Inspection on 03/03/09 for Seahorses

This inspection was carried out on 3rd March 2009.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Seahorses 04/11/09

Seahorses 09/09/09

Seahorses 22/02/08

Seahorses 30/04/07

Seahorses 17/10/06

Seahorses 13/01/06

Seahorses 16/08/05

Seahorses 19/01/05

Seahorses 03/08/04

Extracts from inspection reports are licensed from CQC, this page was updated on 07/08/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Seahorses 8 Park Road Gorleston Gt Yarmouth Norfolk NR31 6EJ     The quality rating for this care home is:   one star adequate 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: Debra Allen     Date: 0 3 0 3 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 28 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 28 Information about the care home Name of care home: Address: Seahorses 8 Park Road Gorleston Gt Yarmouth Norfolk NR31 6EJ 01493655731 F/P01493655731 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mr John Hallam,Mrs Gillian Rose Hallam Name of registered manager (if applicable) Mrs Wendy Bain Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: Huntingtons Disease and other Neurological Disorders Date of last inspection Brief description of the care home Seahorses is an older style, chalet bungalow that is run as a residential care home providing twenty-four hour nursing care to eight adults with Huntingtons Disease or other neurological disorders. All bedrooms are single, on the ground floor and contain a washbasin. People living at Seahorses have communal use of a bathroom, toilet, lounge and conservatory that contains the dining area. There is a well-kept garden to the rear of the property and roadside parking to the Care Homes for Adults (18-65 years) Page 4 of 28 care home 8 Over 65 0 8 Brief description of the care home front. Qualified nurses are part of the staff team and the manager is also a qualified nurse. Seahorses is within walking distance of the sea front, close to healthcare facilities, local shops, hotels and pubs and has its own mini-bus. The current fees for living at the home are in the region of #1,250 per week and are calculated according to individual support needs. Care Homes for Adults (18-65 years) Page 5 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate 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: Care Services are judged against outcome groups, which assess how well a provider delivers outcomes for people using the service. The key inspection of this service has been carried out, by using information from previous inspections, information from the providers, the residents and their relatives, as well as others who work in or visit the home. This has included a recent unannounced visit to the home. This report gives a brief overview of the service and the current judgements for each outcome group. The fieldwork of this inspection was carried out over a period of five hours, during which time a number of people living at Seahorses were observed and a tour of the premises was undertaken, which included seeing peoples personal rooms. Care Homes for Adults (18-65 years) Page 6 of 28 Discussions were also held with the manager, the proprietor and some of the staff on duty. Various records were looked at in detail, which included care/support plans, staff files and other records relating to health and safety. One service user survey was completed and returned to The Commission Five requirements and one recommendation have been made as a result of this inspection. 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.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 28 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective service users have detailed needs assessments carried out before they move in. Evidence: Two care plans were looked at during the inspection, both of which contained copies of pre-admission needs assessments, which also included detailed risk assessments and very descriptive personal profiles, both were seen to have been completed prior to people moving into Seahorses. Care Homes for Adults (18-65 years) Page 10 of 28 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people living at Seahorses have their changing needs and personal goals reflected in an individual plan of care, they are supported to make decisions about their lives as much as possible and take risks as part of an independent lifestyle. Evidence: Two care plans were looked at in detail, observations were made and a brief discussion was held with one person, which helped to confirm that the contents of the plans were accurate. The contents of the care plans included very comprehensive information, to ensure consistency of care and make sure that each person is genuinely treated as an individual and receives the level of support they require. The contents of the care plans were seen to be made up of sections such as: Care Homes for Adults (18-65 years) Page 11 of 28 Evidence: * Flush/Enteral Feed routine and amounts (seen to be signed and dated) * Keyworker Checklist (seen to be signed and dated) * Medical Card * Brief History and Needs Assessment (seen to be clear, simple and strightforward but detailed) * Nursing Letter (confirming Name, Date of Birth, Date of Arrival, Next of Kin, Past Medical History, Allergies, GP Name, Reason for Admission and Diagnosis, Treatment Required and Current Medication) * Speech and Language Therapist Discharge Report * Moving/Positioning (description from previous home, adapted to suit lifestyle at Seahorses) * Inventory of Belongings * Continuing Care Decision Support Tool (summary from the Mental Health Act) * Full Needs Assessments (full and clear information seen from previous placement, together with a full assessment of needs completed by the manager at Seahorses, including moving and handling) * Nursing Care Plan (including risk assessments in respect of areas such as swallowing or developing pressure sores, moving and handling, mobility and falls - all areas included completed and up to date progress and evaluation notes) * Daily/General Notes (including details of sleep, food, fluids, catheter care, hospital and dietician visits) * Hospital Notes It was evident that people continue to be supported to make decisions about their lives as much as possible and one person was noted to be looking after their own finances entirely, with personal bills going directly to them, using a computer to do on-line banking and having their own private telephone in their room. Care Homes for Adults (18-65 years) Page 12 of 28 Care Homes for Adults (18-65 years) Page 13 of 28 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Seahorses are supported to make choices about their lifestyle and participate in various activities, which suit their individual needs and choices, although organised activities could be more frequently available. Evidence: Both the care plans that were looked at in detail were found to contain good evidence and examples of individualised support with regard to how people wanted to spend their time, observations during the inspection also confirmed this. Organised activities were noted to be carried out one day per week (usually on a Wednesday) and these included pub visits, walks along the seafront, picnics, cinemas and local tourist attractions. Although the manager explained that, due to the nature of the peoples illness, one day per week was usually adequate and even this could be Care Homes for Adults (18-65 years) Page 14 of 28 Evidence: very tiring for some. However, it was felt that one or two individuals would still enjoy and be capable of more activities both in and out of the Home and a recommendation has been made to this effect. General observations during the inspection confirmed that the care staff spoke to people in a caring and professional manner and people were treated with respect and dignity. It was noted from observations and the care plans, that people are supported to maintain links with family and friends and can have visitors when they wish. As with the previous inspection, the menus were also looked at as part of the inspection process, individual records were seen and the lunchtime meals were observed. A number of people require their food to be pureed and the content to be of a high calorie/fat nature and, as before, this was observed to be provided in a respectful and dignified manner by the care staff and the meals were noted to be wholesome and nutritious. Care Homes for Adults (18-65 years) Page 15 of 28 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people living at Seahorses receive personal support in the way they prefer, their physical and emotional health needs are met and they are protected by the homes medication policies and procedures. Evidence: Information seen in the care plans, together with general observations throughout the inspection, confirmed that peoples individual wishes are acknowledged in respect of the way they are supported. Some people were also noted to require more support than others in respect of health matters and these were clearly described in their individual care plans - i.e. mobility, eating, drinking and personal hygiene. Numerous individual risk assessments were also seen to have been completed and regularly reviewed in respect of peoples physical and mental wellbeing, including mobility, eating, drinking and personal hygiene. Care Homes for Adults (18-65 years) Page 16 of 28 Evidence: Seahorses was seen to have good and safe practices with regard to the storage, handling, administration and recording of medication, including controlled drugs and the manager undertakes a medication audit on a weekly basis. No errors or omissions were noted in the records during this inspection. Other records looked at confirmed that people are supported to have regular and ongoing involvement with various care professionals such as doctor, community nurse, speech and language therapist, dentist, optician, dietician and chiropodist. Care Homes for Adults (18-65 years) Page 17 of 28 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Seahorses feel their views are listened to and acted upon and staff are well trained in areas such as mental health and adult protection, which helps protect people generally but inadequate recruitment procedures leaves service users vulnerable. Evidence: There have been no formal complaints received by the Commission since the last inspection and a discussion with the manager confirmed that none had been received by the Home either. One service user survey was returned to the Commission prior to this inspection, which stated that the person knew how to make a complaint and who to talk to if they were not happy. A thank you card was also seen from family of a person who had recently stayed at Seahorses for respite care. Training records and discussions with the manager confirmed that the staff have received training in adult protection and understanding abuse but the lack of appropriate recruitment/pre-employment checks means that people are not totally protected. This is covered more fully in the Staffing section. Care Homes for Adults (18-65 years) Page 18 of 28 Care Homes for Adults (18-65 years) Page 19 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Seahorses is a homely, comfortable and safe environment for people to live in, which is clean and hygienic. Evidence: As with the previous inspection, a tour of the premises was carried out, which showed Seahorses to be clean, hygienic and generally pleasantly decorated throughout most areas. It also had a very comfortable and homely atmosphere. Some peoples individual rooms were also seen and these were noted to be very personal and people have the opportunity to personalise them as they wish. Specialist equipment continues to be available and in use, as required, such as hoists, adjustable chairs and beds. Care Homes for Adults (18-65 years) Page 20 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Although staff are well trained, competent and qualified, the Homes recruitment policies and practices are not robust, which means the people living there arent fully protected. Staff are not receiving regular supervision sessions. Evidence: Eight staff files were looked at in detail and, for longer serving members of staff, these were found to contain relevant records such as application forms, references and clear, enhanced Criminal Records Bureau Disclosures. However, for some staff recruited since the last inspection, the files indicated that they had started working at Seahorses prior to the Home having received appropriate references, POVA 1st checks or clear, enhanced, Criminal Records Bureau (CRB) Disclosures. It was noted that one staff member started working at the Home in February 2008 but neither the POVA 1st check nor the CRB Disclosure were received until April 2008, one professional reference was received in March 2008. Another person started working at Seahorses in August 2008 but the POVA 1st and Care Homes for Adults (18-65 years) Page 21 of 28 Evidence: CRB Disclosure were not received until September 2008, this person had one reference, which was from a colleague at Seahorses. It was also noted that the reference requests that were sent from Seahorses for completion by professionals/previous employers did not include an area in which to include the referees full name, title, signature or date, thus making it difficult to be sure of their authenticity. The staff files, training records and certificates that were looked at provided evidence that staff are well trained in areas such as Enteral Feeding, First Aid, Moving and Handling, Fire Safety, Safeguarding and Adult Protection, Hygiene, Palliative Care and Challenging Behaviour. A good level of staff were noted to hold NVQ2 or higher. No evidence was seen of staff receiving formal support and supervision and a discussion with the manager confirmed that these were not happening and the manager said that she was trying to find and attend a course for supervision training. Care Homes for Adults (18-65 years) Page 22 of 28 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Seahorses is generally a well run home, in which the service users overall physical health, safety and welfare is generally protected but the manager must complete the Registered Managers Award, the staffing issues must be addressed and a formal Quality Assurance process must be established and undertaken. Evidence: A discussion with the manager highlighted that, although she had commenced the Registered Managers Award in October 2007, it was still incomplete and the training provider has recently stopped trading. It was confirmed that the manager was making enquiries into accessing a new training provider and intended to resume her RMA as soon as possible. Meanwhile, although a basic quality assurance process has been used in the past, the only records available were dated prior to 2004 and there was no evidence to show that any form of Quality Assurance has been carried out since. However, the proprietor did confirm that he would take responsibility for this without further delay and had Care Homes for Adults (18-65 years) Page 23 of 28 Evidence: already purchased training and guidance material to assist him. Health and safety is promoted well at Seahorses and records looked at confirmed that fire alarm and safety tests are carried out on a regular basis. Cleaning materials/hazardous chemicals were seen to be stored appropriately and staff training in areas relating to health and safety was seen to be up to date. Care Homes for Adults (18-65 years) Page 24 of 28 Are there any outstanding requirements from the last inspection? Yes R 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 1 34 19 Complete recruitment safety 22/02/2008 checks must be carried out on staff prior to commencement of work. 2 37 10 The matron must complete the registered manager?s award (RMA). 30/09/2008 Care Homes for Adults (18-65 years) Page 25 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 34 19 Two satisfactory written 17/06/2009 references must be obtained before people start working at Seahorses and these need to be able to be proven to be authentic. To ensure the people living at the Home are more fully protected. 2 34 19 Staff must not commence work at Seahorses prior to receipt of a clear POVA 1st check and they must be supervised at all times until receipt of a clear Criminal Records Bureau Disclosure. To ensure the people living at the Home are more fully protected. 17/06/2009 3 36 18 Staff must receive formal supervision sessions on a regular basis. 17/06/2009 Care Homes for Adults (18-65 years) Page 26 of 28 To ensure staff are supported and any concerns or issues may be discussed and addressed. 4 37 10 The manager of Seahorses must resume and complete the Registered Managers Award. To ensure she is appropriately qualified, in line with the regulation. 5 39 24 A formal Quality Assurance process must be established and carried out. To ensure service users views are taken into consideration and to ensure the home consistently meets the needs of the people living there and provides a good service. 17/06/2009 17/06/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 12 People should be supported, and be able, to have more frequent access to internal and external activities, in accordance with their individual abilities and wishes. Care Homes for Adults (18-65 years) Page 27 of 28 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 28 of 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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