Inspecting for better lives Key inspection report
Care homes for adults (18-65 years)
Name: Address: Mckechnie House 104 Mill Road Mile End Colchester Essex CO4 5LJ 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: Deborah Kerr Date: 1 2 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. 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: ï· Put the people who use social care first ï· Improve services and stamp out bad practice ï· Be an expert voice on social care ï· 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 36 Care Homes for Adults (18-65 years) Audience Further copies from Copyright 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 36 Information about the care home
Name of care home: Address: Mckechnie House 104 Mill Road Mile End Colchester Essex CO4 5LJ 01206751463 01206843367 broadhorizons@aol.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Broad Horizons Limited Name of registered manager (if applicable) Mrs Jean Brown Fleming Revelle Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 3 0 Care home 3 learning disability Additional conditions: Persons of either sex, under the age of 65 years, who require care by reason of a learning disability (not to exceed 3 persons) Date of last inspection Care Homes for Adults (18-65 years) Page 4 of 36 A bit about the care home McKechnie House is an established small care home registered for three younger adults with learning disabilities. The registered provider is Broad Horizons Ltd. The responsible individual is Mrs Jean Revelle who is also the registered manager. McKechnie House is one of three small care homes, owned by Broad Horizons located in Mill Road, Colchester. The three homes work in close co-operation with each other. Mckechnie House is in a residential area of Colchester, located close to Colchester General Hospital. There are local shops and facilities nearby with the main town centre offering shopping and leisure facilities a short bus ride away. The property is semi-detached adjoining Mill House one of the other Broad Horizon homes and has gardens to the front and rear. There is some off road parking in the front garden. The rear garden is enclosed with a paved area, decking and lawn. Mckechnie House provides accommodation for three people. At the time of this inspection two people were living in the home. Accommodation for two of the residents is on the first floor, both having single rooms with a hand washbasin fitted. The third bedroom is a loft conversion with en-suite toilet and hand washbasin facilities. A new shower room has been added to the first floor. There is also a separate bathroom with bathing, hand washbasin and toilet facilities An office and staff bedroom is also found on the first floor. On the ground floor there is a front lounge and a kitchen and dining area. The current fees charged by the home are between 550 - 575 pounds per week. Hairdressing, papers, magazines, clothing and personal activities are not Care Homes for Adults (18-65 years) Page 5 of 36 included and are charged at extra cost. This was the information provided at the time of this key inspection. People considering using this service may wish to obtain more up to date information from the home. Care Homes for Adults (18-65 years) Page 6 of 36 Summary
This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: Two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home Care Homes for Adults (18-65 years) Page 7 of 36 How we did our inspection: This is what the inspector did when they were at the care home This was a key inspection, which focused on the core standards relating to adults aged 18-65. The inspection was unannounced on a weekday, which lasted four hours. This report has been written using accumulated evidence gathered prior to and during the inspection, including information obtained in the Annual Quality Assurance Assessment (AQAA) issued by the Commission for Social Care Inspection (CSCI). This document gives the provider the opportunity to inform CSCI
Page 8 of 36 Care Homes for Adults (18-65 years) about their service and how well they are performing. We (CSCI) also assessed the outcomes for the people living in the home against the Key Lines Of Regulatory Assessment (KLORA). A tour of the premises was made and a number of records were inspected relating to people using the service, staff, training, the duty roster, medication and health and safety. What the care home does well Care Homes for Adults (18-65 years) Page 9 of 36 People who use this service tell us, they are happy living in the home and that they able to do what they want to do when they want to. Staff provide support to people using the service in a person centred way, which enables them to live the life they choose, both inside the home and in the community. People living in the home are encouraged and supported to help with daily household chores. Care Homes for Adults (18-65 years) Page 10 of 36 What has got better from the last inspection Care plans and risk assessments have been improved to support people living in the home to take responsible risks in their daily lives. The complaints procedure has been amended, in an easy read format, which clearly shows people how and who to complain to. Care Homes for Adults (18-65 years) Page 11 of 36 Staff have supported people living in the home to purchase a new computer so that they can access information via the internet What the care home could do better The service users guide and satisfaction surveys could be improved by making this information easy to read, so that people living in the home know what services are available and can take part in giving feedback about their satisfaction with the service. Care Homes for Adults (18-65 years) Page 12 of 36 Radiators and windows in the home must be assessed for the risk they present to the people living in the home and action taken to minimise any identified risk. Staff working in the home must have up to date training to ensure they have the skills and knowledge to meet the needs of the people living there. 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
Care Homes for Adults (18-65 years) Page 13 of 36 inspector please contact Deborah Kerr 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 14 of 36 Details of our findings
Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 15 of 36 Choice of home
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service
. Broad Horizons have detailed information and admission policies and procedures in place to support people that may consider using this service and which ensures they can meet the individuals needs. Evidence: A comprehensive statement of purpose and service users guide was provided at the inspection, which clearly tells prospective clients about the service, the fees and facilities. However information in the AQAA reflects the service users guide could be further developed using photographs and pictures, to make the information more accessible for people with limited reading skills. People considering using this service are provided with the opportunity to visit the home. The care plan of the most recent person to move into the home was sampled during the inspection, which confirmed they had visited the house on several occasions and stayed for the weekend, before moving in. The records show they were supported through a multi disciplinary team of professionals to ensure this was the right placement for them. This was confirmed in discussion with the individual. Care Homes for Adults (18-65 years) Page 16 of 36 Evidence: A copy of the service users guide was seen in the individuals care plan, which also forms part of their terms and conditions of living in the home. The contract between the individual and Broad Horizons was also seen in the file reflecting the individuals assessed fees of 550.00 pounds per week. The contract included information about the method of payment, the individuals and the company’s rights and obligations and terms and conditions for using the service. A copy of Essex County Council procurement service assessment, which included the contract between the council and Broad Horizons, was also held on their file. The individuals pre admission assessment form reflected the provider had consulted with the out reach team, community nurse and the individuals consultant prior to accepting the individual into the home, to ensure they were able to meet their specific needs. Additionally a copy of the care co-ordinators report from the Adult Learning Disabilities team had been obtained. These assessments combined have formed the basis of the individuals care plan. Care Homes for Adults (18-65 years) Page 17 of 36 Individual needs and choices
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service
. People using this service know they will have their needs and personal goals reflected in their individual care plan and will be supported to take risks as part of an independent lifestyle. Evidence: The care plan of one person was sampled as part of this inspection. Their plan was well organised, person centred and easy to understand. Their plan contained support plans, which covered all aspects of the individual’s health, personal and social care needs. These included a description of the support and interventions required by staff to maximise the individual’s independence and to keep them safe. A previous requirement from the key inspection in 2006, was made for the manager to ensure that staff enable people using the service to take responsible risks and that they are provided with information on which to base decisions, within the individuals care plan, risk assessment and risk management strategies. Each need identified in the individual’s assessment had been identified as an aim with defined objectives. These were listed 1 to 9 providing a good description of daily living
Care Homes for Adults (18-65 years) Page 18 of 36 Evidence: support required and the individuals own abilities to achieve the outcome. These include support to develop their self help skills, such as washing, bathing, literacy, money, use of community resources, such as the post office, restaurants and pubs and interpersonal skills, such appropriate behaviour, personal hygiene, health education and emotional well being. Each aim listed was supported by a detailed risk assessment providing staff with information of how best to support the individual to do what they want to do and to be as independent as they can be, whilst minimising the risks to them. These are being reviewed monthly. Aim 9 in the individuals plan has been developed to support them to manage their behaviour, which particularly relates to obsessive and compulsive behaviours. The plan gives good descriptors of trigger points and guidance for staff if inappropriate behaviour occurs. This is supported by a detailed risk assessment, which reflects the individuals behaviour can change, becoming a danger to them self and to others in crowded places, which can result in them becoming agitated and prone to violent and aggressive outbursts. Recording of incidents that have occurred showed that staff focus on positive behaviours as well as recording the negative behaviour. A section of the care plan, This book is about me has been developed to reflect the individual in their own right and tells staff what they need to know about them as an individual. This is separated into different pages, including my name is, but I like to be called... and states, please read this book, it will help you to get to know me. It provides information as if the individual has written it, telling people about them, people important to them and things they like and dislike. People who use the service are supported to obtain, secure and spend their own personal money. The records of one person showed a clear audit trail of all financial transactions. Monies held on their behalf were checked against their balance sheets and were found to be accurate. The home has a detailed procedure for handling clients cash, which states clients who can, must sign individual spending sheets when drawing their personal allowance. Those unable to sign require two staff signatures, one of whom must be a senior and a staff member. All monies must be accounted for on clients personal spending sheets and receipts must be kept, which show the date, amount, what and where items are purchased and the change accounted for. Receipt numbers are recorded on the spending sheet. Cash balances are checked at each handover and signed as correct by the seniors. Both service users spoken with confirmed they are encouraged to make choices and decisions. This was also evidence through observation of the residents moving freely about their home and choosing what they wanted to do. Care Homes for Adults (18-65 years) Page 19 of 36 Lifestyle
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service
. People using this service are supported to live meaningful lives, both in the home and in the community, enjoying a full and stimulating lifestyle with a variety of options to chose from. Evidence: Observation and discussion with people living in the home confirmed they are supported to follow their interests and be integrated into community life. Time was spent talking with both people, one decided to go to their room to listen to music and watch television, the other person spent time in and out of the kitchen talking with the deputy manager and the inspector. The people living in all three Broad Horizon homes know each other and meet and socialise together regularly. The deputy manager confirmed people living in the home are encouraged and supported to be as independent as they can be taking part in the cleaning and running of the home. One individual was observed drying the cutlery and utensils on the
Care Homes for Adults (18-65 years) Page 20 of 36 Evidence: draining board without any prompting. Both service users were observed helping themselves to hot and cold drinks as and when they required. People using the service are supported to take part in various activities in the home and in the community, such as going to the pub, bowling, going to the cinema, visits to the company caravan in St Osyths for days and holidays and listening to music. The home has sky television and has recently purchased a computer with wireless broadband so that service users can access to Internet. Both people living in the home have regular contact with their relatives. One person told us they see their relative every weekend and enjoy going rambling with them. Following an inspection by the Environmental Health Officer (EHO) the manager was advised they needed to obtain and implement the food safety management system, Safer Food, Better Business and to repair the end of one of the worktops in the kitchen. The repair to the kitchen worktop has not yet been completed, however food safety is being monitored, the fridge and freezer temperatures are being recorded and the temperature at which food is served, in line with food safety standards. Additionally, the organisation has developed a policy, which includes the guidance and reminders for staff with regards to food hygiene and hand washing and procedures for assisting people to eat and refusal to eat. Menus have been designed to ensure meals are balanced with a nutritional basis. The weekly menus are used as a guide only people are offered choices. Nutrition charts seen reflect this. Both service users confirmed they assist staff in food shopping and picking out foods in their local supermarket. Care Homes for Adults (18-65 years) Page 21 of 36 Personal and healthcare support
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service
. The health and personal care people receive is based on their individual needs and preferences. Evidence: People living in the home are supported to have access to health care services. Care plans contained individual health plans, which provided clear information about the individuals health, physical and mental health needs and how these were to be met. Health charts were seen, which monitored peoples health and where potential complications or problems were identified these were dealt with. The principles of respect, dignity and privacy are put into practice and the delivery of personal care is responsive to the needs and preferences of the individual. Both people living in the home are able to manage their own personal care with staff encouragement and support. Observation and discussion with the deputy confirmed they are fully aware of the individual needs of both service users and were able to provide a verbal account of their health, current mental health and well being. Care Homes for Adults (18-65 years) Page 22 of 36 Evidence: The practice of administering medication is generally well managed. Only one person in the home is prescribed regular medication. Their Medication Administration Records (MAR) was looked at. This had a photograph of the individual attached to prove the persons identity. The service has recently changed pharmacies and implemented the use of Monitored Dosage System (MDS) so that prescribed medications are provided in blister packs. The deputy told us that the individual had run out of Procychlindine that morning and that a further supply of their medication had been requested from the pharmacy. This was as a result of seven Procychlindine tablets, which were identified as missing from their blister pack over the Christmas period. A member of staff had signed the individuals MAR sheet to reflect their medication had been administered, instead of using the correct code to reflect the individual was absent from the home. Additionally, there was no system in place to record and monitor the amount of medication leaving and entering the home. An immediate requirement was left for the registered manager to investigate the missing medication. The registered manager has provided us (The Commission) with a detailed response into their investigation, within the timescales set as part of the immediate requirement. The investigation concluded that there was a shortfall of the seven Procychlindine provided to the home as a result of a discrepancy with the repeat prescription, which occurred during the change over in the use of a different pharmacy. Staff have received supervision to ensure they use the correct policy and procedure for recording of medication, including when an individual is on social leave from the home. A copy of this policy was provided with the manager’s response. Medication is locked securely in a cupboard in the kitchen. No one living in the home is currently prescribed controlled drugs, however the deputy manager was advised if anyone in the home is prescribed these in the future it is a legal requirement that the home has a separate metal cupboard of specified gauge with a double locking mechanism which is fixed to a solid wall with either rawl or rag bolts. Care Homes for Adults (18-65 years) Page 23 of 36 Concerns, complaints and protection
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service
. People who use this service have access to a complaints procedure, which is in a format they understand and which enables them to make their views known and are protected from abuse or being placed at risk of harm or abuse. Evidence: Information provided in the AQAA and verified at the inspection confirmed the complaints procedure has been developed in easy read format using symbols and pictures of individual staff and other relevant people. The AQAA also states each person has been issued with their own copy of the complaints procedure, this was confirmed in the care plan sampled at this inspection. A requirement was made at the key inspection in 2006 for the complaints procedure to be amended. This made reference to incorrect information about raising complaints with the registered director of The Commission (CSCI). The manager was informed that we (The Commission) are not a complaints agency and do not have statutory powers to investigate complaints, but we can use our powers of inspection to undertake an enquiry so that we can make a judgment as to whether the provider is complying with the regulations. The registered manager was advised of the need to review this procedure for these inaccuracies. The complaints procedure was seen and has been reviewed and amended and now directs people to raise any concerns they may have with manager and provides timescales for complaints to be investigated and to refer to CSCI if they remain unhappy with outcome. Neither the Commission or the home have received any complaints against this service, since the last key inspection
Care Homes for Adults (18-65 years) Page 24 of 36 Evidence: in 2006. This was confirmed in the complaints log. Broad Horizons have a robust adult protection policy and procedure in place to promote and protect the health, safety and welfare of the people using the service. The procedure provides information about the various forms of abuse and the procedure staff must follow if they suspect or observe any kind of abuse. The deputy manager was clear about their role in the reporting of incidents of poor practice and suspected situations of abuse. They were also familiar with the whistle blowing policy and procedures and their duty of care to raise any concerns they may have about other members of staff conduct. Care Homes for Adults (18-65 years) Page 25 of 36 Environment
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service
. The physical layout and design of Mckechnie House provides people who live there with a safe and comfortable home. Evidence: Mckechnie House provides a small group living environment. It provides homely, safe and comfortable accommodation for the people living there. This was confirmed in discussion with both people currently living in the home, who told us, I am happy living here, I can do what I want to do, when I want to. One of the residents showed the inspector around the home. It is nicely decorated and maintained to a good standard. The building is fully in keeping with neighbouring proprieties and has a medium sized garden, which is accessible to all people who live there. Communal rooms are spacious and well furnished with modern equipment and domestic style furniture, carpets and curtains. The stair carpet has recently been replaced. Bedrooms are suitable for the needs of their occupants, with appropriate furniture and fittings. These are decorated to reflect their individual personalities. However, it was noted that radiators in peoples rooms and in other parts of the home are uncovered, this is a potential risk to people living in the home in respect of them burning or scolding themselves on radiator surfaces or exposed pipe work. Care Homes for Adults (18-65 years) Page 26 of 36 Evidence: The loft conversion is now complete providing a third bedroom. This has en suite toilet and hand-washing facilities. No one is occupying the room at present. The home has a communal shower and bathroom, with hand washbasin and a toilet. The bath and shower have been fitted with thermostatic valves to regulate the hot water temperature. The bath water temperature was checked and was found to be within the safe recommended temperature of 44 degrees centigrade, which minimises the risk of people living in the home being scolded when taking a bath. Written confirmation that thermostatic valves had been purchased and fitted was seen in the homes maintenance file. The home was clean and tidy throughout. Domestic laundering facilities are sited in the kitchen area. These are accessible to the people living in the home who are encouraged to use the facilities to launder their clothing. Only normal household laundry is dealt with in the home. Hand washing facilities and liquid soap and paper towels are provided in all toilet facilities and rooms where staff may be required to provide assistance with personal care. Care Homes for Adults (18-65 years) Page 27 of 36 Staffing
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service
. The home has sufficient staff and robust recruitment procedures in place to protect the people living there, however there is no up to date information to confirm staff are appropriately trained to ensure they have the skills to meet service users assessed needs. Evidence: The homes staffing structure is made up of the registered manager, deputy manager and two support workers. One person is on duty throughout the day and sleeps in over night providing twenty-four hour support, seven days a week, for the two people living there. The deputy and another support worker, work adjacent to each other throughout the week. Their shifts cover a two-week rota, with two days on and three days off, with another carer who works predominately weekends. The deputy confirmed one person is sufficient to meet the needs of the people living in the home and that the proprietor works alongside the staff covering sickness and holidays, as required. They also told us that the staff have been in post for a long time providing a cohesive staff team and continuity for the people living at the home. One staff file was sampled at the inspection. The file had a current photograph of the employee for identification purposes, their terms and conditions of employment and all the relevant documents and recruitment checks required by regulations to determine the fitness of the worker, which had been obtained prior to them commencing
Care Homes for Adults (18-65 years) Page 28 of 36 Evidence: employment. Staff files would benefit from being reorganised, which will make them easier to locate specific documents and ensure these are kept up to date. The deputy manager confirmed that they and the other staff had previously completed the Learning Disabilities Award Framework (LDAF) as part of the induction process, to ensure they had a basic knowledge of working with people with learning disabilities. Certificates held on their file confirmed this. Additionally, they had completed Broad Horizons own the induction workbooks, in line with the Skills For Care Common Induction Standards (CIS) requirements when these were first introduced. Two requirements were made at the previous inspection 2006 for clear records to be kept to show a staff training and development programme and ensure that regular recorded supervision sessions are held in the home. The individual file contained evidence that some training has taken place, however these were not in any specific order making it difficult to ascertain which training had been completed and how recent. Certificates showed training included food hygiene, safeguarding vulnerable adults, fire safety and health and safety. However, the food hygiene was completed in 2007, medication dated back to 2004, understanding abuse and positive communication in 2005, which had been signed off as part of the LDAF training. There was no evidence that staff had received manual handling. It is recognised that both people using the service are fully ambulant, however staff are still required to complete training with regards to handling other objects and keeping safe whilst at work. The AQAA states an individual development plan, which reflects training completed and planned has been implemented, however this was not available for inspection. The staff file confirmed that regular supervision is now taking place, this was also confirmed in discussion with the deputy manager. The documentation reflects that these sessions include discussion of what went well, what worked less well, discussion of practice issues, linked to supporting and policies and procedures. Good practice discussions included discussion about Deprivation of Liberty (DOLS) and the Mental Capacity Act and impact this may have on the service in the future. Broad Horizons provide staff with the opportunity to complete a National Vocational Qualification (NVQ). The home employs a total of three staff, all have completed NVQ level 2 or above, which reflects the service has met the National Minimum Standard (NMS) target of 50 of care staff to hold a recognised qualification. Care Homes for Adults (18-65 years) Page 29 of 36 Conduct and management of the home
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service
. The home is run in the best interests of the people living there, by a competent and qualified manager, however to further protect the safety and welfare of people living and working in the home, where fixture and fittings have been identified as a risk, action must be taken to minimise these. Evidence: The registered provider for McKechnie House is Mrs Jean Revelle she is also the registered manager. Mrs Revelle has the required qualifications to manage the service and has many years experience of working with people with learning disabilities. They continue to develop their knowledge and skills, to manage the service and is currently undertaking a teacher training course and assessor awards. This will enable them to deliver their own training in the future, including their own induction training and verification. They were also attending Deprivation of Liberty (DOLS) training on the day of this inspection. They are supported by a deputy manager, who is currently undertaking the qualification replacing the Registered Managers Award (RMA) and already holds NVQ 4 in health and social care. The most recent annual quality assurance stakeholder survey was completed in
Care Homes for Adults (18-65 years) Page 30 of 36 Evidence: November 2008. Feedback obtained from surveys received was positive about the service provided. People living in the home had been provided with questionnaires. These reflected they were happy with the service they were receiving. However, more could be done to obtain the service users own views, particularly for people with limited reading skills and understanding, by further developing the questionnaires, in a similar format as the complaints procedure using symbols, pictures and photographs. Additionally, where possible people using the service should be supported to complete these with support from an independent advocate. Essex County Council completed a contracts monitoring and compliance visit to both Broad Horizon homes, Mill House and McKechnie House in September 2008. The report for this visit was seen and outcome was that the home continues to provide a good service. Recommendations were made to improve supervision and training for staff. Supervision is now taking place, however staff training needs to be improved. Health and safety is given high priority. The provider employs the services of a company, who visit all three homes to assess health and safety. They undertake annual unannounced inspections and last visited the homes in December 2008. Following their visit they prepare a report of their findings, which is sent to the home. The company also provide staff with a handbook, containing all health and safety policies and procedures and will provide training. The report reflects the overall standard of health and safety culture within the organisation is satisfactory, although it states some areas could be further improved. For Mckechnie House these related to developing a written fire procedure for night time and ensuring keys to front door and back door are kept readily available. The report also make recommendation that accident record sheets are removed from the accident book and held on the individuals personal file for confidentiality of information and to ensure the first aid kit is replenished, this was found to be short of plasters. The fire logbook showed that the smoke alarms and emergency lighting is being tested monthly, the health and safety report states the smoke alarms must be checked weekly. Although the fire log shows regular fire drills take place, these in most cases have involved the same member of staff. The report recommends that all staff working in the home must attend a minimum of two fire drills a year. It was noted during the inspection that the kitchen and lounge doors were wedged open. This was also reflected in the health and safety report stating doors, which are fire doors must be closed and unobstructed when ever people are on the premises, doors when left open nullifies the 30 minute protection they are designed for. Where doors are needed to be kept open the registered manager must consider using a free swing or electronic door device. Records examined confirmed the proprietor complies with relevant legislation to ensure the safety and welfare of people living and working in the home. The most recent Gas and Electrical Safety certificates including Portable Appliance Testing (PAT) were seen. The homes maintenance folder contained appropriate procedures and provided evidence that routine monitoring of systems, such as monitoring hot water
Care Homes for Adults (18-65 years) Page 31 of 36 Evidence: temperatures are completed. The manager needs to assess the vulnerability and risk to each person living in the home, in respect of hot surfaces and windows, which open. As previously mentioned in the environment section of this report, there a number of uncovered radiators in bedrooms and communal rooms throughout the home. These could be a potential risk to people of scolding themselves on the hot surface of the radiator or exposed pipe work. Additionally where the care plan for an individual reflects their window in their bedroom is kept locked for their safety, this restricts the individual’s choice of opening their window to ventilate their room, particularly in the summer months. A review of this decision needs to explore all other avenues, such as fitting and maintaining window restrictors. Care Homes for Adults (18-65 years) Page 32 of 36 Are there any outstanding requirements from the last inspection? Yes ï£ No ï Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards.
No Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 33 of 36 Requirements and recommendations from this inspection
Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours.
No Standard Regulation 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 1 35 18 A training and development programme must be implemented and forwarded to us (The Commission) to reflect people employed to work in the home receive training appropriate to the work they are to perform in accordance with the sector skills workforce training targets. This will ensure appropriately trained staff are meeting the individual and joint needs of people living in the home. 02/04/2009 2 42 23 02/04/2009 The manager must to complete all the recommendations made in the health and safety report in December 2008, including consulting with the fire service to make adequate precautions for containing the spread of fire. Care Homes for Adults (18-65 years) Page 34 of 36 This will protect the health, welfare and safety of people living and working in the home. 3 42 13 Radiators and windows in the 02/04/2009 home must be assessed for the risk they present to the people that use the service and action taken to minimise any identified risk. This will protect the health, welfare and safety of people living in the home. 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 1 More could be done to provide people using the service with information in formats that meet their individuals needs. This includes the service users guide and quality assurance questionnaires. These could be further developed using symbols and pictures like the complaints procedure and photographs and quotes from people who already live in the home giving their comments and experiences about using the service. Care Homes for Adults (18-65 years) Page 35 of 36 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 36 of 36 - 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!