Inspection on 24/02/09 for Godfrey Robinson Home for the Disabled

This inspection was carried out on 24th February 2009.

CSCI 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

Godfrey Robinson Home for the... 30/01/08

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Larch Avenue

Alderson Road 12

Cranworth Close Registered Care Home

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Muston Road (70)

Grayling

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Godfrey Robinson Home for the Disabled Fouracres Woodgates Lane North Ferriby Hull East Yorkshire HU14 3JR     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: Carol Haj-Najafi     Date: 2 4 0 2 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. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. 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 36 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI 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 36 Information about the care home Name of care home: Address: Godfrey Robinson Home for the Disabled Woodgates Lane Fouracres North Ferriby Hull East Yorkshire HU14 3JR 01482632209 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): amanda.short@LCDisability.org Leonard Cheshire Disability Name of registered manager (if applicable) Amanda Louise Short Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability physical disability Additional conditions: The maximum number of service users who can be accommodated is: 19 The registered person may provide the following category of service only: Care home only - Code 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 - Code LD; Physical disability - code PD. Date of last inspection Brief description of the care home The Godfrey Robinson Home is a care home registered to provide care and accommodation to 19 people whose primary disability is physical although some may have additional learning disabilities as well. The home is owned and operated by Leonard Cheshire Foundation, which is a registered charity Care Homes for Adults (18-65 years) Page 4 of 36 care home 19 Over 65 0 0 11 19 Brief description of the care home The home is situated in the village of North Ferriby, which is residential satellite community near to the city of Hull and is close to some local village facilities. The accommodation is on two floors and people using the service have access to the top floor by means of a passenger lift. All the bedrooms are single and there is good communal space and gardens. The home has ample car parking facilities. Some areas of the home are not easily accessible for people with physical disabilities so this can limit independence for wheelchair users. Information about the home, including a Statement of Purpose, Service User Guide and the latest inspection report is available at the home. The manager said the weekly fees range from 500 pounds to 1008 pound. Additonal charges are made for hairdressing, holidays, and transport. Care Homes for Adults (18-65 years) Page 5 of 36 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations- but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. The last key inspection was carried out in January 2007. Before this unannounced visit we reviewed the information we had about the home which included an annual quality assurance assessment (AQAA) that the manager completed. The AQAA provides us with information about the home and tells us what has happened in the last twelve months. We used this information to help us decide what we should do during our Care Homes for Adults (18-65 years) Page 6 of 36 inspection visit. Surveys were sent out to people who live at the home and other people who have an interest in the service. We received surveys from six people who use live at the home, six staff and seven health and social care professional surveys. Comments from the surveys have been included in the report. For some part of the visit, the inspector was joined by an expert by experience. An expert by experience is someone who has expert knowledge of care services through their own experience of using services. They join the inspector to help them get a good picture of the service from the viewpoint of the people who use it. One inspector was at the home for one day. We spoke to people who live at the home, staff, the assistant manager and the registered manager. We looked around the home, and looked at care plans, risk assessments, daily records and staff records. We spent a total of 8.5 hours at the home. Feedback was given to the assistant manager and registered manager at the end of the visit. What the care home does well: What has improved since the last inspection? What they could do better: The home could be better at identifying potential risks to people who live at the home. This will make sure the risk of harm is minimised. The care planning process could be further developed to make sure peoples care needs and aspirations are properly identified. Staff could spend more quality time with people who live at the home. People could be Care Homes for Adults (18-65 years) Page 8 of 36 given more time to communicate their needs and wishes. One person who lives at the home said, We get no keyworking time because staff are always busy doing other things. They dont have time to do the extra bit. There is enough staff to cover the floor but not enough to take off the floor. There were more carers before Leonard Cheshire. Staff also told us that, at certain times, staffing levels are not adequate. People who live at the home could be given more opportunities to be involved in all areas of daily living in the home. This will help promote independence. Peoples medication needs could be properly identified through a risk assessment and care planning process. This will make sure people get the right support and their needs are met. The complaints procedure could be developed into an easy read format with pictures and words, so people living in the home can understand it better and know what to do if they are unhappy with the service. The home could be more accessible throughout to people with physical disabilities and light switches and emergency call bells could be sited in appropriate positions. This will make sure peoples needs are met and their independence is promoted. The home could be decorated to a better standard. This will make sure people live in a pleasant environment. 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 9 of 36 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 10 of 36 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. Peoples needs are properly assessed before they move into the home and they are assured their needs will be met. Evidence: Surveys from people who live at Godfrey Robinson said they were asked if they wanted to stay at the home, and received enough information to help them decide if they wanted to stay. In the AQAA the manager explained the process they follow before people move into the home. This includes providing people with information about the home, organising visits to the home and gathering information from all relevant sources. We looked at one persons file who had moved into the home since the last inspection. The file contained information to show that the persons needs had been assessed before they moved into the home. Care Homes for Adults (18-65 years) Page 11 of 36 Evidence: Staff told us they always receive enough information about peoples needs and people always spend time at the home getting to know everyone before they move in. Information about the home is displayed in the entrance. At the last inspection we found that the Statement of Purpose and Service User Guide was not up to date. The registered manager said both the documents have been reviewed. In the AQAA the manager said they were available in alternative formats for people who are thinking of moving into Godfrey Robinson. Care Homes for Adults (18-65 years) Page 12 of 36 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. In the main, peoples needs are identified and met although gaps in the assessment and care planning process could result in some care needs being overlooked. Evidence: We asked people if they are happy living at Godfrey Robinson. We got a mixed response. Some people said they are happy; others said they are generally happy but suggested improvements. One person said they are unhappy. One person said, My keyworker is very good. Another person said, I like living here. The person who was unhappy said, Its not the right place for me. They said they have had a meeting about this and have talked to the manager, staff and social worker. We received four surveys from people who live at the home. They told us they make decisions about what they do each day. Care Homes for Adults (18-65 years) Page 13 of 36 Evidence: Healthcare professional surveys told us that the service supports people to live they life they chose, and peoples privacy and dignity is respected. One survey said they work in a person centred way, treating everyone as an individual with dignity and respect. Another survey said people always seem happy and content with the service they receive. Staff said the home provides a good service. One staff said, Its a good home and we really care. Another staff said, We all have very good relationships with the people who live here. Another staff said, There is a good atmosphere and good structure. We looked at four peoples care records. Each file contains an assessment of need. The assessments are very basic and cover some key areas of need including mobility and personal care. However they do not include some important areas such as promoting independence or daily living skills. The assessments have a nursing checklist which does not apply to this home. One persons assessment said they cant use the stairs because the stairs are too wide so they have been asked to use the lift. The person uses the stairs. An assessment for behaviour listed some known triggers but does not acknowledge that the person is unhappy and frustrated. The person said this was the main reason they got upset and angry. Files do not have comprehensive risk assessments. People have some detailed risk assessments for medication administration and moving and handling although some information that relates to medication is incorrect. We have covered this in more detail later in the report. The manager said they have identified risk assessment as an area they need to develop and six staff have just completed risk assessment training. We looked at a very good behaviour assessment and support plan that has recently been completed by a staff member who attended the risk assessment training. The information is very specific and clearly identifies the persons needs. The manager said they would be introducing more comprehensive assessments for everyone. Staff said management of risk is an area that could improve. One staff member said, We need to introduce a can do attitude and manage risks positively. Care records contain a lot of information about each person and generally identify when people need support. But the files have too much information so it is difficult to find how peoples care needs should be met. A personal profile identifies that the person has support to go to church every Sunday but this is not recorded in their care Care Homes for Adults (18-65 years) Page 14 of 36 Evidence: plan. The content of some care plans is quite specific. For example one persons plan says, Require mail to be opened and read to her, and explain the information. Other care plans are vague and use terms such as support and supervise but do not give further detail. Professionals have produced guidance to support individuals but this information is not recorded in the persons care plan. One care plan states to use a commode, see risk assessment tor transfer. The care plan does not refer to guidance from a healthcare professional which includes remove sling and use harness for safety and maximum time left 20 minutes. One person talked about wanting to develop their level of independence but said they couldnt do this because the home does not have any facilities. Staff confirmed the person has said very clearly that they want to learn new skills so they can become more independent. The persons care plan does not contain any information about this. Care plans and risk assessments should always contain information that is important to the person. The care plans do not contain very much information about peoples aspirations or goals. Staff complete a monthly care plan review and the form has a section for goals achieved and goals yet to be achieved. These do not have much detail and do not relate to the care plans. People said the care plans and monthly reviews are relatively new systems and keyworkers are still getting used to the documentation. At the last inspection we recommended that care plans should be developed so the care people receive will meet their individual needs. At this inspection we also found that the care planning process should be developed. Staff record important information about people and what they have been doing. The records are very detailed and show how peoples needs are being met. This is good practice because peoples health, welfare and lifestyle can be properly monitored. At the last inspection we also recommended that staff should receive communication training to make sure they engage with people about their individual needs and choices. Ten staff attended communication training in October 2008. In the main, we found that staff communicate well with people but we also found that sometimes staff do not always listen to people who live at the home. One person who lives at the home said, Staff are very kind but sometimes there is Care Homes for Adults (18-65 years) Page 15 of 36 Evidence: not enough time for people with a speech impediment. They think they know what I want. I would like some time. Other people (who live at the home) are saying they dont listen to us. We brought it up at our meeting. People who live at the home told us they have regular service user meetings and everyone talks about the home and what they would like to do. Leonard Cheshire has introduced a service user support team. They visit people every 6-8 weeks and talk to people about their rights and choices; they also attend the service user meetings. Three people who live at the home are part of a national group, SUNA (Service User Networking Association) which focuses on promotion of peoples rights and choices. Care Homes for Adults (18-65 years) Page 16 of 36 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Everyone has worked hard to make sure people have more opportunities to develop and maintain social activities and have a more varied lifestyle. People do not get many opportunities to take part in daily tasks around the home so their independence is not really promoted. Evidence: People told us that since the last inspection there are more opportunities for people to go into the community and do activities at the home. An activity organiser is employed and has started arranging different activities for people. People who live at the home said, (Name of activity organiser) asks us what we would like to do then sorts it out. One staff said, This is a massive improvement. Another staff said, We are definitely heading in the right direction but there is still a way to go. Care Homes for Adults (18-65 years) Page 17 of 36 Evidence: Generally people thought activities during the day still needed to improve. Some people go to day centres and others go to college. Some activities are arranged for people who do not have day placements but staff said these are not as regular as they could be. Some people have additional staff support during the day. If 1-1 staffing has been agreed, a member of staff is allocated to work with the person. Staff record what the person has been doing during the additional support time and staff hours are recorded very clearly on the staff rota. Several volunteers support people with individual activities. This can be at the home or with specific activities in the community. In the AQAA the manager said the home is good at utilising volunteer support to promote integration within the local community and providing individualised support for specific goal achievement. One person who lives at the home said things are often changed. They said they arrange to do things with their keyworker but they are then taken off to do something else. We have covered staffing levels in more detail in the staffing section of the report. The expert by experience talked to three people about their lifestyle. These are some of the comments we received from the expert by experience. One person showed me the activity room and said that each week there was a Communication Class and this included activities such as bird watching, had contact with children in America and Africa, visits to museums (all in Hull), a tour of pubs on Beverley Rd and regular visits to Nth Ferriby Football Club. They also stated that they are involved in training volunteers who come to the home to assist taking people out, etc. Although the persons list of activities was very positive, they did say that although they had been to The Deep, they would like to go again since it has been redeveloped. As this happened over 18 months ago, it appears that their visit wasnt recent. Again, they said they had visited the KC Stadium to have a tour, but hadnt been to a game. The Stadium has been open for six years. Two other people who live at the home didnt mention such a wide choice of lifestyle. One person said they liked reading and did belong to a whale and dolphin group that they went to regularly and had been to the KC Stadium to watch Hull FC (Rugby team). Another person said they were going clothes shopping this weekend into Hull and mentioned their girlfriend at the home. I asked if they were going together and Care Homes for Adults (18-65 years) Page 18 of 36 Evidence: they said no, as things are often planned and then changed. Some routines at the home are quite structured because the service is supporting nineteen people. These routines do not always give people flexibility of choice and chance to develop independence skills in the home. For example the cook or staff prepare cook the meals. We talked to people who live at the home about daily living skills. Everyone told us staff are responsible for cleaning the house, laundry, cooking meals and changing bedding. The home does not have any facilities for people to make snacks or make a drink. The manager said they are looking at this and are planning to have some facilities fitted in the activity room but didnt know when this will happen. One person who lives at the home talked about not having opportunities to make meals or do their own laundry. They said they feel as though they are being fobbed off because staff have said there are plans to have some equipment but it isnt happening. Care plans do not contain information about daily living skills. People should be supported to be more independent and encouraged to take responsibility within their own home. Some staff said people sometimes say they want to have involvement in daily tasks around the home, for example, changing their bedding but are then reluctant when a task needs doing. Care planning should be a process that involves people in making decisions about what they want do, and then progress on achieving goals should be discussed when the plan is reviewed. The expert by experience also identified that peoples independence does not seem to be generally promoted within the home. People who live at the home said they enjoy the meals. One person said, The meals are good. Another person said, The food is good. A cook is employed seven days a week. At the last inspection we recommended that meal arrangements should be reviewed to introduce more flexibility and more space when eating. The home has introduced two sittings when everyone is at home. People said this is a lot better and meal times are more relaxed. Care Homes for Adults (18-65 years) Page 19 of 36 Care Homes for Adults (18-65 years) Page 20 of 36 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. Peoples health and personal care needs are met. Safe medication procedures are in place but these are not always followed and this could result in medication not being administered correctly. Evidence: We received seven health and social care professional surveys. They told us that peoples healthcare needs are met and the service seeks advice when it is appropriate. One survey said they provide an individualised service and sensitive care. Another survey said Godfrey Robinson is an excellent facility for people with multiple, physical and cognitive problems. One healthcare survey said the service doesnt always cope well with complex needs or with people with behaviour issues. We talked to people about privacy and dignity. People who live at the home said staff always respect their privacy and dignity. People also said staff knock on their door before entering. Staff gave us good examples of how they promote privacy and Care Homes for Adults (18-65 years) Page 21 of 36 Evidence: dignity. In the AQAA the manager told us people access a variety of G.P practices, and specialist support services including physiotherapists and occupational therapists, and support is given to visit opticians and dentists. Staff said the home is good at meeting peoples personal and healthcare needs. People who live at the home said they have good support with their personal care and staff make sure they get the right healthcare support if they are unwell. We looked at information that showed us people regularly attend healthcare appointments. Individual records have good information about appointments and shows when people have attended. Care plans do not contain enough information about peoples healthcare needs. One persons care plan says they need chiropody and dentist input but there was no other information. Individual care plans should contain enough information to make sure peoples healthcare needs are identified and met. Peoples care plans and assessments have some information about medication but there is not enough information about administration and some details are incorrect. One persons care plan states that they self administer their medication but staff confirmed they administer the persons medication. Another persons care plan says staff to continue administering medication but the person administers their own medication. One person has their medication with thickened liquid to help with administration but their care plan only has a list of medication that is prescribed. We looked at medication systems. Administration records were completed correctly. Medication is well organised and good systems are in place for checking in and booking out medication. In the AQAA the manager told us accredited training is given to those who administer medication. Care Homes for Adults (18-65 years) Page 22 of 36 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 stay at the home are safeguarded. People are confident that they will be listened to and that appropriate action will be taken when necessary. Evidence: Surveys from people at the home told us they know who to speak to if they are not happy. Staff surveys told us that they know what to do if people have any concerns about the home. Staff said they would report any concerns to the management team and they are confident they would deal with them promptly and appropriately. The expert by experience asked people what they would do if they had a problem or complaint. The expert by experience told us: One person said that they had become a representative of the SUS (service user support) team and this meant if people who live at the home had a problem they could come to him and he could take the complaint up on their behalf. One person said I feel safer here than I would in a home of my own. We have 24 hour care here and what the staff does for us in nobodys business. I think thats great. At the last inspection we recommended that the complaints procedure should be Care Homes for Adults (18-65 years) Page 23 of 36 Evidence: developed into an easy read format with pictures and words, so people living in the home can understand it better and know what to do if they are unhappy with the service. This recommendation has not been met. The service has made one safeguarding referral. This was dealt with appropriately. Staff have received safeguarding training. They were able to say what action they would take if they suspected abuse or had an allegation of abuse made to them. They were also able to describe the different types of abuse. In the AQAA the manager told us they have a Leonard Cheshire policy on handling finance, all records and receipts checked monthly as part of their Quality Audit. Care Homes for Adults (18-65 years) Page 24 of 36 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 adequate 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 safe environment but some areas are not well decorated. Some parts of the home are very accessible; other parts are not very accessible. This limits independence for wheelchair users and people with physical disabilities. Evidence: Surveys from people who live at the home told us the home is always clean. One person said the home is cleaned every day but some areas need updating. When we looked around the home it was clean and tidy. Two healthcare surveys suggested that the environment could be better. One survey said the facility is quite isolated and the building is old and not fully adapted. Another survey said lifts between the ground and upper floor could improve. The expert by experience looked at the environment. These are some of the comments we received: The home has a large car parking area outside the front of the building, but there are no disabled car parking spaces. These should be provided as near to the building as possible as disabled people visitors would find it difficult to manage parts of the Care Homes for Adults (18-65 years) Page 25 of 36 Evidence: steeply sloped car park. I had to park on an angle on a slope and found it extremely difficult as a wheelchair user. I also needed assistance to get back to my car, due to the steep gradient. The entrance has electric doors, but the entrance is at the bottom of a steep slope and I think it would be very difficult for any manual wheelchair users to get out of the home unaided. Many of the internal doors were locked open, but the door to the chapel was shut and this was stiff to open. This could be easily improved by altering the pressure on the door connection at the top. I was able to see a number of different bedrooms and the ground floor bedrooms were considerable smaller than the ones upstairs, with less natural light. I would say the ground floor rooms were the not much bigger than the size of an average box room in a house and certainly wouldnt want to live in one for a number of years. Some of the people had been there for nearly 20 years. It was clear that people were allowed to have the rooms as they wanted regarding layout, etc, as some had wide screen TVs, stereos, collections of cuddly toys and comic signs on their door. The home has a lift to access the upper floors. This lift was very old and involved shutting three doors to make it work. I personally found it quite difficult to use and I imagine most people would not be able to use it. All the lift buttons on both lifts, including the emergency button were accessible. All the light switches in the home were too high for many wheelchair users. All the emergency buttons in the toilets/bathrooms were too high and poorly positioned for many wheelchair users. One of the toilets that was marked as accessible had no space for a wheelchair user to turn round, side transfer to the toilet or to be able to shut the door. The home has a large garden and there is a patio/balcony that overlooks the grounds. The ramp from here looked very steep and dangerous and a person who lives at the home did state that it was dangerous and that it was hoped to level it out, although this appeared to have been ongoing for a number of years. Overall, the home appears to be in the need of considerable decoration and improvements in access to bring it up to a more modern standard. Care Homes for Adults (18-65 years) Page 26 of 36 Evidence: In the AQAA the manager provided us with a list of work that has been carried out to improve the environment. At the inspection the manager discussed the next phase of redecoration which includes three bedrooms and the lounge. The manager also confirmed some work was planned to improve access to the garden. Clinical waste is properly managed and staff wear protective clothing when attending to the personal care needs of people who live at the home. Care Homes for Adults (18-65 years) Page 27 of 36 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 who live at the home are supported by a competent and skilled staff team. Staffing levels do not always give people who live at the home sufficient quality time with staff. Evidence: Healthcare surveys told us that staff have the right skills and experience to support the people who live at the home. One survey said all staff are very helpful and there is a good atmosphere within the home. In the main, people who live at the home said they are happy with the staff at the home. People told us staff always treat them well and carers listen and act on what they say. One person said staff never seem to have time to understand what Im trying to tell them. The expert by experience said the staff seemed friendly, helpful and supportive. Staff said they enjoy working at the home and everyone works well together. Several people talked about the good atmosphere and good teamwork. Staff told us they the staffing structure is better. New management structures have been introduced and Care Homes for Adults (18-65 years) Page 28 of 36 Evidence: staff responsibilities are clearer. Everyone told us good systems are in place to support staff, which included regular staff meetings, supervision and training opportunities. Staff said training and training opportunities are good. Staff told us they receive training that is relevant to their role, and helps them understand and meet the needs of people living at the home, and keeps them up to date with new ways of working. We looked at staff training records and they showed us that staff have received regular training during the last twelve months. One staff said, We do lots of training which helps us to do our job better and understand service users needs more. One person suggested the team would benefit from more training in dealing with challenging behaviour. The manager confirmed that twelve staff had attended challenging behaviour training in November 2008. Other staff would also be attending. We received six staff surveys. They all told us a thorough recruitment process was carried out before they started working at the home. We looked at recruitment files for two people that have started working at the agency since the last inspection. Both files had all the information to confirm that proper pre-employment checks were carried out. Staffing levels were changed about nine months ago, and the number of staff on an evening shift was reduced. Staff said this has impacted on the care people receive. Staff told us staffing levels are generally satisfactory during the day but they do not have enough staff on an evening. At the inspection staff raised concerns about staffing levels on an evening, and five out of six surveys made reference to needing more staff. One staff said, On an afternoon there seems to be no time for socialising or activities due to one staff member less, and the same number of service users. Another staff said, We dont have enough time to give quality time, only the main care like personal care, feeding and washing. One person who lives at the home said, We get no keyworking time because staff are always busy doing other things. They dont have time to do the extra bit. There is enough staff to cover the floor but not enough to take off the floor. There were more carers before Leonard Cheshire. Volunteers work with people who live at the home on an individual basis. Everyone said the help of the volunteers benefits people who live at the home. The manager confirmed they have increased the number of volunteers from 14 to 34. The manager Care Homes for Adults (18-65 years) Page 29 of 36 Evidence: said people at the home identify what they would like from a volunteer, they then find a suitable volunteer to carry out the specific role. Care Homes for Adults (18-65 years) Page 30 of 36 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 everyone feels supported. Evidence: People told us they are very happy with how the home is managed and said communication is good. One staff said, The home is very well managed. Another staff said, The management team are open to suggestions and ideas. One healthcare survey made very positive comments about the management. They said excellent manager which leads to excellent staff. The registered manager is experienced in the management of care services and is suitably qualified. She has been the registered manager of Godfrey Robinson for a number of years. The home sent us their annual quality assurance assessment (AQAA) when we asked for it. The AQAA gave us information about the service. It gave us examples of what they do well, how they have improved and what they want to do better. They also told Care Homes for Adults (18-65 years) Page 31 of 36 Evidence: us about changes they have made as a result of listening to people who use the service. The home has some good systems in place for monitoring the quality of the home. The management team carry out a range of monthly and quarterly audits. People who live at the home attend regular meetings and are asked about the quality of the home. The area manager visits the home at least monthly and talks to people who live at the home and staff, looks at records and the environment. They then complete a report. Surveys are being devised to send out to people who have an interest in the service and as yet the home does not have surveys for people who live at the home. The manager said they need to further develop systems for seeking the individual views of people who live at the home. We looked at health and safety records, which included fire alarm testing and environment checks. These had all been carried out on a regular basis. Fire tests had been completed regularly and a fire evacuation drill was completed in January 2009. In the AQAA the manager told us they have all relevant policies and procedures in place. An environmental health visit was carried out in June 2008. The manager said all recommendations from the visit had been addressed. Care Homes for Adults (18-65 years) Page 32 of 36 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 33 of 36 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 Potential risks to people who 31/05/2009 live at the home must be properly assessed and risk management strategies agreed. This will make sure the risk of harm is minimised. 2 20 13 Peoples medication needs must be properly identified through a risk assessment and care planning process. This will make sure people get the right support and their needs are met 31/05/2009 3 33 18 People who live at the home must receive enough staff support. This will make sure peoples assessed needs are met. 31/05/2009 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. Care Homes for Adults (18-65 years) Page 34 of 36 No. Refer to Standard Good Practice Recommendations 1 6 The care planning process should continue to be developed to make sure peoples care needs and aspirations are properly identified. This will make sure peoples needs and wishes are met. People who live at the home should always be given sufficient time to communicate their needs and wishes. This will make sure their needs and wishes are met. People who live at the home should be given more opportunities to be involved in all areas of daily living in the home. This will help promote independence. Peoples healthcare needs should be identified through the care planning process. This will make sure their healthcare needs are identified and met. The complaints procedure should be developed into an easy read format with pictures and words, so people living in the home can understand it better and know what to do if they are unhappy with the service. Systems for seeking the views of people who use the service and have an interest in the service should be further developed. This will make sure everyone has an opportunity to put forward their views of the home. 2 6 3 16 4 19 5 22 6 39 Care Homes for Adults (18-65 years) Page 35 of 36 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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