Inspection on 21/10/08 for Juniper

This inspection was carried out on 21st October 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

Juniper 02/11/06

Juniper 05/01/06

Juniper 16/08/05

Juniper 14/02/05

Juniper 09/09/04

Similar services:

Thorndene

Insight - Eastchurch

Southfields

Magenta

Seabourne House

33 St John`s Church Road

Dovedale Court

Lyncol House

Extracts from inspection reports are licensed from CQC, this page was updated on 05/12/2008.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Juniper The Forstal Mersham Ashford Kent TN25 6NU     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: Mary Cochrane     Date: 2 1 1 0 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: · · · · Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 29 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 29 Information about the care home Name of care home: Address: Juniper The Forstal Mersham Ashford Kent TN25 6NU 01233720849 Telephone number: Fax number: Email address: Provider web address: juniper@counticare.co.uk Name of registered provider(s): Name of registered manager (if applicable) Mrs Marie Danielle Short Type of registration: Number of places registered: Counticare Ltd care home 3 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users to be accommodated is 3. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning disability (LD). Date of last inspection Brief description of the care home Juniper provides residential care for up to 3 adults with a learning disability. The home is owned by the Caretech Company, who are providers for other servcies throughout the East Kent area. The Home is situated in the village of Mersham, some 15 minutes drive from the town of Ashford where there is a variety of amenities such as shops, swimming pool, a cinema, churches, pubs, clubs and colleges. The home has access to a minibus and other vehicles owned by the company. Service Users also make use of the day centre owned by the company. Juniper is a detached bungalow comprising of a Care Homes for Adults (18-65 years) Page 4 of 29 Over 65 0 3 Brief description of the care home single bedroom for each resident, a lounge, kitchen, conservatory/dining room, laundry room and office. There is a small enclosed rear garden with seating and a barbecue area, and there is a parking area to the front of the property. Staffing comprises the registered manager, deputy manager and support staff. Fees for this service range between £986.00 and £1021.00 with additional charges for hairdressing, magazines and leisure activities. Care Homes for Adults (18-65 years) Page 5 of 29 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 did the last key inspection at Juniper on the 3rd November 2006. This visit to the service was an unannounced key inspection and it took place over one day. All the core standards were looked at. The registered manager was available throughout the site visit. The people living at the home and the staff on duty were helpful and co-operative. The visit included talking with people living in the home, the manager and staff. General observations were made during the day of how people are supported. We had a look around the home and various records were inspected. We observed how staff supported service users during social activities and when Care Homes for Adults (18-65 years) Page 6 of 29 offering care. We looked at and discussed service users individual support plans and their risk assessments and saw some polices. We also looked at staff training records and the homes quality assurance. An annual service assurance assessment (AQAA) was sent to us by the service. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. Information received from the home since the last inspection was used in the report. We also took into account the things that have happened in the service, these are called ‘notifications’ and are a legal requirement. One recommendation was made. 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 29 Care Homes for Adults (18-65 years) Page 9 of 29 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 29 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. Service users know that the home will be able to meet their assessed need and aspirations. Service users know what they are paying for and their places at the home are protected. Evidence: The manager has updated the homes statement of purpose and service users guide. Each person living at the home has a copy which is personalised. The guide is easy to read and is pictorial. It contains all the information needed to let people know what the home has to offer. There is information on activities and the support staff will offer. It explains about support plans, activities, laundry and catering. There is also a picture of people’s key workers and it explains how to make a complaint. One new person has come to live at the home since the last inspection. The registered manager told us a thorough pre assessment procedure was undertaken before the person moved in. The assessment was conducted sensitively with the service user at Care Homes for Adults (18-65 years) Page 11 of 29 Evidence: the centre. The other people living at the home were also involved in deciding if it would work. The person was given the opportunity to test drive the home before they made a final decision. Terms and Conditions of Residence/Contract are in place and are updated on an annual basis. They are all individualised and kept in the service users guide so the people living at the home can access them whenever they want. The registered manager is waiting for the new annual fees to be sent and this will be added. They also state who pays the fees and when. The contracts include information on any additional charges made by the company stipulating the amount and the reason why. The document is signed by the service user, by a relative and the manager and dated. Care Homes for Adults (18-65 years) Page 12 of 29 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The assessed needs and personal goals of people living in the home are reflected in an individual plan of care. They are consulted and participate in all aspects of life. Risks are taken as part of living an independent and fulfillling life. Evidence: We looked at 2 of the service users plans. They cover aspects of health and social care, medical needs, specialised needs, behaviour management, perferences , and nutritional information. Service users have been fully consulted in the development of their person centred plans. Plans are all individual and we saw that the service users were familar and actively involved in how they were supported and on a daily basis. The plans are very personal to each person. We saw from looking at the plans speaking to service users and staff and from watching what was happening that the service users are in control of their own lives. Staff are there to fit around them and give them the support that they need. Care Homes for Adults (18-65 years) Page 13 of 29 Evidence: Personal goals and aspirations for the future are identified and recorded and kept under review so staff know if people are getting the right support. One service user told us about how he acheiving his goals and what he plans to do next. He plans to take more control over his own medication and plans to be independent within the home. The staff are fully supportive of whatever the service users want to do. The plans contain information on equality and diversity. Daily records contain relevant information to show how the residents have made choices and decisions. It was possible to cross reference information The service users have regular 1 to 1 talk times with there key workers . These sessions are used to make sure that all the service users are listened to and time is allowed to for them to express how they are feeling. It was seen that staff listened to what the service users want and acted on this. There are regular weekly service users meetings to discuss and plan for the week ahead. This includes planning menus and activities. Monthly meetings are held to talk about more generic topics. Risks have been assessed with individuals with more focus on enabling people and giving them control. Risks are being reviewed regularly to be certain that only absolutely necessary restrictions are imposed. Service users have freedom and choice. Care Homes for Adults (18-65 years) Page 14 of 29 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. Service users have real opportunities to develop and have the lifestyle they choose. Evidence: We saw that the home promote and support the individuals right to live an ordinary and meaningful life. The service users have a stimulating life style with lots of options to choose from. One of the servcie users has a job in the local area and also has chosen to do another job voluntary. People attend college courses and have attained certificates in healthcare emergencies and food hygeine. Other service users go the companys day centre. Service users use the local leisure facilities regularly and go swimming and trampolining. They are also part of the local community and use all the local facilities. There are visits to the pub and to the other Caretech homes in the local area. Care Homes for Adults (18-65 years) Page 15 of 29 Evidence: The service users are encouraged and supported to maintain contact with their family and relationships with people out-side the home are supported and encouraged. Everyone has an annual holiday and service users were trying to organise another weekend break in November. Service users are supported to be independent and involved all areas of daily living within teh home The service told us in their Aqaa and this was confirmed by service users at the visit that meals are good, healthy and varied. Service users are encouraged to choose healthy options and plan their own menu’s on a weekly basis. Daily diaries highlighted spontaneous changes requested and accomadated. Service users are able to choose when and where to enjoy their meals, and whether to eat alone or with others including staff. Care Homes for Adults (18-65 years) Page 16 of 29 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 physical and emotional needs of people living in the home are met and they are protected by the home’s policies and procedures for dealing with medication. Evidence: We saw that individual plans clearly and concisely record how the service users like to have their personal needs met. They focus on what people can do for themselves and detail exactly how staff will give the support needed while allowing the service users to be as independent as possible. Service user’s health is monitored and if any problems arise they are dealt with promptly and appropriately. Everyone has a GP. Annual health checks are done. There are regular appointments with chiropodists dentist and opticians. There is easy access to specialist input from the local learning disability team and this is sought on a when needed basis. We did see that a servcie user had recently been identified as having a medical appointment for a physical complaint. The health plan did not reflect what action the Care Homes for Adults (18-65 years) Page 17 of 29 Evidence: home were taking to monitor this issue. For example there was nothing in place to record when the person reported they were experiencing pain or discomfort. The plan did not say what was being done to resolve the issue. We also saw that people had conditions which were not fully explored and risk assessed in their plan. We were told that this was because the condition had been dormant for years. Staff would still need to know what to do in the event that it should occur. The manager told us she would incorporate these needs into the plans. The home uses a pre- packed medication system and all staff who administer medication have received appropriate training. The medication is stored in a locked cupboard. One service user does self medicate and has access to the drug cupboard were his medication is stored. The manger is going to look at ways to make this procedure safer. There are protocols in place for medication that is given when required. Medication is reviewed regularly and competencies are checked. The monthly reports done by the service did highlight that 2 people were not signing the prescription sheet when handwriting prescriptions. This issue was being addressed and rectified. Care Homes for Adults (18-65 years) Page 18 of 29 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 living in the home know their views will be listened to and acted on and they are protected from abuse and neglect. Evidence: We spoke to service users and they told us what they would if they had any concerns or worries. They are able to speak for themselves and are encourage and supported to express their views and concerns. Views are sort on a regular basis both in meetings and on a 1:1 basis. Views are recorded and acted upon. There is a complaints procedure in place, which meets all relevant requirements. There has been one complaint made to the home since the last inspection. This was recorded and actioned appropriately. The changes made as a result to the outcome of the complaint was also recorded. The company provides training for all the staff in safeguarding vulnerable adults. The home has an Adult Protection Policy including whistle blowing. The manager and the service users told us they are able to take care of their finances and are given support when requested. Care Homes for Adults (18-65 years) Page 19 of 29 Care Homes for Adults (18-65 years) Page 20 of 29 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. People benefit from living in a safe, comfortable and homely environment with adequate personal and communal space to meet their needs. Evidence: We looked around the home. We saw that the majority of the home is maintained to a good standard. The lounge and dining area are spacious and homely and provided an environment for people to relax in. The bedrooms we looked at were well decorated and furnished. Service users choose how they decorate their rooms. They are individual and reflected the personalities of the people who live at the home. Service Users have support to clean their rooms and take part in other household chores. We also found that one of the bedrooms smells damp. The registered manager told us various people have come to look at it but the issue remains unresolved. The home did not have a maintenace and renewal programme with timescales so we were not able to see see if and when these issues are going to be dealt with The kitchen was clean and service user can help themselves to drinks and snacks. There are 2 communal bathroom and a wet room. We found that the hot tap in downstairs bedroom was not working and cold was only a trickle. This means people Care Homes for Adults (18-65 years) Page 21 of 29 Evidence: cannot wash there hands properly. Requests were seen to have been made to repair this but to date nothing has happened. This needs to be addressed. The service showed us evidence that monthly enviromental safety checks are done. All areas of the environment are looked at. If they are not satisfactory an action plan is developed to address the issue .The service does need to make sure they put time scales on actions so to make sure the work is done in a timely fashion. The laundry room has the appropriate equipment and storage space. We were told that service users are encouraged and supported to do their own washing. Care Homes for Adults (18-65 years) Page 22 of 29 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. Service users are supported by a competent and qualified staff team and are protected by the homes recruitment procedures. Evidence: The service users told us that the staff working at the home are very good. They said that staff listen to what they say. They told us that they are supported and helped to do what they want. Staff reported that they have developed good relationships with the service users and promote independence and automomy. There is a key worker system. Service users said they can choose who works with them. We saw that there was respect and positive relationships between the service users and staff. It was observed that the staff are accessible and approachable. It was evidenced that the staff on duty put the needs of the residents first.The service users responded positively and openly to staff. The home has an NVQ programme. The home has reached the 50 target of staff with NVQ level 2 or above. The number of staff on duty depends on what service users want to do and where they want to go. Service users told us they can do what the want when they want. Care Homes for Adults (18-65 years) Page 23 of 29 Evidence: Most staff are up to date with their mandatory training. There are a few gaps which have been identified by the registered manager and training has been booked. Staff do have specialist training. There is an induction programme in place for new staff and these were evidence on staff files. The home has thorough recruitment practises. All original documents on recruitment is kept at the companies head office and a detailed records of all safety checks and references are kept safely the home. Service are involved in interviewing new staff and have say about who is employed at the home to work with them. All staff receive regular supervision and annual appraisals Care Homes for Adults (18-65 years) Page 24 of 29 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 run and in the best interest of the people who live there. The health, safety and welfare of the service users is promoted and protected. Evidence: The registered manager has the skills and experience to run the home. She has a clear understanding of the key principles and focus of the service. She understands and promotes the importance of person centred care and looks towards improving the lives of the people who live at the home. She guides and leads the staff team positively. The registered manager makes sure that the home is run in the best interests of the service users. She is keeps up to date with methodology and current legislation. All records have been kept up to date and are in good order. Staff said they feel supported by the management. The staff are working well as a team. The service has effective quality assurance and monitoring systems. They told us they have a quality assurance audit files, which include audits in medication, finances, health action and health and safety. Care Homes for Adults (18-65 years) Page 25 of 29 Evidence: Questionnaires have been sent to service users , care managers, relatives and staff in the spring. The results of these questionnaires are being collated. The information needs to be returned to the home so they can start taking steps to improve the service offered to the people who live at Juniper. The results of the survey need to be published and made available to the service users. The Area Manager visits the home every month to carry out Regulation 26 visits. All of the necessary Health and Safety checks have been carried out in the home. A fire assessment has been done. Fire checks and drills are done at the necessary intervals. Water temperatures are taken and comply with regulations. The service is aware of reporting incidences to the Commission under Regulation 37. Containment of Substances Hazardous to Health (COSHH) products are locked away safely and regular audits are done. Care Homes for Adults (18-65 years) Page 26 of 29 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 27 of 29 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 1 24 The service needs to develop a plan for renewal maintenace of all of the home with timescales This means that issues like no hot water in the wet-room and teh damp in teh service users bedroom can be dealt with in a timely fashion.u Care Homes for Adults (18-65 years) Page 28 of 29 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 29 of 29 - 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!