Inspection on 18/09/08 for Five-Ways

This inspection was carried out on 18th September 2008.

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.

Other inspections for this house

Extracts from inspection reports are licensed from CQC, this page was updated on 23/11/2008.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Five-Ways 42 Albert Road New Milton Hampshire BH25 6SP     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: Patricia Trim     Date: 1 8 0 9 2 0 0 8 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. the things that people have said are important to them: They reflect 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. Care Homes for Adults (18-65 years) Page 2 of 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) 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.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 27 Information about the care home Name of care home: Address: Five-Ways 42 Albert Road New Milton Hampshire BH25 6SP 01425 617051 01425 628630 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable): Type of registration: Number of places registered: Contemplation Care Ltd care home 3 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users to be accommodated is 3. The registered person may provide the following category of service only: Care Home only (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning Disability (LD). 0 Over 65 0 Date of last inspection Brief description of the care home Five-ways is situated in a quiet residential area in New Milton, a medium sized town on the outskirts of the New Forest. The home is a detached bungalow, which provides accommodation and support/personal care for three service users with a learning disability. Five-ways is within easy walking distance of the town centre via a pedestrian walkway. The home was recently taken over, together with two other learning disability services, by Contemplation Care Limited. The weekly fees are from 602 to 935 pounds per week. Care Homes for Adults (18-65 years) Page 4 of 27 Care Homes for Adults (18-65 years) Page 5 of 27 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 peterchart Concerns, complaints and protection Environment Staffing Conduct and management of the home Poor Adequate Good Excellent How we did our inspection: The information used to write this report was obtained in the following ways. We looked to see if we had received any complaints about the home and saw that we had not. We also looked at any information the home had given us about what might have happened since we visited. We used some of the information the provider gave us about the home in a form called the Annual Quality Assurance Assessment (AQAA). This is a form the home has to fill out every year to tell us what they are doing to make sure the home gives the people who have used the service the care that they want. Care Homes for Adults (18-65 years) Page 6 of 27 We also used information we received from surveys. We sent surveys to the three people who use the service to ask what they thought about it. We received three surveys back. A three and a half hour visit was made to the home by one inspector to carry out a key unannounced inspection. During the visit time was spent talking with three of the people who use the service to get their views about it. Some people in the home have limited verbal communication, so time was also spent observing staff practice and the interactions between people who use the service and staff. There was also an opportunity to get the views of one member of staff who worked in the home. Time was also spent discussing the provider’s plans for the home and looking at the environment. A random selection of documents was viewed. Three people who use the service were case tracked. This means their records were looked at to see how the provider identified their needs and made sure they were met. The home is currently without a registered manager. The service is being managed by the registered manager of Denehurst, another of Contemplation Care Limiteds homes, with support from the organisation. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line – 0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 27 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 27 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. Detailed pre admission assessments are completed that enable the registered manager to be sure people who use the service will only be offered a place if the home can meet their needs. Evidence: There have been no admissions to the home since the new providers took over. In depth assessments had been completed for the people currently living in the home. The AQAA recorded that an in depth assessment would be completed prior to any new admissions. All three people living in the home completed survey forms. They answered yes to the question which asked if they had been involved in deciding whether they should move to the home. Two people spoken with confirmed they had been able to take their time deciding to move to the home. Care Homes for Adults (18-65 years) Page 10 of 27 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. Care plans and risk assessments are not up to date so may not reflect the current wishes and aspirations of the people who use the service or support them to do the things they want to safely. Evidence: The AQAA recorded that the organisation used person centred planning that involved individuals in planning their care. The manager said each person had an individual care plan to identify their abilities and needs. She was currently reviewing the information in each folder, as plans had not been updated since the previous registered manager left and much of the information stored in the file was obsolete. One plan was seen that was being reviewed. The person to whom the plan related said Care Homes for Adults (18-65 years) Page 11 of 27 they had been involved in discussing what they could do and what help they needed. This had been translated into a personal care plan, but the process needed to be repeated to cover all aspects of the person’s daily living and wishes and aspirations. The manager said the new person centred plans were more detailed and would cover every aspect of the person’s life and involve the person in deciding what information should be recorded. The file seen contained a number of limitations imposed on the person concerned, such as limiting the number of cigarettes they had each day. The person said they had agreed to this limitation but the need to actively involve them in managing it was discussed with the acting manager. The new format should address these issues and help the person manage the limitation with staff support. Risk assessments were included for a wide range of activities, but in some cases it was not clear what the risk would be of not following the guidelines. For example, one person was described as ‘overweight’ when they no longer were and there was nothing to say why the person needed to continue with a healthy eating programme or what the risks were of not following one. The manager said the risk assessments would be reviewed as part of the care plan review to make sure they were accurate and relevant. Feedback from three surveys completed by people who use the service showed they thought they were usually able to make decisions about their lives. The three people living in the home also said they were able to choose how they spent their time. People spoken with said they did not have keys to their bedrooms, but one said they would like to and one said they would think about whether they would. They also do not have lockable storage space. The manager said she thought the new furniture would include this and also said she would ensure people had a key to their room if they wanted one. Care Homes for Adults (18-65 years) Page 12 of 27 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 who use the service are able to make choices about their lifestyle and are supported to develop their life skills. Social, educational, cultural and recreational activities meet individual’s expectations. Evidence: People who use the service said they felt generally able to make choices about how they spend their time. Two out of three responded in the survey forms that they thought they could always make decisions about their lives but one person thought they could only do this sometimes and that they were not always able to make a choice about how they spent the weekend. Care Homes for Adults (18-65 years) Page 13 of 27 Each person living in the home has a different daily routine and care plans reflect these individual preferences. For example, one person likes to get up early before having breakfast whilst another likes to have breakfast in their room, before washing and dressing. Care plans are being reviewed to make sure these personal preferences are recorded. People who use the service said they are able to join in a lot of activities and regularly go out in the community. Activities include attending college courses such as cookery and keep fit, local clubs and going out for meals and drinks. They are able to go out on trips and attend a weekly club, run by the organisation for everyone who lives in their three local homes. People who use the service said they felt involved in the daily routine of the home and are encouraged to help with house work, house shopping and food and drink preparation. This is not always recorded as an objective in the care plan. The manager said the new providers are reviewing care plans to make sure they reflected the wishes and aspirations of the people who used the service in all aspects of their daily lives. The manager said people who used the service were supported to maintain contact with family and friends, through visits and telephone calls. Relatives and friends were invited to attend the summer barbeque. A new menu plan had been introduced to provide more variety. People who use the service were able to choose their own breakfast and lunch and were supported to get it themselves if they could. Those spoken with said they liked choosing what they had. One main meal is offered, but records kept showed people could choose an alternative if they wished. The manager said the amount of fresh fruit available has been increased to offer people more choice of snacks. Care Homes for Adults (18-65 years) Page 14 of 27 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 that people receive is based on their individual needs. The principles of respect, dignity and privacy are put into practice. Staff receive training and guidance that enables them to manage medication safely. Evidence: The manager is currently reviewing peoples’ care plans to make sure they reflect their personal preferences in relation to health and personal care. A completed one was seen that gave staff detailed guidance on how to support the person with their care needs. The person concerned confirmed they had been involved in writing it and that it described what help they needed. For example, it recorded when they liked to shower, and that they wanted staff to blow dry their hair. Some of the people who use the service need minimal support with personal care. Their plans ensure that staff prompt them, rather than offer assistance. Daily records showed that people have access to a wide range of health care, such as Care Homes for Adults (18-65 years) Page 15 of 27 the doctor, dentist and chiropodist. Referrals are also made to specialist health care provision when necessary. The manager said that no one currently living in the home looked after their own medication, although they would be supported to within a risk management strategy if this was an identified personal goal. Only staff who have completed medication training are permitted to give people their medicine and individual records are kept. The records had been completed correctly and medication was stored appropriately. There was a procedure in place that made sure medication received into the home was checked to ensure it was correct and there was a system for returning unused medication to the pharmacy. Care Homes for Adults (18-65 years) Page 16 of 27 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 who use the service are able to express their concerns and have access to an effective complaints procedure. People are protected from abuse and have their rights protected. Evidence: Feedback in survey forms completed by the people who use the service showed they knew how to make complaints and were confident their concerns would be listened to. The manager said the current pictorial complaints procedure was being reviewed as it was felt it did not meet the needs of everyone living in the home. The AQAA recorded the home had received no complaints from the people who use the service, neither had the commission received any. The home had a policy and procedure for safeguarding adults and had a copy of the latest guidance from the local authority. One care plan contained guidance about managing allegations that did not comply with the procedure. The manager said this aspect of the plan was due to be reviewed. She agreed the guidance was incorrect and confirmed that it would be reviewed and updated immediately to make sure it complied with the safeguarding procedure. Care Homes for Adults (18-65 years) Page 17 of 27 The AQAA stated that staff had safeguarding training. The member of staff on duty had completed a safeguarding course. The manager said the new organisation was currently reviewing all staff training and would be arranging courses and refresher training where necessary. All staff were required to complete Protection of Vulnerable Adults (POVA) and Criminal Records Bureau (CRB) checks before starting work in the home to ensure people who use the service are protected. Care plans included guidance on how to use distraction techniques to diffuse potential challenging situations and staff have had training on working with challenging behaviour. The manager said staff are not required to use restraint techniques with any of the people currently living in the home. The home keeps a record of any money held on behalf of the people who use the service. The manager said the new organisation is introducing its own accounting system to improve the current arrangements for looking after peoples’ personal allowance. This still includes making sure accurate records are kept of any income, expenditure and receipts, together with regular audits of any money held. Care Homes for Adults (18-65 years) Page 18 of 27 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 physical design and layout of the home enables residents to live in a safe, wellmaintained and comfortable environment, which encourages independence. Evidence: The new providers are investing in a renovation programme for the home. New furniture is being provided in the communal areas and in everyone’s bedroom. Future plans include renovating the bathroom and replacing the bath. A maintenance person is employed to carry out minor repairs and a list is kept of tasks that need doing. The garden at the rear of the house is very overgrown with weeds and the greenhouse is no longer being used by the people who use the service to grow plants. The manager said plans for the garden are being discussed as part of the renovation programme. People who use the service said they liked the environment and were able to look after their rooms themselves. One person was very pleased with the new armchair in their room and said they liked cleaning the room every week. Feedback from the survey forms evidenced people felt the home was kept clean. Care Homes for Adults (18-65 years) Page 19 of 27 There is a small domestic laundry, which is able to easily manage the requirements of the people who use the service. The AQAA recorded that all three staff have completed infection control training and a certificate for one staff was seen to support this statement. Care Homes for Adults (18-65 years) Page 20 of 27 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. Staff in the home are trained, skilled and in sufficient numbers to support the people who use the service. The home operates a robust staff recruitment procedure to protect people who live in the home. Evidence: Feedback from the survey forms completed by the people who use the service showed they thought staff listened to them and acted on what they said. All three people said they liked the staff and felt they looked after them well. The staff working in the home have been there a long time and have a good knowledge of how the people living in the home like to be supported. The people currently living in the home require minimal support and only one needs help with personal care. Staffing levels reflect this independence and only one staff is on duty each day to provide support and supervision when needed. One sleeping night staff covers nights. The manager said no new staff had been appointed. The file for the staff working in the home at the time of the visit showed she had been required to go through a robust employment procedure before being appointed. This included completing a Care Homes for Adults (18-65 years) Page 21 of 27 detailed employment history, attending an interview, providing copies of previous training and having a Criminal Records Bureau (CRB) and Protection of Vulnerable Adults (POVA) check before starting work. The member of staff had completed an induction programme, specific to working with people who have a learning disability (LDAF). She had also completed a National Vocational Qualification (NVQ) 2. The manager said every employee was required to complete the same recruitment and induction programmes. The AQAA recorded that two of the three staff had completed their NVQ 2 and the third was currently doing it. The AQAA stated that staff training was being reviewed in all three homes and the acting manager confirmed she and the training officer were currently identifying training required for all staff for the next year. As part of the review she was having supervision meetings with staff to discuss their individual needs. One supervision was being held on the day of the visit. Care Homes for Adults (18-65 years) Page 22 of 27 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 management and administration of the home is based on openness and respect and effective quality assurance systems are being developed by the service providers that will enable people who use the service to give feedback. Evidence: The registered manager left shortly after the new providers took over and the registered manager of Denehurst has been managing the home. Discussions are taking place between the new providers and the commission about the registration of a new manager. People who use the service knew the manager of Denehurst well and said they were happy to take any concerns to her to resolve. The AQAA recorded that the new providers are introducing their own quality audit system. This includes getting feedback from the people who use the service about the Care Homes for Adults (18-65 years) Page 23 of 27 care they receive. Staff meetings are also being held to make sure staff have information about changes to the way they work. A monthly visit is completed by a representative of the organisation to monitor the way in which the home is running. A written record of this visit is given to the home. Part of the in house audit carried out by staff includes monitoring health and safety issues. Hot water temperatures and fridge/freezer temperatures are regularly recorded, as are fire equipment tests. The organisation employs a facilities manager who will be responsible for monitoring the health and safety arrangements in the home. Information received in the AQAA, together with a random selection of documents seen at the home show that equipment is regularly serviced to ensure the safety of people who use the service and staff. Staff have fire training and monthly fire drills. Staff also have mandatory training and refresher training such as moving and handling, first aid and food hygiene. As stated in other sections of this report, training is being reviewed to make sure all staff have up to date training. Care Homes for Adults (18-65 years) Page 24 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 25 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 26 of 27 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.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 © (2008) 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. Care Homes for Adults (18-65 years) Page 27 of 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!