Inspection on 20/11/08 for Howson Care Centre

This inspection was carried out on 20th November 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

Howson Care Centre 22/11/07

Howson Care Centre 07/11/06

Howson Care Centre 01/02/06

Howson Care Centre 04/07/05

Howson Care Centre 22/02/05

Howson Care Centre 21/06/04

Howson Care Centre 03/03/04

Howson Care Centre 24/07/03

Howson Care Centre 13/11/02

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: Howson Care Centre Howson Care Centre Willingham by Stow Gainsborough Lincolnshire DN21 5JZ 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: Julie Western Date: 2 0 1 1 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. They reflect the things that people have said are important to them: This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to:  Put the people who use social care first  Improve services and stamp out bad practice  Be an expert voice on social care  Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Reader Information Document Purpose Author Inspection report CSCI Page 2 of 24 Care Homes for Adults (18-65 years) Audience Further copies from Copyright 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 24 Information about the care home Name of care home: Address: Howson Care Centre Howson Care Centre Willingham by Stow Gainsborough Lincolnshire DN21 5JZ 01427788283 01427787567 lous@howsoncare.fsbusiness.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Howson Care Centre Limited Name of registered manager (if applicable) Mrs Carole Anne Horne Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 9 22 22 0 0 0 0 25 care home 78 dementia learning disability mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: The registered persons may provide the following category of service only: Care home with nursing - Code N to service users of the following gender: Either whose primary care needs on admission are within the following category: Dementia - code DE Learning disabilities - Code LD Mental Disability - Code MD. Old Age not falling within any other category - code OP. Residents in `The Laurels` must be admitted under the LD category and require personal care only. Care Homes for Adults (18-65 years) Page 4 of 24 Residents admitted in the DE category must be fifty years of age or over. The maximum number of people who can be accommodated is 78. Date of last inspection 2 2 1 1 2 0 0 7 A bit about the care home Howson Care Centre is situated at the edge of the village of Willingham By Stow and is set in landscaped grounds with car parking spaces to the front of the building. The home is owned by Howson Care Centre Limited and is managed by Mrs. C. Horne. The accommodation comprises of four areas; The Flat offers first floor accommodation for up to 8 service users who have a Learning Disability and who are working towards supported living placements. The Main House, provides services for up to 22 people with Mental Health problems. The Wing provides accommodation for up to 7 older people and 2 younger adults with a Learning Disability. The Court provides both nursing and residential services for up to 25 older people. The newly registered unit, known as The Laurels, is a separate, two-storey, purpose-built unit for up to 15 people with a learning disability. At the time of the inspection the home confirmed that the weekly fees ranged from 351 to 500 pounds, depending on the assessed needs of the resident. Additional charges are made for services such as chiropody and hairdressing. Information about these costs as well as the day-to-day operation of the home, including a copy of the last inspection report is available in the administrators office. Care Homes for Adults (18-65 years) Page 5 of 24 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home Care Homes for Adults (18-65 years) Page 6 of 24 How we did our inspection: This is what the inspector did when they were at the care home This was an unannounced visit and it formed part of a key inspection, focusing on key standards, which have the potential to affect the health, safety and welfare of people who use the service. Throughout this report the terms we and us refer to The Commission for Social Care Inspection [CSCI]. The visit lasted approximately four hours and we took into account previous information held by us including the previous inspection report, their service history and records of any incidents that we had been notified of since the last inspection. Before we made our visit the provider had returned the Annual Quality Assurance Assessment [AQAA]. This gave us information about their own assessment of how well they are meeting standards and their plans to improve aspects of the service. We sent out surveys to people before we visited the service. The main method used to carry out the inspection is called case tracking; this includes following the care of a sample of people through their records and assessing their care. We spoke with five people who use the service and saw rooms of those people who gave us permission. We spoke with three staff members. The owner and the deputy manager were present at the time of the inspection and the general outcomes of the visit were discussed with them. Care Homes for Adults (18-65 years) Page 7 of 24 At the time of the inspection the home confirmed that the weekly fees ranged from 351 to 500 pounds, depending on the assessed needs of the resident. Additional charges are made for services such as chiropody and hairdressing. Information about these costs as well as the day-to-day operation of the home, including a copy of the last inspection report is available in the reception area or the managers office. What the care home does well What has got better from the last inspection A refurbishment of the Main House has now been undertaken, with bedrooms, bathrooms and communal rooms redecorated. The statement of purpose has been updated to include general information about The Laurels and this building has its own service user guide. The redecoration of the Main House has brought a more domestic atmosphere to Care Homes for Adults (18-65 years) Page 8 of 24 the home. What the care home could do better If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Julie Western 33 Greycoat Street London SW1P 2QF 02079792000 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 9 of 24 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 24 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 . The information provided is freely available to residents and clearly sets out what is available for them. A comprehensive initial assessment ensures that the needs of residents can be met. Prospective residents are encouraged to take time before making the decision to move into the home on a permanent basis. Evidence: The deputy manager told us that she or the manager always visited prospective residents at home or in another care setting to undertake a thorough assessment of all their care needs. We saw records confirming this. The manager said a welcome pack was given to people before admission; this contained a statement of purpose and a service user guide. The Laurels had a separate service user guide. The documents were all easy to read and gave people all they needed to make an informed choice. We saw admission records for people that were clear and gave staff enough information to meet their needs. Terms and conditions and contracts we saw were up to date. The administrator confirmed that residents received these on admission to the home. We spoke to a resident who said she had visited before she was sure she wanted to Care Homes for Adults (18-65 years) Page 11 of 24 Evidence: move in permanently. Records we saw confirmed this. We spoke to a staff member who described the admission process and the importance of making new residents and their families welcomed. Care Homes for Adults (18-65 years) Page 12 of 24 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 . Care plans accurately describe service users support needs and service users are fully consulted. Residents are regularly asked for their opinions on the running of the home and what their wishes and preferences are. There are good assessments in place to minimise risks to service users. Evidence: We saw care plans selected from people living in each of the areas of the home. They had a wide range of information about peoples daily support needs. We saw evidence of peoples participation, including their signatures where possible. Care Homes for Adults (18-65 years) Page 13 of 24 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 . A good variety of leisure activities and outings are provided to ensure that service users have an enjoyable stay. Service users have a choice of meals from a balanced and varied menu. Evidence: The service actively promotes independence, choice and privacy by listening to people and their relatives/representatives. Equality and diversity are promoted through the policies and procedures and through the staff induction procedures, ensuring that peoples individual needs can be met. The home employs an activities coordinator who works from Monday to Friday. We saw a printed calendar of activities for the month, with something happening daily; one resident said Theres always something going off, were never bored. There is a Snoezelen [light and relaxation room] and an aromatherapist attend regularly. Other activities included bingo, exercise classes and visits from outside entertainers. Television and books were available and the home has a trolley for Care Homes for Adults (18-65 years) Page 14 of 24 Evidence: people to make various purchases from , there being no shop in the village. On the day of the inspection some people were going bowling with staff members. A resident spoken with described trips out to local garden centres or shopping and said My favourite is going to the pub for a meal. Another mentioned going to see the Christmas lights being turned on in Gainsborough. The home has a people carrier and a mini-bus. Another described the recent Autumn Fair held the day before, which he had enjoyed. We saw people eating and enjoying the mid-day meal; one said Its good, fine and another gave a thumbs-up sign and a big smile. We saw that menus were balanced and varied, with a choice of meals and fresh vegetables and fruit used. Meals were prepared in kitchens around the home and in The Laurels we saw people helping to prepare their own food. Care Homes for Adults (18-65 years) Page 15 of 24 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 . Care plans are in sufficient depth and detail to ensure that residents health care needs can be met. Evidence: We saw peoples separate medication files, which showed that people are well supported by a staff group who knows their needs well. The local GP visits weekly and other health care professional as and when needed. We saw that monthly reviews were held by the staff. We saw records of visits by health care professionals, including a weekly visit by the local GP each Thursday. We spoke to a senior staff member who said all senior staff had recently received update training in medication. Medication policies were clear and the pharmacist visited regularly. Her last last visit on 10/06/08 highlighted one minor issue which was addressed immediately. We spoke to a senior staff member who said all senior staff had recently received update training in medication. Care Homes for Adults (18-65 years) Page 16 of 24 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 homes procedures for addressing complaints and for protection from abuse are clear. Residents and their families are confident that their comments and concerns will be listened to. Evidence: The complaints procedure is available in writing and symbols to enable service users to understand it where possible. There has been one complaint since the last inspection, concerning various aspects of a persons care, which was unsubstantiated. We spoke to people who said I dont want to complain and I know how to complain but Ive never done it. A returned survey form commented There is nothing I would wish to complain about; my relative is well cared for. There was a copy of the latest Local Authority safeguarding adults document and we spoke to staff who knew what to do in the event of a serious concern.The deputy manager said that all staff members had received either in-house or external training in safeguarding adults, some from a Local Authority Safeguarding team member. Care Homes for Adults (18-65 years) Page 17 of 24 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 residents live in a safe, comfortable and pleasant environment that is suitable for their needs. Evidence: Since the last inspection, a lot of work has gone into improving the environment, particularly in the Main House. The standard of decoration externally was very good, with well tended grounds and areas for people to sit out or play various games. The Main House had been redecorated, particularly with regard to bedrooms and bathrooms. The Laurels, being newly built, was built to a high standard and offered a pleasant environment for the people who lived there. Rooms were well personalised and all were en-suite; there was also a seperate Jaccuzi-style bath. It had a large activities area and a secure garden and decked seating area. Around the home there were seperate kitchens where people could help with making their own meals. One said I like it here and another compared the home favourably with another he had lived in. The home smelled clean and fresh throughout. Care Homes for Adults (18-65 years) Page 18 of 24 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 numbers are in sufficient quantity for them to be able to care for the residents. Staff members are suitably trained, qualified and competent to meet the needs of residents. Evidence: The daily staff rota showed that in addition to the manager and deputy manager, there were usually 10 to 13 staff members during the day; one in the Flat, three in the Main House, two in the Wing, three to four in the Court and two to three in The Laurels. In addition a twilight shift from 6 to 10 pm had been introduced in the Laurels and the Main House. In addition to the care staff the home employed nine cleaners, a cook and 2.5 kitchen assistants and a full-time gardener. Staff members said that there were enough staff to complete their tasks in time and people we spoke with said Theyre always around if I need help and I like them to sometimes give me help - theyre all nice. Staff members we spoke with had been working at the home for many years. Staff training records we saw showed that 19 staff members had completed the National Vocational Qualification [a nationally recognised qualification] at level two and 8 staff members had achieved NVQ at level 3. Five cleaners had achieved NVQ at level 2 in housekeeping and two kitchen staff had NVQ 2 in catering. One staff member was working towards NVQ at Level 4 and two towards an award for assessors in NVQ. The training records showed that all staff members were up to date with mandatory Care Homes for Adults (18-65 years) Page 19 of 24 Evidence: training and additional recent training had included the Mental Capacity Act. Staff records we saw confirmed that they had interviews, gave references; underwent an induction course and had CRB/POVA checks carried out. There were no up to date photographs in staff folders. Records demonstrated that staff received regular supervision staff meetings. Care Homes for Adults (18-65 years) Page 20 of 24 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The home is well managed and the health, safety and welfare of the residents are promoted. The views of the residents are listened to and they are involved in decisions affecting them. Evidence: The registered manager of the home is a qualified nurse with 9 years experience in care home management. She has the Registered Managers Award, a professional qualification. The deputy manager, who was present at the inspection, is a registered Mental Nurse of 10 years experience, 9 of them at this home. spoken with said that the management team at local and at area level were approachable and accessible.The owner visits the home on a weekly basis and these visits were recorded. People we spoke with said they had regular meetings with the staff and there was a daily comment book for people to the meals served. A new questionnaire for people and their families to give their opinions about the running of the home is currently being developed. The manager said that a fire audit was conducted last week and staff confirmed this. Care Homes for Adults (18-65 years) Page 21 of 24 Are there any outstanding requirements from the last inspection? Yes  No  Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 22 of 24 Requirements and recommendations from this inspection Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No Standard Regulation Description Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set No Standard Regulation Description Timescale for action 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 23 of 24 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 24 of 24 - 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!