Care Home: 17 Ella Bank Road

What the care home does well The care home finds out what people need and write this down. Staff read these reports so that they can help people to keep healthy and as active as possible.People were helped to have interesting lives. Staff gave them individual attention and they were treated with respect.The home`s policies and procedures kept people safe. Policies are rules about how to do things. Procedures tell people how to follow the rules.People were living in a comfortable, homely and safe environment.Staff have training so they understand how to meet people`s needs.The care home was well managed. People were safe and their rights were recognised. What has improved since the last inspection? There were new practices and procedures for the safe use of medicines.More staff had received fire safety training. What the care home could do better: All staff must have fire safety training at least once a year, and twice a year when working at night. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: 17 Ella Bank Road 17 Ella Bank Road Heanor Derbyshire DE75 7HF two star good service The quality rating for this care home is: 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: Tony Barker Date: 1 6 0 6 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area Outcome area (for example: Choice of home) These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to:  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. 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. Internet address www.cqc.org.uk Information about the care home Name of care home: Address: 17 Ella Bank Road 17 Ella Bank Road Heanor Derbyshire DE75 7HF (01773)760806 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : maureen.foster@unitedresponse.org.uk United Response care home 3 Number of places (if applicable): Under 65 Over 65 3 0 learning disability Additional conditions: The registered persons 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 are within the following category: Learning disability - Code LD. The maximum number of service users who can be accommodated is 3. Date of last inspection 0 8 0 5 2 0 0 8 A bit about the care home 17 Ella Bank Road is a detached house situated on a residential road on the outskirts of Heanor. The people living here are provided with adequate accommodation and single rooms. There is a rear garden. Ella Bank Road offers personal and social care to people with a severe learning disability with associated conditions that may include autism, sensory disability or challenging behaviour. Activities are planned to meet individual needs. Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home How we did our inspection: This is what the inspector did when they were at the care home The inspector visited at short notice. The last key inspection at this care home was on 8th May 2008. We had asked the Acting Manager to complete a questionnaire about the home, before this inspection. We had asked other people to tell us what they think about the home. Four people sent us their views. We looked at what staff had written about one persons life. We also looked around the care home and at two bedrooms. The people who live in the care home were not able to talk to us as they had high levels of dependency. But we saw how staff treated people and we spoke to the Acting Manager and staff. The weekly fees at the time of this Inspection were from £1172 to £1471 What the care home does well The care home finds out what people need and write this down. Staff read these reports so that they can help people to keep healthy and as active as possible. People were helped to have interesting lives. Staff gave them individual attention and they were treated with respect. The homes policies and procedures kept people safe. Policies are rules about how to do things. Procedures tell people how to follow the rules. People were living in a comfortable, homely and safe environment. Staff have training so they understand how to meet peoples needs. The care home was well managed. People were safe and their rights were recognised. What has got better from the last inspection There were new practices and procedures for the safe use of medicines. More staff had received fire safety training. What the care home could do better If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Tony Barker CQC Citygate Gallowgate Newcastle Upon Tyne NE1 4PA Tel: 0300 061 6161 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 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 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 . Individual written needs assessments were in place before people were admitted to the Service so that their diverse needs were identified and planned for. Evidence: All the people had lived at this Service for a number of years. An assessment of their needs had been made prior to their admission, as confirmed by examination of care records at a previous inspection. 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 use the Service had comprehensive and individual plans of care which demonstrated that their health, personal and social care needs were being met and they were enabled to make decisions about their lives. Evidence: The care plan of the person case tracked was examined. It was well worded, holistic and person centred. It had been reviewed on a six-monthly basis but the only recorded evidence was by change of date. However, through the recent introduction of Active Support sheets an active reviewing process had been put in place. These sheets gave a helpful breakdown of staff tasks based on a range of peoples independence skills and were a valuable guide to staff, ensuring that peoples needs were being met. These new sheets, on the file examined, were not dated or signed to ensure accountability and aid the monitoring process. A monthly summary sheet for May 2009 was also examined. The Acting Manager said he was introducing daily diaries to form the basis of the monthly reviews. We see this as evidence of the Service moving towards a more proactive approach to residential care. Annual reviews of peoples care plans were taking place at person-centred review meetings. These were being facilitated by another United Response manager who would take an independent role. Notes from the last review meeting relating to the case tracked person were comprehensive and person centred with appropriate use of photographs. There was a helpful Action Plan. These processes ensure that regular, independent monitoring of the needs, and preferences, of people living at the Service, is taking place which fully involves the people themselves. Information supplied by the Acting Manager before the inspection stated that, We are Evidence: starting to use a Decision Making Profile to help enable people to make choices. These forms were examined and they described how to support people to make a decision. The senior support worker we spoke with gave examples of people making decisions and choices. These showed that new opportunities being provided by staff were enabling people to request new activities such as, for the case tracked person, a request to go swimming. There was a good range of comprehensive recorded risk assessments. These showed that the Service was aware of potential risks to which people were exposed and indicated ways of managing these risks. However, they did not reflect elements of risk for the case tracked person while out in the community. For instance, the person was said by staff to love talking to strangers and there were also road safety issues, though staff always accompanied the service user when out. There was also evidence that risk assessments were not being actively reviewed and we discussed this with the Acting Manager. The senior support worker we spoke with showed an understanding of the concept, and use, of responsible risk taking in order to increase peoples independence. She gave us examples. The Acting Manager provided us with evidence that the Service has been considering less restrictive ways of people being safe. For instance, the dining room door is no longer locked to restrict access to the kitchen, as other ways have been found to address the risk of one person indiscriminately drinking from the kitchen tap. 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 . The Service provided activities and services that were age-appropriate and valued by the people who live here, and promoted their independence. Evidence: Two of the people living at the Service were being provided with four days a week day service at a Derbyshire County Council establishment and the third was receiving a similar day service three days a week. On other week-days, people were being supported by support workers from the Service, with a view to increasing involvement in the local community. The senior support worker we spoke with was able to provide evidence of people being involved in valued and fulfilling activities. This evidence included the case tracked persons love of shopping and having a meal at MacDonalds. We were able to confirm the persons enjoyment on the day of this inspection, when they returned with staff after choosing a toy mobile phone - a purchase eagerly anticipated and, later, proudly displayed. Information supplied by the Acting Manager before the inspection included, I have identified with the staff team that one of the best ways to communicate new opportunities to people is to go out and try new things with them and record and learn from these experiences. We examined Learning Logs that reflected these new opportunities and should feed into the care planning review process. The senior support worker we spoke with gave examples showing that people living at the Service had a positive involvement in the local community. This included the case tracked persons introduction to a disco. Evidence: There was generally good contact between the people living at the Service and their relatives. Two people have a befriender too who had been a staff member at a previous care home and takes the people out for meals as well as attending care plan review meetings as an advocate, to ensure their views are fully taken account of. The senior support worker confirmed that routines, at the Service, are flexible to meet peoples individual needs and circumstances. She said, No two days are the same...based on the ladies needs. A new photo board was displayed in the hall showing photographs of the staff on shift. This was particularly useful to the case tracked person who tended to regularly ask about who was on duty. It was clear to us that routines at the Service promote peoples independence. All people were involved in food shopping, preparation and clearing the table after mealtimes. The Services three-week rolling menu indicated that people were being provided with a varied and nutritious diet. The Acting Manager spoke of plans to put pictures to this menu so provided people with a more easily recognisable pictorial menu. We saw some photographs that would start this process. Peoples food preferences were recorded on file. Food stocks were found to be at a satisfactory level and included fresh vegetables. We observed the evening meal and this was a relaxed occasion. 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 Service was providing people with personal support in the way they preferred and required and was meeting their physical, emotional and health needs. Evidence: At this Inspection we observed positive interaction between staff and the people living here. There was evidence of equipment in place that maximised peoples independence. For instance, handrails were in place in front of the premises and these had been painted so they looked less institutional. Information supplied by the Acting Manager before the inspection referred to several items have been purchased to maximise participation in preparing meals. At the inspection we saw two simple chopping machines that provided a safe means of chopping food. From observation and discussion with the Acting Manager it was clear that peoples communication needs had been assessed and, wherever possible, were being met. For example, the case tracked persons Communication Chart acted as a translation of the persons behaviour into what staff believe the person is trying to communicate. There were also photographs in this persons file showing the person actively enjoying certain activities. Peoples likes and dislikes were recorded on file. There was evidence of the Service considering the Mental Capacity Act (MCA)/Deprivation of Liberty Safeguards legislation and looking responsibly at each persons mental capacity to make decisions. The Acting Manager said the Service had made no applications for assessments under the MCA, though he had plans to consider this. He added that he and the Senior Support Worker with Additional Responsibility had attended MCA training two months ago and planned to cascade this to his team. Care plans provided evidence of each persons health care needs being met. There was evidence on the case tracked persons records of involvement of a range of external health professionals. Small format ring files called My Health File were in place for Evidence: each person living at the Service. These were worded in a person centred way although they were not always being used appropriately or consistently to record health appointments. Report/Feedback sheets were being completed following all health appointments. However, there was no record of any follow-up to a Report/Feedback sheet that referred to a scan being considered in order to determine whether one person had gall stones. Staff later confirmed the matter had been sorted. Report/Feedback sheets were not in date order which made it difficult for the Service to monitor peoples health needs. All three people who live at the Service need help with managing their continence. However, there was no record of how the Service provides people with this help. The Medication Administration Record (MAR) sheet, of the case tracked person, was examined and record keeping was satisfactory. The sheet was checked against the persons prescribed blister-packed medication and no errors were found. Attached to the MAR sheets was a record of staff signatures/initials, to ensure that signatures can be cross-referenced against staff names. The system of administering prn (as and when required) medicines was safer than that found at the last inspection. A written procedure for their use was now in place and clear Protocol sheets had been written so as to ensure that people were receiving medication appropriate to their needs. Medicines were securely stored and the date of opening of creams was being recorded, to ensure they were safe to use. No controlled drugs were prescribed. Most staff had received training in the safe use of medicines within the past two years. 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 . Good procedures for handling complaints and abuse were in place ensuring that people were fully protected. Evidence: The Services complaints procedure was displayed in the entrance hall. It was satisfactory and included some symbols to help with peoples understanding. It had been updated as recommended at the last inspection. The Acting Manager stated that there had been no complaints received by the Service up to the date of this inspection. An appropriate complaints record form was available for such use. The Acting Manager said that as the people living here are unable to voice a complaint he, with colleagues, is developing a Support Plan to guide staff in observing how people express unhappiness. The Service had a written policy and procedure on prevention of abuse linked to the statutory procedures and prepared by United Response. The senior support worker spoken with showed good awareness of these procedures and the Services whistle blowing policy. She felt that the people living here, and staff, were safe and she felt confident in managing any challenging behaviour exhibited by people. Most staff had been provided with training, on the subject of Safeguarding Adults, within the past three years - though one staff member last received this training in September 2004. 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 were living in a comfortable, homely and safe environment. Evidence: The Services environment was homely and well furnished and decorated. The case tracked persons bedroom was viewed and was found to be well personalised and attractively decorated. There was no toilet roll in the first floor toilet. The Acting Manager explained that rolls are dropped down the toilet bowl. The pre-inspection questionnaire refers to plans to, change the old sleep-in room to a personal space room. The Acting Manager explained that sensory materials would be provided in this room. He also spoke of plans to erect a conservatory on the rear of the premises. Both these sets of plans address concerns expressed by staff in their completed preinspection surveys - where they spoke of the need for more space for the people living here. They also referred to a significant slope to the back garden, limiting its usability. From the tour of the premises there was evidence of good standards of cleanliness and hygiene throughout, with no unpleasant odours. The senior support worker spoken with described good practice regarding the transportation of soiled articles of clothing and bedding within the premises. The questionnaire completed by the Acting Manager referred to all the staff having completed Infection Control training. Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The Service had a group of generally well trained staff to ensure that people living here were safe and their needs were met. Evidence: Six of the eight care staff had achieved a National Vocational Qualification (NVQ) in Care to level 2 or above. This meets the National Minimum Standard to maintain a staff group with at least 50 qualified staff. Of this six, two had an NVQ level 3 in Care and an additional one had an NVQ level 4 qualification. Several staff made reference, in their completed pre-inspection surveys, to there being need for, more staff to provide more individual attention to the people who live here. The Acting Manager said that there are mostly two staff on duty during waking hours and we noted that staffing rotas supported this. He did say that there had been occasions in recent days when just one staff member had been on duty - due to annual leave and unplanned sickness and sudden urgent family leave. He said that staff would prefer more than two staff on duty. The Acting Manager spoke about the Service having held a 21-hour vacancy for some time and continual efforts were being made to recruit to this post, as well as, building up a pool of relief staff. Staffing rotas showed that staff are no longer working the excessive hours that was found at the last inspection. There had been no staff appointed since the last inspection and so it was not possible to confirm, on this occasion, whether United Response was following the recruitment practices required by current Regulations. Training records confirmed that most staff had been provided with all mandatory training. The number of staff who had received fire safety training had improved since the last inspection although there were still two staff who had not been provided with this training since January 2006. Evidence: The Acting Manager said that he was moving towards achieving a frequency of six supervision sessions a year and the staff supervision chart supported this. The senior support worker told us that the Acting Manager now schedules one-to-one staff supervision sessions on the staffing rota. Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The Service was well managed so that people living here were protected and their best interests were promoted by the systems in place. Evidence: The Acting Manager started managing this Service in October 2008. He told us he had completed an application form to become the Registered Manager of the Service and was due to send this to the Commission during the week of this inspection. Monthly independent audit visits to the Service, on behalf of the Registered Provider, as required by Regulation 26, were taking place. An additional quarterly management audit was also being undertaken and a Service Plan for 2009/10 had been drafted. These quality assurance measures indicated that due attention was being given to systematic Service reviews. Quality assurance questionnaires were being sent to staff, relatives and external professionals, for their views on the quality of service provided. One relative and one care manager had recently completed and returned a questionnaire and these were positive. The Acting Manager said that team meetings are held every three weeks and these are used to share United Responses values and discuss what the people living here can achieve. Good food hygiene practices were noted including the regular daily recording of refrigerator and freezer temperatures. The Environmental Health Officer inspected the Service in March 2009 and found matters to be satisfactory. Cleaning materials were being safely stored in the laundry. Records, completed by the Acting Manager, indicated that equipment at the Service was being maintained and good Health and Safety practices followed. Fire alarm tests were carried out weekly and fire drills were held monthly. No Health and Safety hazards were found at this inspection. Are there any outstanding requirements from the last inspection? Yes  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 Requirements and recommendations from this inspection Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No Standard Regulation Description Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set No Standard Regulation Description Timescale for action 1 35 23 23(4)(d) All staff must be 01/09/2009 provided with Fire Safety training at least once a year, and twice yearly when undertaking night care shifts. This will ensure staff awareness of how to prevent fires and keep people safe. 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 2 3 4 5 6 9 9 19 19 Care planning documents should all be dated and signed. Risk assessments should reflect all potential risks to which people may be exposed. Risk assessments should be actively reviewed. There should be a record of how the Service provides people with help to manage their continence. Records should clearly show how health issues are being monitored and followed up, and should be filed so as to promote this monitoring. 6 7 8 19 24 33 Health appointments should be recorded consistently. Continue to consider ways of managing people’s personal hygiene in the first floor toilet. Ensure that, wherever possible, relief staff are available to meet the contingencies resulting from sudden staff illness. 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. 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