Care Home: 19 Stone Lane

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What the care home does well People are receiving good care and being enabled to be as independent as possible.People are receiving support with doing things they enjoy.A consistent level of care is being provided by staff who receive appropriate training and support, and the home is well managed.There is a homely and relaxed atmosphere which people benefit from. What has improved since the last inspection? Each person has activities planned and provided for them which reflect their personal aims and interests.Care plans are becoming more detailed and show better how the person wishes their care to be provided.Improvements to the premises have included the purchase of new garden furniture, the painting of external areas and the purchase of two new beds.The service continues to listen to suggestions for improvement, for example with the purchase of a games console and a trampoline, and providing people with an opportunity to attend a sports club. What the care home could do better: No requirements were made at this visit. Key inspection report Care homes for adults (18-65 years) Name: Address: 19 Stone Lane 19 Stone Lane Worthing West Sussex BN13 2BA two star good service The quality rating for this care home is: 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: Edward McLeod Date: 2 2 0 9 2 0 0 9 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. The first part of the review gives the overall quality rating for the care home:  3 stars – excellent  2 stars – good  1 star – adequate  0 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. 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 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 Information about the care home Name of care home: Address: 19 Stone Lane 19 Stone Lane Worthing West Sussex BN13 2BA 01903693453 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Sutton Court Nursing Home Ltd Name of registered manager (if applicable) Mrs Carol Susan Williams Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 6 0 care home 6 learning disability Additional conditions: The maximum number of service users to be accommodated is 6. The registered person may provide the following category/ies 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 A bit about the care home 19 Stone Lane is a care home registered to provide personal care for up to six people who have learning disabilities (LD). The home is in a converted house on the outskirts of Worthing. Local shops are close by and there is access to public transport. Accommodation is provided on two floors. All rooms are single occupancy. One room has an ensuite facility. The service is privately owned and the registered provider is Sutton Court Nursing Home Ltd. The registered manager is Mrs Carol Williams and the responsible person for the provider is Mr Neil Ramdin. The fees range from 1000 to 1400 pounds per week. 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 visit was arranged to update our assessments of the homes compliance with the Key National Minimum Standards for Care Homes for Adults 18-65 and the Care Homes Regulations 2001. The visit took place on the 22nd September 2009 and lasted from 1.30 p.m. until 4 p.m. In preparing for this visit we looked at all the information that we had received or asked for since the last key inspection and this included the annual quality assurance assessment (AQAA) that was sent to us by the service. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. The AQAA was received by the due date and included the information we asked for. We also took into account what the service has told us about things that have happened in the service, what other people have told us about the service and relevant information from other organisations. Some of the information received before our visit has been included in this report. During our visit we spoke with a member of staff, the responsible individual, a family member and the manager. We also met four people living in the home. Records and policies and procedures we sampled during our visit included the pre admission assessments for two people living in the home, the care plans for two people living in the home, recruitment records for two members of staff and training records for two members of staff and manager. Records including health and safety, complaints and medication were also sampled. We observed interactions between staff and people living in the home, and sat in during a staff handover meeting. What the care home does well People are receiving good care and being enabled to be as independent as possible. People are receiving support with doing things they enjoy. A consistent level of care is being provided by staff who receive appropriate training and support, and the home is well managed. There is a homely and relaxed atmosphere which people benefit from. What has got better from the last inspection Each person has activities planned and provided for them which reflect their personal aims and interests. Care plans are becoming more detailed and show better how the person wishes their care to be provided. Improvements to the premises have included the purchase of new garden furniture, the painting of external areas and the purchase of two new beds. The service continues to listen to suggestions for improvement, for example with the purchase of a games console and a trampoline, and providing people with an opportunity to attend a sports club. 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 Edward McLeod, Care Quality Commission South East Region, Citygate, Gallowgate, Newcastle upon Tyne NE1 4PA. 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 http:/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. 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. Evidence: We sampled two sets of care plans and found that assessments of needs had been carried out before admission was agreed. The AQAA tells us that all people living in the home have a copy of the agreement between the service and the funding authority which specifies the arrangements made. 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. Peoples 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. Evidence: The AQAA tells us that care plans and risk assessments are updated and reviewed every 3 months with the involvement of the person receiving the care. We looked at the care plans for two people receiving care. We found the care plans to be very detailed and provide good guidance on how the person wishes their care to provided and how their needs are to be met. We found that care plans are recorded in a concise and jargon-free way that are easy to read and understand. Staff we spoke to told us that guidance on how the person communicates had been drawn up with family members to ensure that an in-depth understanding of the persons ability to communicate was achieved. We noted during our visit that staff refer to the guidelines for meeting the persons needs regularly, particularly when there is a change to the care plan or the needs are particularly complex. Evidence: On the day of our visit a member of family was attending a care plan review. The relative told us that staff are very caring, provide excellent care and have good knowledge of the people they are working with. We observed interactions between staff and people receiving a service, and observed that staff are very able at providing information and support to encourage people to be making individual choices and decisions. The manager Mrs Williams discussed with us how people are supported to manage and take responsibility for their money as far as possible - for example having a bank card and drawing out their money. A relative we spoke to said that staff change care arrangements to meet the needs of the individual and are always prepared to try new things - for example by providing a trampoline for one person who liked trampolining and making reflexology massage available. We are told in the AQAA that staff attend training on equality and diversity issues such as choice, rights, inclusion and independence. 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. Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, 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 their personal interests and activities. Evidence: At our visit we found that people are supported to increase their skills and to participate in a range of activities. We looked at the activities plan for one person which indicated they have the opportunity to do the things they are interested in and enjoy, and spend time with their peers. People had photographs of them on holidays and participating in activities, and some people had obtained certificates for college courses they had completed. During our visit one person was being encouraged to read and staff told us that one person who finds it difficult to socialise in the house has been more able to do this since a Wii games console had been purchased and located in the sitting room. We attended a staff handover meeting where it was reported that people that morning had variously attended college, been out shopping, been doing active things in the home, Evidence: or on outings with family. The AQAA tells us that people are going into the local community for shopping, swimming, and horse riding. On the evening of our visit some people were planning to attend a club that offered sports like table tennis and bowling. During our visit we learned that one person attends a local church. The service has purchased Wii games which are helping people to develop their hand and eye coordination. The AQAA tells us that one person has support from staff, family and the local community team to develop the relationship with their fiancee. A member of family we spoke to told us that their relative was now doing so much more, is blooming, and is happy. The member of family said they were always made to feel welcome when visiting. Residents meetings are held monthly. We are told in the AQAA that weekly cooking sessions where people are supported to bake and make simple meals have been introduced. During our visit we found that people are more involved in planning meals and that peoples dietary needs have led to there being more emphasis on healthy eating. People are involved in planning their weekly menus. 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 receive personal support from staff in the way they prefer and want. Their physical and emotional healh 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. Evidence: Care plans we sampled indicated that the persons preferences and wishes are recorded and staff are supporting them in choosing what they wish to do. A member of staff we spoke to told us that one person who had previously needed staff to shower them and wash their hair, now is mostly independent in doing this. Staff told us that the person would ask staff what they should wear, but now makes the choice themselves. Each person has a key worker, and a member of staff we spoke to said that the key worker will, for example, ensure that the person has all the toileteries and clothes they need, and support them in buying presents and cards for family. The AQAA tells us that records are kept of dentist, doctor, optician, chiropodist and other health care visits. We attended a staff handover meeting at which staff were indicating ways in which each persons health issues were being addressed or monitored. A member of staff we spoke to told us about the arrangements in place to monitor the Evidence: risk of one person having seizures, and the plan in place of action to take when a seizure happens. We spoke to a member of family, who told us that staff have dealt with medical conditions consistently and put in place the arrangements to do this. Discussion with the manager Mrs Williams indicated that where there have been concerns about a persons medication this is being discussed with medical staff and reviews of the medication have taken place. We sampled records for the adminstration of medicines, and found that good arrangements are in place to ensure medicines are administered safely. Training records sampled indicated that staff are receiving training in the safe administration of medicines. 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. If people have concerns about 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 home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. Evidence: There is a complaints policy and procedure in place and a copy of this in a format people can understand is provided in the service user guide which each person receives. We looked at the complaints records, and found that where a complaint had been made this was being clearly recorded. The investigation into the complaint, the action taken and the feedback given to the complainant were all clearly recorded, and complaints had been handled within the timescales set out in the policy and procedure. There had been no safeguarding referrals or investigations since our previous visit. Training records sampled indicated that staff are continuing to receive training in safeguarding. Staff we spoke to told us that they receive training in managing difficult situations, and in safeguarding vulnerable adults. We looked at the arrangements in place for holding money for people living in the home where this is needed. Mrs Williams told us that family are also usually involved in supporting people to manage their money but that where people can draw out their own money and make their own purchases this is also supported. We sampled the records kept for holding money for two people, and the records were laid Evidence: out clearly and simply with receipts and balances set out which can be checked against the persons regular bank statements. Mrs Williams told us that internal audits of these arrangements are carried out within the company, and that Mr Ramdin does spot checks of the records. 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 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. Their room feels like their own, it is comfortable and they feel safe when they use it. Evidence: Improvements to the premises since our previous visit have included the purchase of new garden furniture, the painting of some external areas, and the purchase of two new beds. Staff told us that one person had requested a bigger bed so this had been obtained. We sampled the maintenance records in the home which told us that when jobs that need doing are identified these are quickly undertaken and completed. There is a conservatory, a dining room and a sitting room which provide homely and comfortable communal areas for people to use. The AQAA tells us that it is planned to redecorate all bedrooms with people choosing the colour they wish for their room, and during our visit staff told us about one persons choice for a new colour and new decor. Staff told us that a television with freeview was obtained for one person who enjoys television, and that one person had chosen their room colour and duvet covers. There are six bedrooms, one with an en suite wet room. The four bedrooms we visited had been arranged and furnished to meet the needs of the Evidence: person. For example, one person who often prefers to have their meals in their room has a dining table in their room. We asked the responsible individual Mr Ramdin why only one bedroom was provided with a sink. Mr Ramdin advised us that after incidents of flooding and taps left running that for the safety of the people accomodated sinks should be removed in five of the six bedrooms. Communal areas include a bath room, a shower room, and a cloakroom. All areas of the home we visited were found to be clean, uncluttered and free from odours. A relative we spoke to said that she found it homely and comfortable, and that there were never any unpleasant odours. 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. 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. Peoples needs are met and they are supported because staff get the right training, supervision and support they need from managers. Evidence: The AQAA tells us that no temporary (agency) staff had been employed in the home in a twelve month period. Mrs Williams advised that due to the complex needs of people, temporary (agency) staff are not used as this can compromise the continuity of care provided, and where there is a need for more staffing this is usually covered by their own staff. During our visit we found that people who required regular one to one support were receiving this. The staff on duty were able to meet peoples needs, accompany them on outings and carry out activities together. We are told in the AQAA that all staff who have begun work in the home in a twelve month period have had satisfactory pre-employment checks, and that staff beginning work have a full induction training. We sampled recruitment records for two people working on the day of our visit, and found that the required checks and references had been obtained before people had started work. This helps protect the people living in the home. The AQAA tells us that 5 of the 9 care staff have achieved the National Vocational Qualification (NVQ) in care at least at level 2, and the member of staff we talked to Evidence: during our visit said they were presently undertaking NVQ at level 3. We found that staff were undertaking specialist training relevant to the work they do, for example training in epilepsy and autism. Mr Ramdin told us that staff have one day training every 6 weeks, and that particular attention is given to staff receiving training in the particular disabilities of the person they are key worker for. Staff training records we sampled indicated that staff also receive training in mandatory topics such as safeguarding and moving and handling. We are told in the AQAA that all staff receive one to one supervision at least 6 times a year. We looked at the supervision records for two staff and found that arrangements for regular supervision which covered the working ethos of the home, practical issues, and training needs were in place. 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 have confidence in the care home because it is run and managed appropirately. Peoples 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. Evidence: Mrs Carol Susan Williams was registered as manager for the service in November 2008. Mrs Williams has attained NVQ at level 4, the registered manager award, and Learning Disability Award Framework certificate. Training certificates we sampled indicated that Mrs Williams continues to update her training and skills. A member of family we spoke to said that under the new manager the home had become more homely, more resident friendly. Things happen that they say will happen. Theres an open door if Im concerned about something. Arrangements are in place for the views of people on the service to be obtained, such as an annual questionnaire. We found that the service was responsive to suggestions made about improvements to the service - for example the purchase of a games console and a trampoline, and Evidence: introducing opportunities for people to attend a sports club. People also have the opportunity through residents meetings to influence the running of the service. The AQAA advises us of the most recent services and inspections carried out on equipment in the home. We sampled records for water temperature checks, substances hazardous to health assessments and fire safety checks and records and these indicated that safety is being maintained in these areas. We sampled the monthly health and safety audit carried out in the home for August 2009 and found that where shortfalls were identified action had been taken to put things right. Staff training records we sampled indicated that staff are receiving training in topics such a health and safety, food hygiene, first aid, and infection control. 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 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 Helpline: Telephone: 03000 616161 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) 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. - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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