Inspection on 24/02/09 for Horncastle Care Centre

This inspection was carried out on 24th February 2009.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

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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: Horncastle Care Centre Plawhatch Lane Sharpethorne East Grinstead West Sussex RH19 4JH     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: Annie Taggart     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 28 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.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 28 Information about the care home Name of care home: Address: Horncastle Care Centre Plawhatch Lane Sharpethorne East Grinstead West Sussex RH19 4JH 01403217338 01403219842 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Dr Shafik Hussein Sachedina,Mr Shiraz Boghani care home 20 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 to be accommodated is 10. The maximum number of service users to be accommodated is 20. The registered person may provide the following category/ies of service only: Care home with nursing - (N) 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) Physical disability (PD). The service may provider care to users between the age of 16 and 18, providing no service user at the service is over 25 years of age Date of last inspection 20 20 Over 65 0 0 Care Homes for Adults (18-65 years) Page 4 of 28 Brief description of the care home Horncastle Care Centre is a care home registered to provide personal and nursing care to ten people in the category of younger adults. The home is purpose built and has wide corridors, specialist equipment such as overhead tracking hoists and specialist bathing equipment and there is also a multi sensory room and a hydrotherapy spa. Service users bedrooms are all on the ground floor and there is access to patio areas and extensive gardens. The home is situated near the town of East Grinstead and a minibus is avialable to enable service user to access the local community. The Registered Manager is Mr Rezaul Hossen and the Registered Providers are Dr Shafik Hussein Sachedina and Mr Shiraz Boghani. Current fees are between one thousand one hundred and two thousand nine hundred pounds a week. Care Homes for Adults (18-65 years) Page 5 of 28 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: This is the first inspection for this home. In preparation for the visit we sent an Annual Quality Assurance Assessment (AQAA) to the manager for completion. This was returned within the given timescales and gave us clear and comprehensive information about the services on offer in the home. The unannounced visit was carried out by Annie Taggart on 24th February 2009 and lasted for four hours. During that time we tracked the care plans for three of the four people currently living in the home and we saw supporting documentation such as health plans, risk assessments and daily records. We tracked the system for storing and administering medication and saw lunch being prepared and served. We spent time with service users in communal areas and in their private bedrooms and we spoke with the staff on duty. Care Homes for Adults (18-65 years) Page 6 of 28 Four staff files were checked, we saw that all the required documentation was in place and we looked at evidence of staff induction, training and supervision. Records for the running of the business were seen and this included Regulation 26 Providers visit reports, the system for recording complaints, incidents and accidents and we looked at maintenance and health and safety records. Feedback was given to the Registered Manager, Mr Hossen following the visit. 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 28 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 28 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. There is clear and accessible information available about the services on offer in the home, people have their needs and wishes assessed and recorded, they are able to visit the home before moving in and families and other professionals are involved in the assessment process. Evidence: There is a Statement of Purpose and Service User Guide in place that gives very clear information about the services on offer and the documents can be produced in different formats to suit peoples individual communication needs. We saw that there is an intensive pre admission process carried out before the home offers people a place and this includes visits made to them at their present accommodation. There are very detailed assessments carried out and recorded and service users, families and healthcare professionals are involved in the process. An example we saw of this was that the home had contacted local healthcare teams to gain advice and ensure that the support needed for the person would be avaialable. Care Homes for Adults (18-65 years) Page 10 of 28 Evidence: People told us that they were able to visit the home and stay for trial periods, sometimes on more than one occasion and there is a flat kept free where families can stay overnight to assist the person to settle in and advise on peoples routines. The manager told us that there is an emphasis on compatibility of service users and the home is working closely with healthcare professionals to ensure that peoples individual and diverse healthcare and emotional needs can be met. Care Homes for Adults (18-65 years) Page 11 of 28 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. In order to ensure that the care staff have the information they need to safely support people, there are detailed care plans in place, risk assessments are completed and recorded and peoples care is kept under review. Evidence: For each of the four people currently living in the home there is a detailed care plan in place that has been devised with information taken from the assessment process and from spending time with service users, families and healthcare professionals. The plans are person centred and address all areas of peoples life including preferences regarding how personal care is provided, healthcare support, nutritional assessments and spiritual, social and emotional needs. Risk assessment both environmental and personal have been completed and where peoples freedoms are curtailed, for example by the use of wheelchair restraints or harnesses, this is clearly documented and risk assessed as a safety measure for people. Care Homes for Adults (18-65 years) Page 12 of 28 Evidence: The care plans are very clear about what social and emotional support people need and how this will be supported. We saw that the staff team have been trained in one persons communication system and there was good interaction with the person. The manager explained how the person communicated to the inspector and she told us that she was very happy in the home. Daily records are kept for each shift and those that we saw were comprehensive, clear and written in respectful language. As the needs of the people living in the home are complex, the care plans are large documents with very detailed information. The Registered Manager, Mr Hossen told us that care planning training was being provided for the senior staff team and that he is working on a shortened version for use in staff induction and to be kept in peoples rooms for quick reference. Care Homes for Adults (18-65 years) Page 13 of 28 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people living in the home are offered a range of activities and outings, routines are flexible to suit peoples individual needs and choices and people are offered a choice of fresh, home cooked meals. Evidence: In order to provide a range of activities and outings for people the home employs an activities coordinator and there is a minibus with a team of drivers to give people access to the local town and to social outings. The home also has links to local day care facilities if people wish to further their education opportunities and skills. The activities available are displayed in a pictorial format for each day and service users can choose what they would like to do. In the AQAA we were told that one of the aims of the home is to support people to continue with their personal development and the people living in the home confirmed this was carried out in practice. One person said, in the place I lived before I came here it was very institutionalised with rigid routines. Care Homes for Adults (18-65 years) Page 14 of 28 Evidence: Here I have the freedom to make my own choices, I can sleep in if I want, go to bed when I want and choose what I eat, everyone is so friendly, I love it here. Another person was using a communication aid and the staff team had been trained in its use. The person usually communicates using a computer and this was being set up. The staff team would then receive further training. From looking at care plans and records we saw that for some people their spiritual needs are very important to them and the home is supporting people with accessing local churches. There is a multi sensory room and a spa bath available and people have the specialist equipment they need to make us of these facilities. The manager told us that there was also a swimming pool owned by the care group about ten minutes away and people have access to this. People can also have physiotherapy and hydrotherapy. We looked at food records and saw that there were pictorial menus in place and that people were offered a range of fresh home cooked meals. During the visit the four people living in the home all chose a different meal and this was catered for. One person has cultural nutritional needs and this was identified in their care plans and catered for. Care Homes for Adults (18-65 years) Page 15 of 28 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 people living in the home receive a high standard of healthcare support, they have the equipment to support their independence and individual needs and their medication is being well managed. Evidence: The people currently living in the home have complex physical and healthcare support needs and the three care plans we tracked contained very detailed information to guide the staff team as to how people wish to be supported. The care plans contained the aims and objectives for individual support that had been agreed with service users and there were clear guidelines and good information for the staff team to follow. We saw that people had the specialist equipment they need to support their independence and care, pressure area care was assessed and recorded and there are specialist beds and overhead tracking hoists. We saw there were current records being completed for people who need to be turned when in bed and there are also nutritional records in place. From looking at records and talking to service users we saw that the home works with a variety of healthcare professionals, during the visit there was a local doctor visiting Care Homes for Adults (18-65 years) Page 16 of 28 Evidence: and records show that people have physiotherapy and hydrotherapy services, mental healthcare support and advice and support from community teams such as the local Diabetic Community Team. When people come to live in the home they are introduced to a key worker and a named nurse and this ensures continuity of care. We looked at daily records and saw that both nurse and support worker notes are completed each shift. They were clear and informative and written in respectful language. Service users were very complimentary about the care they are receiving and a staff member told us, it is very challenging but rewarding working here, as service users have such diverse healthcare needs and we are providing very individualised nursing care and support. The home had policies and procedures in place for medication management and only trained nurses administer medication. We looked at the system and saw that Medication Recording Sheets (MAR) were completed and up to date and we checked on one controlled medication and found that the records were correct. During the visit a local Pharmacist was in the home setting up a new system. Care Homes for Adults (18-65 years) Page 17 of 28 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. The people living in the home have their complaints and concerns responded to in a timely manner and the policies, procedures and working practices are designed to protect people from risk of abuse or harm. Evidence: There is a complaints procedure in place, a copy of which forms part of the Service User Guide and is also displayed in the home. We were told that the procedure could be provided in a number of accessible formats to meet service users individual communication needs. No complaints have been received by the home and none have been received by the Commission. From looking at staffing records we saw that the staff team receive training on safeguarding people from risk of abuse or harm and the three staff members we spoke to during the visit were aware of their responsibilities and told us that they would report any suspected abuse. Service users told us that they would feel confident in communicating their complaints and concerns, one person said, they are very good here and listen to you and if anything is wrong they put it right straight away. The home had guidelines and procedures in place regarding the management of service users monies and we saw that one person was being advised by an advocate Care Homes for Adults (18-65 years) Page 18 of 28 Evidence: and external professionals to assist them in money management. Care Homes for Adults (18-65 years) Page 19 of 28 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a comfortable and homely environment for the people who live there. There is a high standard of decor and furnishings and a range of specialist equipment is in place. People can personalise their private space and infection control issues are addressed. Evidence: Horncastle Care Centre is a purpose built home designed to provide specialist accommodation for younger people. The main part of the building is situated one one level with a large dining room, a light and airy lounge and wide corridors with good access for wheelchairs and other equipment. The top floor has staff accomodation and a flat for visitors. There is a specialist bathroom, a multi sensory room and also a spa pool and the home is fitted with overhead hoist tracking. Nursing beds are in place but we saw that some people had chosen to bring their specialist beds with them when they moved in. Service users bedrooms are large enough to ensure that people with electric wheelchairs can easily move around and all bedrooms have large en-suite shower rooms. People can personalise their rooms to suit their individual taste and we saw that one person had brought their own bed, furniture and soft furnishings with them making their room very homely. In one bathroom we saw builders working to change Care Homes for Adults (18-65 years) Page 20 of 28 Evidence: the way the room was arranged so that the service user could be more independent. For one person with sight difficulties there were clear guidelines in place for people to follow on how the furniture and belongings were to be situated and details of how people were to make themselves known before entering the room to ensure the persons privacy. Each of the bedrooms has an outside door leading to a patio area and Mr Hossen told us that people would be assisted in making small individual gardens if they wished to do so. Although the environment has been purpose built it has a homely and friendly feel and was clean and hygienic throughout. People told us that they were very happy with their rooms and with the facilities in the home in general. Care Homes for Adults (18-65 years) Page 21 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people living in the home are being supported by a competent, well trained and well supported staff team and they are being protected by there being a robust staff recruitment process. Evidence: From looking at staffing rotas and talking to service users we saw that there are sufficient staff on duty to meet the needs of the four people currently living in the home. During the day there is one trained nurse and two support workers and at night one nurse and one carer. There was also a chef, a cleaner and a driver, the activities coordinator was on a leave day. The manager is a Registered Nurse and his duties are extra to the rota. Mr Hossen told us that when new service users are admitted he works one shift with them to assess their needs and ensure they settle in well. Mr Hossen told us that when the home is full the staffing levels will be increased to a two to one ratio. We saw that the staff on duty had a good rapport with the people they were supporting and the atmosphere was calm and supportive. Service Users were very complimentary about the staff team describing them as lovely, really kind and friendly. We looked at the recruitment records for three members of staff and saw evidence of an interview process and there were current Criminal Bureau Checks (CRB) and Care Homes for Adults (18-65 years) Page 22 of 28 Evidence: references on file. All new staff receive a structured induction during which time they receive mandatory training. A training and development plan is in place for each person and we saw that there is a programme of specialised training being provided to meet the individual needs of service users. From training records we saw that people had attended such courses as neurological conditions, nutrition, dementia awareness, diabetes and person centred planning. All of the staff team receive health and safety training but to ensure a higher level of safety knowledge, kitchen staff, the maintenance person and drivers attend a two day certificated course. Staff meetings are held every two months and we saw evidence of the staff team receiving supervision and support. Care Homes for Adults (18-65 years) Page 23 of 28 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 being run in the best interests of service users and the staff team by a competent and qualified manager. Records are in good order and health and safety issues are monitored and addressed Evidence: The Registered Manager has the skills and experience to run the home, having managed other homes and holding the NVQ4 and Registered Managers Award. Mr Hossen is also a Registered Nurse and the staff on duty described him as open, supportive and approachable. The home has not yet been open for a year but a quality assurance process has begun by satisfaction surveys being sent to service users and families. Mr Hossen told us that they would also be sending surveys to other stakeholders in order to get feedback and suggestions that could be used to inform the future development of the home. Regulation 26 Registered Providers visits are carried out and we saw that reports are completed and kept in the home. Care Homes for Adults (18-65 years) Page 24 of 28 Evidence: There are processes in place for reporting, recording and monitoring incidents and accidents but none have been recorded since the home was opened. From looking at records we saw that regular maintenance checks are carried out, staff receive fire training and health and safety issues are monitored and addressed. A staff member told us, before the home was opened, we were all trained together as a team and as the work here is so complex, this helps us with improved communication and teamwork and we get good guidance from the manager. Care Homes for Adults (18-65 years) Page 25 of 28 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 26 of 28 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 27 of 28 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 © (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. Care Homes for Adults (18-65 years) Page 28 of 28 - 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!