Care Home: 10a Coates Lane

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What the care home does well This service is good at providing information about what they and Turning Point provide in terms of care and services. They also make sure that any new admission is done with a lot of care, good assessment and planned visits. We saw examples of very good care planning in place. People in the service could tell us about the high level of input they had into these plans. • “I have a copy of my plan in my room to read any time I want. I discuss it with my link worker if it needs changed...doesn’t need much and we do it together.” DS0000022544.V378025.R01.S.doc Version 5.3 10a Coates LaneWe judged that the plans that support people through any reoccurrence of their mental health problems were extremely detailed. We also judged that staff monitor and record any difficulties appropriately. The service makes sure that people’s wishes and needs are taken into consideration and that any risks are assessed and managed. • “the staff help me so that I get advice if I feel anxious about having to deal with things...I have found this hard in the past but there is always someone there to help me...often its the manager who helps me if I feel things might be risky...”.People are helped to make informed decisions and are given support to work through any life planning they want to do. They have a range of individual and group activities in place. Some people go to further education classes or attend college; they participate in recreational activities in the community. Some people attend church or are involved in specific clubs. The staff also help arrange individual and group activities in the home. There are trips and parties and entertainments on offer. People go on holiday and visit friends. They are encouraged to maintain former relationships and to make new friendships. The people who live in Coates lane make good use of all the amenities of this town. • “I like being central to everything and I know a lot of people and there are things to do...”The home provides good quality meals and snacks and people help with cooking and menu planning. They make their own drinks and snacks as they wish. • “The food is fine and we plan our meals and do bits of shopping and cooking together.”On the day we were told by residents that they were happy with the support they were given with personal care. They are helped to access health care professionals. There was lots of evidence to show that the staff help people to get treatment and they make sure ill health is prevented where possible. People have access to psychiatric services and their mental health care needs are under constant review. Staff are very good at promoting emotional and psychological well being. We saw evidence on the day of staff working in an empathic way and looking at all sorts of support that can be found for people. • “Karen and the staff know me...know my mental and physical health problems and they step in if I am unwell and need to see the psychiatrist or the nurse. It makes me feel safe...”10a Coates LaneDS0000022544.V378025.R01.S.docVersion 5.3Page 7Medicines are well managed in the service. We could see that improvements are being made so that people can start to manage more of these for themselves. We judged that care plans about medicines are very well written. The service does not use sedative medicines routinely. Medication is kept under constant review and advice sought from health care professionals. The staff and residents make sure that the environment is kept clean and fresh. People have good sized rooms that they are encouraged to personalise. • “My new room furniture was good quality and I chose it for myself as it suits my lifestyle and my taste. I like to spend time in my own space...”The home is suitably staffed by day and night. All of the staff team work both day and night so they can understand the needs of residents. There is a good mix of staff in terms of training, experience, skills and gender. New staff are recruited with help from residents. People who live in the home are on the interview panel. No one starts with the team until all checks and references have been completed. • “I interviewed for new staff...after all we have to live with the decisions...I was good at interviewing and we made good choices...”All staff have personal development portfolios that tie together training, development, skills and competences. We looked at a number of these and found that staff received individual support that developed them appropriately. There is a detailed training plan for the home and staff can also attend Turning Point training out of the area. • “I find Turning Point training to be really good and we do in-house things too that residents come to.”The home is managed by a suitably qualified and experienced person. Staff and residents trust her ability and judgement. • “Karen is always there for me...helps me stay well...and she makes sure staff do things the way I want.”The home has a quality assurance programme that allows all systems to be checked and gives people who live in the service the chance to comment and be involved in improvement and planning.10a Coates LaneDS0000022544.V378025.R01.S.docVersion 5.3Page 8 What has improved since the last inspection? Since our last visit the manager has made sure that health and safety issues are risk assessed and managed correctly when building work is being undertaken. She has made sure that staff know how to maintain safety when building work is ongoing. Staff have had training in the principles of manual handling and in fire safety. The building has undergone major renovation and repair work to the roof and to the rendering on the external walls. This was done to deal with problems of dampness. The interior has been redecorated and new furniture purchased. What the care home could do better: We judged that although the service provides good standards of catering further work could be done with people who find it hard to keep their nutritional levels up. We also want the manager to make sure staff are able to competently help people if someone were to have problems with their mobility. We want the manager to make sure that fire instruction and drills are planned and recorded in a more formal way so that everyone has the opportunity to understand what to do in a fire situation. Key inspection report CARE HOME ADULTS 18-65 10a Coates Lane Whitehaven Cumbria CA28 7BZ Lead Inspector Nancy Saich KeyUnannounced Inspection 13th October 2009 09:30 10a Coates Lane DS0000022544.V378025.R01.S.doc Version 5.3 Page 1 This report is a review of the 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. 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 home adults 18-65 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. 10a Coates Lane DS0000022544.V378025.R01.S.doc Version 5.3 Page 2 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 10a Coates Lane DS0000022544.V378025.R01.S.doc Version 5.3 Page 3 SERVICE INFORMATION Name of service 10a Coates Lane Address Whitehaven Cumbria CA28 7BZ Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01946 691336 karen.russell@turning-point.co.uk Turning Point Mrs K E Russell-Haines Care Home 9 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (9) of places 10a Coates Lane DS0000022544.V378025.R01.S.doc Version 5.3 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Mental disorder, excluding learning disability or dementia - Code MD The maximum number of service users who can be accommodated is: 9 Date of last inspection 17th September 2008 Brief Description of the Service: 10a Coates Lane is a Georgian house situated in the centre of Whitehaven. It is home to nine people who have long-term difficulties with their mental health. The home is operated by Turning Point who run residential homes and other services throughout the country. Karen Russell- Haines manages the home on their behalf. The home is on two floors and is not suitable for people who have problems with their mobility. Information about the home can be obtained from the manager at the above address or from Turning Point’s website. Charges range from £337 to £1057 per week 10a Coates Lane DS0000022544.V378025.R01.S.doc Version 5.3 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is three star. The means that people who use the service experience Excellent outcomes. This was the main or ‘key’ inspection for this service for this year. Some weeks before our visit we sent out a form to the manager called the Annual Quality Assurance Audit (the AQAA). Providers must, by law, fill out one of these every year. In it we ask about what has happened in the home in the previous year and for details of future plans. We also ask for some statistics about the service and the people who live or work there. This document was returned promptly with plenty of information. We also received documents that they chose to send us that backed this information up. We visited the home on the above date just after nine and we met all of the people who live in the home and some of the staff. No one was aware of our visit and the manager returned from a meeting to make sure we had as much information as we needed. We spent most of the day in the service and we had in-depth discussions with the people we met. We read a wide range of files and documents related to care and to the way the service operates. These things along with our observations and discussions with management and staff gave us the evidence for this report. We left surveys for residents, relatives, advocates and visiting professionals on the day. We quote from them and from conversations we had in the home in this summary. What the service does well: This service is good at providing information about what they and Turning Point provide in terms of care and services. They also make sure that any new admission is done with a lot of care, good assessment and planned visits. We saw examples of very good care planning in place. People in the service could tell us about the high level of input they had into these plans. • “I have a copy of my plan in my room to read any time I want. I discuss it with my link worker if it needs changed...doesn’t need much and we do it together.” DS0000022544.V378025.R01.S.doc Version 5.3 Page 6 10a Coates Lane We judged that the plans that support people through any reoccurrence of their mental health problems were extremely detailed. We also judged that staff monitor and record any difficulties appropriately. The service makes sure that people’s wishes and needs are taken into consideration and that any risks are assessed and managed. • “the staff help me so that I get advice if I feel anxious about having to deal with things...I have found this hard in the past but there is always someone there to help me...often its the manager who helps me if I feel things might be risky...”. People are helped to make informed decisions and are given support to work through any life planning they want to do. They have a range of individual and group activities in place. Some people go to further education classes or attend college; they participate in recreational activities in the community. Some people attend church or are involved in specific clubs. The staff also help arrange individual and group activities in the home. There are trips and parties and entertainments on offer. People go on holiday and visit friends. They are encouraged to maintain former relationships and to make new friendships. The people who live in Coates lane make good use of all the amenities of this town. • “I like being central to everything and I know a lot of people and there are things to do...” The home provides good quality meals and snacks and people help with cooking and menu planning. They make their own drinks and snacks as they wish. • “The food is fine and we plan our meals and do bits of shopping and cooking together.” On the day we were told by residents that they were happy with the support they were given with personal care. They are helped to access health care professionals. There was lots of evidence to show that the staff help people to get treatment and they make sure ill health is prevented where possible. People have access to psychiatric services and their mental health care needs are under constant review. Staff are very good at promoting emotional and psychological well being. We saw evidence on the day of staff working in an empathic way and looking at all sorts of support that can be found for people. • “Karen and the staff know me...know my mental and physical health problems and they step in if I am unwell and need to see the psychiatrist or the nurse. It makes me feel safe...” 10a Coates Lane DS0000022544.V378025.R01.S.doc Version 5.3 Page 7 Medicines are well managed in the service. We could see that improvements are being made so that people can start to manage more of these for themselves. We judged that care plans about medicines are very well written. The service does not use sedative medicines routinely. Medication is kept under constant review and advice sought from health care professionals. The staff and residents make sure that the environment is kept clean and fresh. People have good sized rooms that they are encouraged to personalise. • “My new room furniture was good quality and I chose it for myself as it suits my lifestyle and my taste. I like to spend time in my own space...” The home is suitably staffed by day and night. All of the staff team work both day and night so they can understand the needs of residents. There is a good mix of staff in terms of training, experience, skills and gender. New staff are recruited with help from residents. People who live in the home are on the interview panel. No one starts with the team until all checks and references have been completed. • “I interviewed for new staff...after all we have to live with the decisions...I was good at interviewing and we made good choices...” All staff have personal development portfolios that tie together training, development, skills and competences. We looked at a number of these and found that staff received individual support that developed them appropriately. There is a detailed training plan for the home and staff can also attend Turning Point training out of the area. • “I find Turning Point training to be really good and we do in-house things too that residents come to.” The home is managed by a suitably qualified and experienced person. Staff and residents trust her ability and judgement. • “Karen is always there for me...helps me stay well...and she makes sure staff do things the way I want.” The home has a quality assurance programme that allows all systems to be checked and gives people who live in the service the chance to comment and be involved in improvement and planning. 10a Coates Lane DS0000022544.V378025.R01.S.doc Version 5.3 Page 8 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. 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. 10a Coates Lane DS0000022544.V378025.R01.S.doc Version 5.3 Page 9 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection 10a Coates Lane DS0000022544.V378025.R01.S.doc Version 5.3 Page 10 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1,2 People using the 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 may wish to use this service are given good information before any admission is considered. EVIDENCE: There is clear and easy to follow information about the work of Turning Point available on their website and in brochures and user guides. 10a Coates lane has good information available that people who live in the home have helped to write. The manager is clear about how any admission will be handled. There have been no admissions in the last year as people are settled in the home. We saw evidence to show that admission is done with a lot of thought and planning. Admission is normally only by a referral from health or social services; the manager does a full assessment of need and then the person comes for trial visits. This makes sure that new people can receive the right kind of care and that any new admission will not impact on the lives of people who have this house as their permanent home. 10a Coates Lane DS0000022544.V378025.R01.S.doc Version 5.3 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9 People using the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are very good systems in place that allow people in this home to have their needs and wishes met in a planned and considered way that allows choice and fulfilment. EVIDENCE: We spoke to all of the people in the home on the day. They were aware of the content of their care plans and told us that staff spent a lot of time with them developing plans about their health, personal care needs and lifestyle choices. We read a number of these plans. The home uses a planning system called ‘Recovery Star’. This helps people get the right kind of support to help them maintain good levels of mental health and also looks at the whole person. We read a number of extremely detailed plans. Some files had ‘workbooks’ that people had done with staff to help them reach targets they had set or to 10a Coates Lane DS0000022544.V378025.R01.S.doc Version 5.3 Page 12 help minimise symptoms of mental distress. Some of these used pictures to help people work through what they wanted to do. There were very good contingency plans in place to help when things were not going well for individuals. There were specific instructions for staff so that everyone approached difficulties in the same way. There were care plans that worked with peoples’ strengths and aspirations. We could see that these plans helped people to be as well and as fulfilled as possible. The plans were easy to follow, yet very detailed. They were regularly reviewed and daily notes informed the progress of the planning. The plans and the minutes of residents meetings and individual reviews showed that people who live in this service are supported to make their own decisions. People have the right to make their own decisions even when staff may not be sure this is the way forward. A lot of attention is paid to this and when a person decides to do something that might be risky there are suitable risk management plans in place. We saw a number of examples where people had improved their lives through being able to make decisions that in the past they would not have been supported in. Each plan also included risk assessments and risk management plans. These allow people to be as independent as possible given their needs. The risk assessments were regularly reviewed and updated. They outlined the potential risks if a person were to have a problem related to their mental health. 10a Coates Lane DS0000022544.V378025.R01.S.doc Version 5.3 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): This is what people staying in this care home experience: 12,13,15,16,17 People using the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals who live in this service are helped to have as fulfilling a life as possible by being encouraged in group, individual and community activities. EVIDENCE: On the day of our visit an older person went out to a lunch club and another person went to a club for people with mental health needs. We learned from residents that each of them had their own chosen activities and hobbies. One person attends a local college. Some people choose to be involved with church activities. There is information available about leisure and cultural activities in the local community and we saw in the records that people went to a variety of these. Some people had gone to yoga or relaxation classes. Individuals went to different concerts or other local entertainments. 10a Coates Lane DS0000022544.V378025.R01.S.doc Version 5.3 Page 14 Most of the residents make use of the amenities of the town and go out alone to shop or have coffee. They told us about all the opportunities they took to participate in local events. They have been involved in local groups who are reviewing and planning mental health services in the area. People also go out alone by public transport to other parts of the county. We learned about day outings with staff. One person had been to a number of concerts in different parts of the country because she is interested in music. The staff in the service also arrange activities and outings for the whole group. These include trips out for meals or drinks and also discussion groups. People told us about healthy eating groups they had participated in. They told us they enjoyed learning and discussing things together. There are also some leisure group activities that staff arrange. For example they organise ‘walking groups’ where people can go out together. People in the service enjoy holidays away from the home. One or two people had stayed in this country but others had been to Spain and France and one person was planning a trip to America. Some people in the home had never had a passport before and told us how much this had changed their outlook. People in the service can receive visitors at any time and relatives and friends are invited to social events in the home. We had evidence to show that people can develop or maintain relationships of a personal nature. Each person in the home is aware that they have their right to privacy and dignity but they also realise that they need to respect each other. Everyone who comes to this service signs a ‘license’ agreement’. These inform people of their responsibilities. It is expected that people respect others beliefs and culture and that each individual takes participates in shared responsibilities for the home. People are supported to manage their own daily living tasks where possible. We were asked to share lunch with residents. They were happy with the food provided and told us they helped plan menus. We judged that good quality foods are bought for the home and that staff and residents prepare meals well. The meals contain a good range of fresh fruit and vegetable and main meals contain good quality meat and fish. We looked at care plans for one or two people who find getting the right levels of nutrients a problem. Care plans did contain instruction and suggestions about this. We judged that there was some room for improvement where people were reluctant to eat and we suggested that the manager help her staff access information about nutritional planning for people who have this problem. 10a Coates Lane DS0000022544.V378025.R01.S.doc Version 5.3 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20 People using the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People in this service are helped to have the best physical and mental health care possible so that they can stay well. EVIDENCE: The people who live in Coates Lane told us they were helped only when they requested through care planning or when they needed assistance. This means that individuals get the right level of personal care support. We could see in care plans that for some people the support is more about encouragement than actual intervention. Some people do need some help at times and they told us this was done discretely. People in the service are asked about how they want this done and can chose whether they have a male or female staff member to help them. We saw in files and on the day that people are helped and encouraged to visit doctors or dentists for both treatment and preventative care. One person told us about a health problem and how he visits the nurse. His care plan included 10a Coates Lane DS0000022544.V378025.R01.S.doc Version 5.3 Page 16 things like nutrition and exercise advice. People are helped with physical change and normal ageing processes. They were able to talk about these things and they are reflected in their files. A great deal of the support staff give in this service is psychological and emotional because of past or present mental health needs. Again the files gave good direction to staff about how to do this and we saw very genuine empathy for people and their anxieties, hopes and fears. People told us they got very good support from management and staff and from outside professionals. All these things help people with their well being. Some of the groupwork offered also helps people to talk through these issues in a therapeutic way. We checked on the systems in place for managing medication. We found that the ordering, storage, administration and disposal of drugs ensured that medication was safely and appropriately administered. We judged that the care plans about medication were very thorough. This is important as staff have to deal with people who may, due to their mental health problems, find taking medicines problematic or who may need urgent changes to medicine. We saw that they consulted psychiatrists, G.Ps and specialist nurses and also spent a lot of time with individuals. The action to be taken when changes are needed or when ‘as required’ medicines are called for is written up in a balanced and clear way so that the person and the staff involved are fully aware of what needs to be done. We were also pleased to learn from residents that steps are being taken to help people to manage their own medicines where possible. People do take medicines to keep mental ill health at bay but sedatives are not routinely used in this service. 10a Coates Lane DS0000022544.V378025.R01.S.doc Version 5.3 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 People using the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People in this home are listened to and their concerns and complaints dealt with appropriately so that they know they are valued and protected. EVIDENCE: The people who live in the home were very open with us and able to talk frankly about their experiences of living there. They said they were encouraged to do this by management and staff. We could tell by talking to them that they were comfortable about praising the care given and talking about what they wanted from the service and about things they wanted changed. No one had any major concerns or complaints on the day. The manager keeps a log of any complaint however small and records how this is dealt with. The company keep a watching brief on this. There had been some day to day concerns but these had been dealt with straight away. Residents were satisfied with the responses the manager gave them. We also saw that some things get changed when the group bring them to management through their ‘house group’. We learnt from staff that they were to have their training on adult safeguarding updated the next day. The manager has attended a number of courses on this and she cascades this training to her staff group. Staff were very knowledgeable about what was abusive and explained how they 10a Coates Lane DS0000022544.V378025.R01.S.doc Version 5.3 Page 18 monitored risk with residents. Management understood their responsibilities in reporting any safeguarding. The people who live in the home told us they were not concerned about anything happening in the home. They told us they would speak up if anyone was being abused. They also have access to an advocate who would speak on their behalf. One or two people also explained that they were made aware of external risks and they were advised by staff how to keep themselves safe. Care plans reflect this and both the manager and the company take safeguarding of people seriously. There are good policies and procedures for staff and residents to follow. There have been no allegations made of this nature for some years. 10a Coates Lane DS0000022544.V378025.R01.S.doc Version 5.3 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 24,30 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. This house meets people’s needs as it is homely and comfortable and is located in the centre of town giving them a lot of freedom and security. EVIDENCE: 10a Coates Lane is a listed Georgian building in the centre of town. Parking in the area is restricted but the home is easily accessible by public transport. The disabled access is limited due to the restrictions because of its’ listed status. The company are clear about these in its description of the facilities. The accommodation is on two floors and has its own enclosed garden. The front of the home is directly on the street. There are suitable security measures in place. The home does not have a passenger lift and there is no call bell system. The management is clear about levels of physical dependency they can cater for. 10a Coates Lane DS0000022544.V378025.R01.S.doc Version 5.3 Page 20 People who come to live in the home must have a certain degree of physical ability. The manager takes this into consideration when assessing new people. There is a pleasant kitchen and dining area that leads into the walled rear garden. People told us they had enjoyed growing their own vegetables during the summer and often use this area for barbeques and parties in fine weather. The home also has a large sitting room where people enjoy spending time together or where they watch TV, listen to music or get involved in group work or activities. Each person has their own bedroom. Some of these single rooms are above the minimum size. None of them have ensuite toilet facilities but each room has its own wash hand basin. There are two bathrooms and two shower rooms, adequate toilets and a laundry room. All these areas are down for refurbishment in the next few years. Every bedroom has been redecorated and new bedroom furniture bought. People told us they had chosen their own colour schemes and each room reflects personal taste and preference. Rooms also have comfortable chairs or sofas and people have their own TVs, radios and up to date electronic equipment for listening to music. This house had serious problems with dampness in the past. In the last year a major renovation of the property has taken place. This has included repairs to the roof and the rendering, internal plastering and full redecoration. The external fire escape has been renovated. There were still two small areas of discoloration on plaster but these are not in residents’ rooms. The manager said this was being monitored as it was thought to only be residual dampness from previous penetrating dampness. The company will continue to keep a close eye on this and report it to the company who own and manage the building. On the day of the visit the home was clean and fresh; shared areas were decorated and furnished in a restful and tasteful way. People told us that the building work had been worth the inconvenience and the house is now a pleasant place to live. There were good systems in place for monitoring cleaning systems and staff and residents alike were fully aware of how to manage infection control. 10a Coates Lane DS0000022544.V378025.R01.S.doc Version 5.3 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 32,34,35 People using the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. This home is staffed by a suitably skilled and highly motivated staff team who know that their manager strives to help them develop as much as possible so that people get the best standards of care. EVIDENCE: We saw copies of the rostered hours for this home. Staff work three types of shift in this home, two by day and one waking night shift. Every person apart from the management team work these shifts in rotation. Management may work some of these hours and someone is always on call for back up. Residents told us there was always enough staff on duty to give them plenty of attention. We judged that staffing levels are good and that the numbers of staff on each shift ensures that care and services are provided at the right level. There was a good mix of gender, skills and experience on each shift. 10a Coates Lane DS0000022544.V378025.R01.S.doc Version 5.3 Page 22 We looked at staff personal development files and we checked on some recent recruitment. We also looked at the record of training given and the new training plan. We checked on records of staff supervision, training and development. We found that new people are only taken on after they have been interviewed by management and residents. They then have background and suitability checks completed. No one has access to residents or any information about the service until the manager is sure they have a suitable character and criminal and work records have been checked. New staff are then put on their own individual personal development programme. This starts with induction that includes training on the needs of people with mental health problems. New starters are informed of the philosophy of the company and the aims and objectives of the home. A manager mentors the new person and they receive supervision and coaching. They are only left alone after all of this has been completed. We saw records of supervision where all staff are helped to identify their ongoing strengths, needs and wishes. The files showed how training, supervision and co-working was undertaken so that each person could fulfil their job role and their potential. We judged that these personal development files exceed the standard we expect and show how all the elements of staff development in this service are planned and carried out. We saw evidence to show that this approach has led to an ever improving picture of care delivery. All staff attend core training that covers wide ranging subjects. These include health and safety, confidentiality, equality and diversity, safeguarding and specific needs of individuals. We observed a fairly new member of staff and saw by her practice and by talking to her that she had a good understanding of her role, the needs of the residents and of relevant legislation. We judged that there is a very good programme of appraisal and development in the home and staff told us they were happy with their personal development. Workers at all levels are encouraged to complete National Vocational Qualifications at levels 2, 3 and 4. Turning Point gives staff the opportunity to join in corporate training and to access external training, attend conferences and gain other qualifications that will help in their job roles. There were two areas that we discuss below where we want the manager to review training and development arrangements and to ensure there are competence checks in place. 10a Coates Lane DS0000022544.V378025.R01.S.doc Version 5.3 Page 23 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 37,39,42 People using the 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 management systems in this home run well ensuring people can live a stress free life knowing the team are functioning well. EVIDENCE: The manager of this service has been in post for a number of years. She is suitably qualified and experience to manage a care home for people with mental health needs. She continues to update her knowledge and skills and has just completed an advanced certificate in managing social care services. Residents and staff were very satisfied with the way she managed the home and told us of the respect and trust they had in her ability. 10a Coates Lane DS0000022544.V378025.R01.S.doc Version 5.3 Page 24 Turning Point has an established quality management system that covers all of their services. We could see from talking to staff, checking records and cross referencing that this home works within this total quality management system. People who use this service are at the heart of this. For example we judged that it is very good practice that the residents’ representative attends every staff meeting and that residents help recruit new staff. They are encouraged to comment on quality and have access to different avenues to voice their opinions. They inform the change programmes set up in the service and have sat on consultative groups. They are also involved in wider groups that comment on the quality of mental health services in Cumbria and beyond. The home had an external audit of quality completed by the company earlier in the year and they continue to make improvements based on this and on residents’ opinions. Together these things form ongoing business development. When we visited the service in 2008 we asked that the provider made sure that everyone had received training in how to move and handle objects and people. The service currently has no one who needs this kind of help on a daily basis. We saw that staff had received training in this but that they had not had the opportunity to put this into practice and their competence in these skills has not been assessed. We judged that this was not a pressing issue but we asked the manager to make sure she had plans in place to meet any new needs that might arise so that staff would feel confident and competent enough to deal with manual handling matters if they arose. We made a good practice recommendation about this on the day. We also checked on the fire safety arrangements in the home as this too had been an issue at our last visit. We saw that every person had received fire training and that good risk management plans had been in place during the recent building work. The manager was in the process of updating the fire management plan and other working documents and sent us copies of these shortly after the visit. We could see that systems are regularly checked and that instructions and drills are carried out. Both staff and residents are given instructions on what to do if there is a fire. We saw from the records that these drills and instructions are not being planned on a regular basis and recording is not specific enough. We made a recommendation that drills and instructions are managed in a more formal way so that all staff feel confident and are competent in managing a fire situation. Other matters of health, safety and maintenance were being managed correctly. Staff were confident in things like infection control and food safety. We were pleased to see that residents were advised and informed of their role in things like this. Sometimes this training has been for staff and residents alike. This approach shows that the management believe that people in a care 10a Coates Lane DS0000022544.V378025.R01.S.doc Version 5.3 Page 25 service have both rights and responsibilities. It allows people to ‘own’ their service and participate in day to day matters and in future planning. 10a Coates Lane DS0000022544.V378025.R01.S.doc Version 5.3 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 4 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 4 23 4 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 4 35 4 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 4 X 4 X LIFESTYLES Standard No Score 11 X 12 3 13 4 14 4 15 3 16 4 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 4 3 X 3 X 4 X X 2 X Version 5.3 Page 27 10a Coates Lane DS0000022544.V378025.R01.S.doc Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA17 Good Practice Recommendations It is recommended that the home continue to develop nutritional planning for people who need with their dietary needs. It is recommended that the manager keep under review any potential need for staff to undertake manual handling of people. It is recommended that improvements are made to the systems used to check that fire instruction is completed in a timely manner and with the frequency suggested by fire risk assessment. 2. 3. YA42 YA42 10a Coates Lane DS0000022544.V378025.R01.S.doc Version 5.3 Page 28 Care Quality Commission Care Quality Commission North West Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries.northwest@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) 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. 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