactive and responsive to patients changing needs Service users do require support with taking medication. None are self medicating. And some require medication on an as required basis. This involves an element of judgement on the part of the staff. A written protocol is in place to support this decision making. When staff account for these decisions they are not always clearly detailing how the steps of the protocol have been followed. One of these reports was a loose paper entry in the diary. The medication is securely stored and keys are held by the person in charge of the shift. The staff records show that staff have received half day training in handling medications. The medications are dispensed from their original containers and the medication administration records (MAR) are hand written. but these are not checked and countersigned as correct. One entry in the MAR showed an incorrect dose for one medication when cross checked against the label on the medication. One MAR had gaps in the record of administration where staff had not used a code for refused medication. The record of medication receipt and disposal is not a continuous record, so the audit trail is difficult to follow. Care Homes for Adults (18-65 years) Page 21 of 33 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. The homes policies and procedures are clear. These and recent staff training safeguard service users from harm. Evidence: The home has a complaints procedure and a complaints record. The homes procedure includes all contact details. No complaints about the service have been received since the last inspection. Service users and staff who responded to the survey recorded that they knew who to speak to if they were unhappy with the service and were aware of the homes complaints procedures. The Service User Guide contains a copy of the Complaints Procedure. The home has staff guidance and procedures in place to protect vulnerable adults from abuse, (safeguarding). Staff files show that staff have received training in the local procedures. The manager said that copies of these procedures were received as part of the training and that staff have had training in the Mental Capacity Act, with further training to follow. The Home maintains financial records on behalf of the service users. Each person has an individual bank account. There was evidence of personal spending and receipts are kept. The provider of the service trains staff in crisis intervention and the manager said that the provider has updated his qualification to provide this in 2008. Staff have received training in conflict management in 2008. Care Homes for Adults (18-65 years) Page 22 of 33 Evidence: Care Homes for Adults (18-65 years) Page 23 of 33 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The home provides service users with a safe, clean and comfortable place to live through on going maintenance and improvement. Evidence: The home is a small mid terrace house and is totally in keeping with the local community. The home is attractively decorated throughout. Two service users had been involved in improvements to the small sitting room. There is sufficient space for service users to enjoy internally and externally. The home has a domestic washing machine located off the kitchen. The local environmental health department accepted this arrangement when the home was registered, as it is in keeping with the scale of the service. The manager confirmed that the staff have been provided with information on infection control. Some of these notices are posted up in the kitchen area. All areas of the home were seen to be clean, hygienic and free from unpleasant odours. Plans to upgrade other parts of the home, beginning with the bathroom, were described by the manager. Care Homes for Adults (18-65 years) Page 24 of 33 Evidence: Care Homes for Adults (18-65 years) Page 25 of 33 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The staff are recruited and trained to safely care for and meet the needs of the service users. Some of the recruitment steps are out of sequence for best practice. Evidence: Staffing arrangements are flexible to meet the needs of the service and the service users. The owner has other services based in Linton. Staff from these services cover for holidays and other special circumstances. The manager said that in this way the service users always have someone they already know working with them. Staff records are not kept at the home. The records were examined on a separate occasion at the owners office. They showed that staff are required to complete an application form and criminal record checks are carried out prior to staff being employed, to protect the service users. Though staff can work under supervision on the basis of a preliminary check. For one person only one reference had been obtained. For other staff the records were not clear enough to verify that references were from the most recent employer. The criminal record checks do not take up all possible checks. For example the checks to do with protecting children are not taken up. Care Homes for Adults (18-65 years) Page 26 of 33 Evidence: For one staff a post check interview had taken place and this was fully recorded. This is good practice. However this took place after the staff had been cleared to work alone. The records and staff surveys show that staff receive basic induction training, followed by mandatory training in health and safety, first aid, moving and handling, food safety. the manager has a training schedule to update these subjects. The manager stated the owner has a certificate to train staff in the use of physical intervention. The majority of staff have now completed this training. The manager maintains a file of courses available to the staff team. Since the last inspection some staff have attended courses on the Mental Capacity Act. Other specialised training has taken place, for example healthy food and special diets. Some of the staff hold national vocational qualification ( NVQ). Arrangements for the supervision and appraisal of staff have developed since the last inspection. These are now more structured and the appraisal process includes a self assessment by the staff. The manager has undertaken training in supervision. In surveys the staff indicated that the manager and the owners are supportive. Care Homes for Adults (18-65 years) Page 27 of 33 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The home is well managed and the choices of service users and their well being are respected. There are some gaps in some records and some information is not secure. Evidence: The manager has experience in working with adults with learning disabilities and has completed the Registered Managers Award. Since the last inspection the manager has undertaken training in supervision and is booked to take further training to do with training staff. Meetings are held in the home. The minutes showed that service users are asked about choices and activities. There is a Quality Assurance policy statement. The owner makes monthly visits and reports of these visits are available. He also visits the service frequently and is in dayto-day contact with staff, service users and their families. The manager issues questionnaires to the service users every three months to find out their opinion of the service. Care Homes for Adults (18-65 years) Page 28 of 33 Evidence: Maintenance contracts and test certificates are in place and fire safety equipment is tested at the appropriate intervals. This helps to ensure the service users safety. The staff confirmed that they had received up to date health and safety training. The fire officer has provided the home with user-friendly information for the residents regarding fire safety and procedures. No safety hazards or unsafe practices were observed during the inspection. Care Homes for Adults (18-65 years) Page 29 of 33 Are there any outstanding requirements from the last inspection? Yes No x Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 30 of 33 Requirements and recommendations from this inspection Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No Standard Regulation 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 15 15/08/2009 Where staff take action to follow protocol for managing behaviour, this must be recorded in the service user plan. This will ensure that the care plan and progress can be clearly monitored and evaluated. 2 20 13 Arrangements must be put in 10/07/2009 place for the effective ordering, receipt, storage, administration, disposal and timely recording of all medicines used in the home. This will help to ensure that peoples health and wellbeing needs are being met through the safe and correct use of prescribed medicines. Care Homes for Adults (18-65 years) Page 31 of 33 3 34 19 Two written references must 15/08/2009 be obtained for each person working at the home. One of these should be from a most recent employer. This will help to protect service users interests. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 1 Information about the home should be provided in a format that is accessible to people, taking account of their abilities and needs. The home should adapt the assessment process so that it is accessible and demonstrates how service users will be supported and encouraged to be involved in the assessment process, taking into account their abilities and needs. Information relevant to the service user plan should be written in the service user plan so that it is a more secure record, can be seen to support the plan of care and can be easily reviewed and audited. The service user plans should be in a format more accessible to service users, taking into account their abilities and needs to do with communication and be a comprehensive document that considers all aspects of the persons life. All possible checks against the criminal record bureau should be taken up, including for offences against children. Staff should not work alone until the employer is fully satisfied with the application outcome. 2 2 3 6 4 6 5 6 34 34 Care Homes for Adults (18-65 years) Page 32 of 33 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. 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