Care Home: 108 Barnet Wood Lane

What the care home does well The service has only been in operation since August 2009. As a result of the limited length of time the service has been providing care for the people living there it is difficult to fully ascertain to effectiveness of the service. There is however detailed policies and procedures in place which if fully implemented should provide people who live at the home with safe, secure and stable environment to live in. The environment in which the residents will live in is of a good standard, with furnishings and fittings throughout the home that meets the needs of the service users. It is noted from comments made by the people who live at the service were very positive about the service, one service user mentioned the "great staff" who support him. The quality and quantity of the communal rooms will provide good areas for the residents to engage in individual or group activities without being invasive or cramped to others who are not participating. What has improved since the last inspection? Not applicable new service. What the care home could do better: The manager must ensure that all Lenard Cheshire policies and procedures are fully implemented, to ensure that the service users receive a constant package of care and their continued protection is not compromised. Staff files must be audited to ensure that they contain all relevant documentation required by law when operating a care home. The registered provider must ensure that staff receive all mandatory training to ensure that their practises are safe and the service users are supported appropriately. There must be a clear understanding of the roles and responsibilities of the manager and staff in order to operate a care home under the requirements of the National Minimum Standards for Younger Adults. Key inspection report Care homes for adults (18-65 years) Name: Address: 108 Barnet Wood Lane 108 Barnett Wood Lane Ashtead Surrey KT21 2LS     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Kenneth Dunn     Date: 2 9 1 2 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. 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. Care Homes for Adults (18-65 years) Page 2 of 27 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). 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 CQC 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 27 Information about the care home Name of care home: Address: 108 Barnet Wood Lane 108 Barnett Wood Lane Ashtead Surrey KT21 2LS 01372206231 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): joan.muthu@sabp.nhs.uk Leonard Cheshire Disability Name of registered manager (if applicable) Joan Muthu Type of registration: Number of places registered: care home 6 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 6. The registered person may provide the following category 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 108 Barnett Wood Lane is a care home for adults with learning disabilities. Registration is for up to six service users with learning disabilities. The home is a large converted, detached house that has been suitably adapted. The premises are domestic in style and character. The all-single bedroom accommodation is arranged on the ground and first floor. Communal areas are well appointed, comfortable and homely. Provision includes off road parking to the front of the home, and a large, secluded garden to the rear. Care Homes for Adults (18-65 years) Page 4 of 27 Over 65 0 6 Brief description of the care home Weekly fees £1642.36 Care Homes for Adults (18-65 years) Page 5 of 27 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: This inspection of the Service was an unannounced Key Inspection. The Inspector arrived at the Service at 09.15 and was in the Service for four and a half hours. The home has capacity to accommodate 6 people; at the the service had four service users resident and two vacancies. This is a new service registered on the 3rd of August 2009. As this was the first Key Unannounced site visit undertaken by the Care Quality Commission since the service was registered. It was a thorough look at how well the Service is doing. It took into account detailed information provided by the Services in the form of a Annual Quality Assurance Assessment and any other additional information that the Commission for Social Care has received about the Service since the home was registered and information received Care Homes for Adults (18-65 years) Page 6 of 27 from the people who use the service on the day of the visit Care Homes for Adults (18-65 years) Page 7 of 27 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 on page 4. Care Homes for Adults (18-65 years) Page 8 of 27 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 9 of 27 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 27 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. People who are considering moving to the 108 Barnett Wood Lane have sufficient information about the home to help them decide if the home will be suitable for them. The homes admission and assessment procedures should ensure peoples individual needs are understood and can be met. Evidence: The home has developed a statement of purpose and service users guide both documents contain sufficient information about the service and the services offered to enable them to decide if the home will be suitable for their needs. The Information in both the statement of purpose and service user guide has been set out in a very user friendly format, which the manager stated was accessible to the service users living in the home at the time of the site visit. It was however discussed during this site visit that the information contained in the statement of purpose and service user guide should be expanded to include all specialists training undertaken by staff in order to demonstrate how the home Care Homes for Adults (18-65 years) Page 11 of 27 Evidence: effectively meets the needs of all service users. The manager stated that the statement of purpose and any relevant information required to assist people with understanding the services offered by the home would be further developed. There is a detailed assessment process where people who are considering moving to the home, their advocates, families and care managers are invited to the home. The manager stated that this process is flexible and can be designed to the specific needs of the individual being assessed. The manager stated that wherever possible the initial assessments will takes place in the persons current home, so the environment that is currently meeting their needs can be viewed as well, gaining valuable information from current carers and or family. In addition to this, the persons former care plan, risk assessments, historical information and the Care Managers assessment of needs, where available, is used to inform the assessment process and enable a planned transition to take place. Any specialist support needs are also identified at this stage. A random sample of two service users files was undertaken as part of the site visit this identified that full needs assessments have been completed, the assessment documents were very detailed and contained all relevant information about the individual service users. Care Homes for Adults (18-65 years) Page 12 of 27 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 who live in the home have detailed care plans and risk assessments in place. Measures have been put in place to ensure their needs are met and they are protected form harm whilst being supported to lead fulfilling lives at the home. Evidence: The manager stated that all service users living at the home have full care plans in place, the plans have been developed to provide a clear understanding of the needs of the individual service users. There was detailed information on file to ensure that the service users could be confident that their individual needs and preferences are understood. The manger stated that each person has been assessed and their future care plans have been developed according to their individual need. The random sample of service users files provided evidence that the service users have been fully involved in the planning and reviewing their care needs. Care Homes for Adults (18-65 years) Page 13 of 27 Evidence: There is evidence on file that both individuals are being encouraged to make decisions according to their individual needs and abilities. There a set of clear guidelines for staff to follow when offering to support and guide the service users to make appropriate decisions. Both care plans were sampled as part of the case tracking process. These documents include detailed information about each persons physical, personal and health care needs, their social skills, communication, independence, activities and daily living skills. Aims and objectives are clearly recorded. At the time of this site visit the individuals at the home are protected form harm through risk management processes. Care plans sampled include individual risk assessments, which provide guidance on how to minimise risk in regard to specific activities. Care Homes for Adults (18-65 years) Page 14 of 27 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 who live in the home are encouraged and supported to participate in a range of activities both within the home and in the local community. They are provided with a flexible, healthy and balanced diet. Evidence: There is evidence that the people living at the home are supported to take part in a variety of activities and to be a part of the local community. The manager stated that the activities are constantly being developed and reviewed to ensure that the service users can access areas they are interested in. The manager stated that during the assessment period the service has ensured that service users receive continuity by attending day services provided by the previouse nprovider of the home. There are no restrictions on visitors to the home. The service will endeavour to supports people to maintain appropriate relationships with their families and friends. The manager stated that where families are involved they will be invited to be involved in the care of their Care Homes for Adults (18-65 years) Page 15 of 27 Evidence: relatives. There was documented evidence available during this site visit to support the frequent visits and support provided to the service users by their visiting relatives. One service users was away at the time of the visit preferring to spend Christmas with his family. The service has developed a robust policy ensure the respect peoples privacy and dignity by knocking on bedroom doors before entering; calling people by their preferred names and providing personal care in the privacy of their own rooms. During this site visit the interaction observed between the manager, staff and the individual service users was appropriate. Information provided in the AQAA informs that Equality and Diversity are promoted through the Equal opportunities Policies and Procedures. Evidence found during the site visit supports the information sent to us in the Annual Quality Assurance Assessment (AQAA) completed by the provider as part of our inspection. Care Homes for Adults (18-65 years) Page 16 of 27 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. People who live in the home should be protected from harm through the safe handling of medication. Measures are in place to ensure that individuals can be confident that their physical and health care needs will be met. Evidence: Arrangements are in place to ensure that the people who live in the home can be confident they will receive the personal care and support they require. The manager stated that each person is supported to choose the time they go to bed and get up in the morning and the clothes they wish to wear. The manager provided details of who the home will promote the health needs of the people who will live there. There are provisions in place to ensure that each service users has an individual health action plan in place. The service users are all registered with the local GP practice, and have access to a Dentist, Optician, and Chiropodist, and all National Health Services as required. The manager continued to state that records of all appointments and health checks are maintained and stored in the individuals care files of each service user. The records reviewed during the site visit supported the manager and provided evidence that clear records are kept providing Care Homes for Adults (18-65 years) Page 17 of 27 Evidence: effective information regarding the health needs of the service users. There is evidence that the manager and staff understood know who to contact in an emergency for any immediate health concerns. People who live in the home are protected through the safe handling of medication. All medication was being appropriately stored and administered. All staff employed at the home has received full training in the safe medication handling and administration. The records of medication administered to the people living at the home have been well kept to ensure there is no mishandling. The manager stated that there was no service currently living at the home that had been assessed to self medicate. It was however noted that no risk assessments had been completed by the service to indicate how this outcome was achieved. This was discussed with the manager during the site visit who stated that risk assessments would be completed in conjunction with the service users to demonstrate their ability to self medicate in the future. Care Homes for Adults (18-65 years) Page 18 of 27 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. Provisions are in place to ensure that people who live in the home will be listened to and protected from abuse. Evidence: The home has a robust set of procedure for concerns, complaints and protection. The manager stated that the complaints procedure is explained to people who are living in the home and in a format that is designed to be user friendly. People are protected from abuse through policies, procedures and provisions are in place for staff training. The home has the local Multi Agency Procedure for Protection of Vulnerable Adults (MAPPVA) in place. Care Homes for Adults (18-65 years) Page 19 of 27 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 who live in the home benefit from facilities and an environment that is safe, homely and comfortable at meets their indavidual and group needs. Evidence: The property is detached and the accommodation is on two floors, accessed by stairs. People who live in the home benefit from the spacious, comfortable and safe environment. A part tour of the premises was undertaken, all areas seen were bright and airy, and the premises were clean and relatively well maintained throughout. The one service user was delighted to assist in the tour and invited the inspector into his own bedroom. The bedroom was highly individual spacious and had been highly personalised by the service user. The room contained many photographs and mementos collected by the service user and demonstrated his ownership of the bedroom. In addition to the occupied bedroom the tour included the two vacant bedrooms which again were large bright rooms. The manager stated that in the event of the home admitting new service users the bedrooms would be redecorated to meet their requirements and tastes. The home is furnished and decorated to an adequate standard. There is a main sitting room, a domestic style kitchen, dining room, games room, toilets and office. Care Homes for Adults (18-65 years) Page 20 of 27 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 arrangements for staffing at the time of the site visit are satisfactory, ensuring staff have the qualities and training to meet the needs of the reduced resident numbers. People who use the service should be protected by the organisations recruitment policy and procedures. Evidence: The duty rota was viewed during the site visit, this provided evidence that there are sufficient members of staff on duty to meet the needs of the residents. The home follows the Organisation recruitment policy and procedure. Three recruitment files were randomly sampled during the site visit. Each file included an application form, proof of identification, health screening and records of notes taken during the interview. Records of Criminal Record Bureau check reference numbers were maintained for all staff. It was noted that in all three files had gaps in the staffs previous employment histories and in two files the staff member only had one reference and the third file had references from people other than the ones stated on their application form. This was discussed with the manager who stated that an audit of all staff files would be undertaken to ensure that there are no further gaps and where they are found they would be discussed with the member of staff and documented on their file. The manager further stated that full files were retained at Care Homes for Adults (18-65 years) Page 21 of 27 Evidence: the organisations regional offices and was sure all the relevant documentation would be on file there. Staff have individual training and development files where training certificates are maintained. During the random sample of three training records it was apparent that there were gaps in all of the mandatory training areas of the staff members. The manager stated that there had been a request has been drafted to ensure that the registered provider priorities all mandatory training. The manager has commenced providing formal one to one recorded supervision for each member of staff. Records of these were evidenced during the site visit. During discussions staff told us that they receive regular supervision sessions. The AQAA informs that all staff receive regular support session which monitor the effectiveness of training raise or identify any training or performance needs. Evidence found during the site visit supported the information provided in the AQAA. Care Homes for Adults (18-65 years) Page 22 of 27 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. People who will live in the home should be confident the home is run in their best interests by a well qualified and experienced manager. There arrangements are in place to promote the health and safety of people who live in the home. Evidence: Arrangements have been made to ensure that the people who will live at the home could be confident the home is run in their best interests. The manager has relevant qualifications and is experienced in caring for people with the individual and complex needs. The organisation who operates 108 Barnett Wood Lane (Leonard Cheshire Disability) has provided the home with a complete set of policies and procedures. A review of the policies and a discussion with the manager and staff of the service highlighted confusion with some of the operational procedures. The discussion demonstrated that there is a need for Leonard Cheshire Disability to provide additional support to ensure Care Homes for Adults (18-65 years) Page 23 of 27 Evidence: that there is a clear understanding of the policies and procedures and the way the effect the service and the provision of care at the home. There is a quality assurance (QA) procedure in place, to ensure that the people who live in the home and their families or any other professional involved in their care will have the opportunity to comment on the home. There was evidence found during the site visit, which supports the information sent to us in the Annual Quality Assurance Assessment (AQAA) completed by the manager. This document also shows there is a development plan to further improve services to people who live in the home. People are protected from harm through safe working practises. Information provided in the AQAA and submitted during the registration process and supported by the manager during the site visit shows that safety checks of all equipment and installations have been undertaken. Care Homes for Adults (18-65 years) Page 24 of 27 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 25 of 27 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 The registered provider must ensure that all staff files contain all relevant documentation required by legal regulations. To ensure that the service users are safeguarded by employment practises. 18/02/2010 2 35 18 The registered provider must ensure that all staff complete all mandatory training. To ensure that the service users receive appropriate care from staff who are trained to met their needs. 18/02/2010 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 26 of 27 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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