Care Home: 30 Mill Road

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What the care home does well This home provided a physical environment that was appropriate to the specific needs of the residents. The home was clean and tidy and promoted privacy and dignity for the residents. People living at this home received personal and healthcare support that was based on dignity, equality, fairness, autonomy and respect. As far as possible independence was encouraged and supported, and actively promoted the right of individuals to make informed choices. Training for safeguarding was provided for staff in this home, and other training around de-escalation and managing verbal and physical aggression was also on the training programme for all staff. Staffing levels reflected the needs of the people who used the service. The manager was competent in delivering effective care. She has good people skills and understood the importance of person centered care. All prospective clients received a full assessment of needs, and were then invited to make unlimited visits to the home, in order to assess compatibility with other residents and the staff. This home understood the importance of having sufficient information when choosing a home. The statements of purpose and service user guide included photographs so that it might be meaningful to the residents. What has improved since the last inspection? At the last inspection staff were unable to locate the care documentation relating to a new resident. This told us that staff did not use the documentation to work from. At this inspection records were available in the home and in the residents bedrooms. We were also concerned last year that one male member of staff was working alone to provide care and support, while other members of staff transported residents to various activities. Staffing levels were satisfactory at this inspection. The skill and gender mix of the staff team ensured that a resident would receive their care from a person that they trusted and felt confident with and who had the necessary skill and/or qualifications. What the care home could do better: There was a need to ensure that risk assessments provided information as to how a risk should be managed. There was a need to look at the activities available to people living at 30 Mill Road. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: 30 Mill Road 30 Mill Road Sharnbrook Bedfordshire MK44 1NX     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Sally Snelson     Date: 0 7 0 7 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 29 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 29 Information about the care home Name of care home: Address: 30 Mill Road 30 Mill Road Sharnbrook Bedfordshire MK44 1NX 01234782806 01234783108 manager.30millroad@fremantletrust.org 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) : The Fremantle Trust care home 6 Number of places (if applicable): Under 65 Over 65 0 learning disability Additional conditions: 6 The maximum number of service users who can be accommodated is: 6 The registered person may provide the following category of service only: Care home Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following category: Learning Disability - Code LD Date of last inspection Brief description of the care home 30 Mill Road is a home for up to six adults with learning disabilities managed by the Fremantle Trust, in partnership with Bedfordshire Pilgrims Housing Association. The Housing Association is responsible for the maintenance and upkeep of the building. The home is situated on the outskirts of the North Bedfordshire village of Sharnbrook, which is approximately 9 miles from Bedford town centre. The home provides its own transport. The home is a large bungalow, with individual bedrooms for each of the residents. Communal space consists of a lounge, dining room, kitchen, bathing/shower facilities, and a separate laundry room. Doors lead out onto patio areas and paths round the bungalow. The home is set in very large gardens. The garage, which is a separate building, has been converted into an activity centre. The home is set back from the main road up a steep slope and there is adequate parking space. Care Homes for Adults (18-65 years) Page 4 of 29 Care Homes for Adults (18-65 years) Page 5 of 29 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 peterchart Poor Adequate Good Excellent How we did our inspection: This inspection was carried out in accordance with the care quality commission (CQC) policy and methodologies, which requires review of the key standards for the provision of a care home for adults. The methodology takes account of the views of the people using the service (residents) and information received about the service since the last inspection. Evidence used and judgments made within the main body of the report also includes information from this visit. Sally Snelson undertook this inspection of 30 Mill Road. It was a key inspection, was unannounced, and took place from 09:30hrs on the 7th July 2009. Helen Gruber the registered manger was present throughout and Liz Harris, the Care Homes for Adults (18-65 years) Page 6 of 29 operational manager, attended for the feedback. During the inspection the care of two of the people using the service was case tracked in detail. This involved reading their records and comparing what was documented to what was provided. In addition to sampling files, people who lived at the home and staff were spoken to, and their opinions sought. Any comments received from staff or residents about their views of the home, plus all the information gathered on the day was used to form a judgment about the service. The residents had limited verbal communication, but staff were able to make them aware of the inspection process. We would like to thank all those involved for their assistance with the inspection. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking Care Homes for Adults (18-65 years) Page 8 of 29 following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 29 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 29 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. The service recognized the importance of ensuring that a new resident could be looked after by the staff team, but would also fit in with those already residing at the home. Evidence: The home had a statement of purpose and Service Users Guide that covered all the areas required by the National Minimum Standards. The Statement of Purpose had been updated the month previously and the Service Users Guide had also been recently updated Computer problems had prevented an updated copy being printed. The new guide included some recent changes to the way residents were to pay towards the use of homes transport. Both documents were in photographic style. There had been no new admissions to the home since the last inspection, but we looked at the file of a resident who had been in the process of moving in at the time of the last inspection. It was clear that his transition to living at 30 Mill Road had been phased. Detailed records had been kept of each visit. These notes had helped to form the care plans. Currently the home had one vacancy. Care Homes for Adults (18-65 years) Page 11 of 29 Evidence: The staff ability to meet the needs of the people using the service will be discussed in the staffing section of this report. Each of the residents had a contract which had been signed, or indicated the reaction of the resident when the information in the contract was explained to them. For example as an agreement it stated (name of resident) sat and listened and smiled. Care Homes for Adults (18-65 years) Page 12 of 29 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. Care plans were easy to understand and covered all areas of the individuals life. They were regularly reviewed and focused on progress and achievement. Risk assessments were completed, but these were basic and mainly focused on keeping residents safe. Evidence: Each of the people using the service had a variety of different plans of care which gave clear guidance to staff of the needs and support required by the resident. The plans were reviewed at least annually and changes were made as necessary. It was clear from the two files we sampled that goals had been set and plans were altered and dated as changes occurred. For example one resident had started to help prepare his packed lunch and a new goal of cooking simple meals had been set. All of the plans were written with moving towards a more independent lifestyle in mind, even though for some this would be very unlikely. The information in the care files included some photographs, which possibly made the information meaningful to the resident. Care Homes for Adults (18-65 years) Page 13 of 29 Evidence: Documentation showed how staff demonstrated that decisions had been made by the resident in a non-verbal way. For example the agreement for the care plan for one resident said (name of resident) sat in the office while we looked a file and smiled at what was being said. Further documentation suggested that this resident was strong willed and would not accept anything she was not happy with. This showed us that the staff had tried to include her in the care planning process. The homes advocate was also used to aid this process. Staff supported residents in a respectful manner that recognised the residents skills to be as independent as possible. There was a homely atmosphere within the home, the residents were relaxed and friendly with each other and the staff. People living at the home were supported to take risks and risk assessments were in place. These needed to include more detail as to how the risk was to be managed and needed to be less generic and more individulaised. The risk assessments that had been written had been kept under review. Care Homes for Adults (18-65 years) Page 14 of 29 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service were given the opportunity to take part in activities both within the home and in the community. Where possible, staff gathered information on community-based events and try to make individual arrangements for people to attend. The variety of activities needs to be expanded. Evidence: At the time of the inspection one resident was attending a local college one day a week and the same resident spent four days a week at a day center. The other residents had a plan of activity that involved visits and sessions inside and out of the house. Residents were being encouraged by staff to communicate their likes and dislikes but there remained long periods of the day when people did not appear to engage in very meaningful activities. Each resident had three planned activities a day, but these were sometimes very short or not to the residents liking at the time. Care Homes for Adults (18-65 years) Page 15 of 29 Evidence: Files included information about a residents family so that staff could support them to maintain contact or talk to them about their families. There were plans for Fremantle to open a day unit that would be accessible to residents from all the local homes and allow them to participate in a variety of activities on a sessional basis. Each of the residents, that wanted, were supported by staff to have a holiday away from the home. Mealtimes were a sociable occasion. Staff and residents had worked together to create seasonal menus that all the residents liked. Picture menu were also used and the staff always put a picture on the dining table of the next meal as a reminder for the residents. Care Homes for Adults (18-65 years) Page 16 of 29 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. Residents had access to healthcare. Staff made sure that those who needed it were encouraged to keep appointments, and have regular health checks. Evidence: Each person had been registered with a local GP and there was evidence that community health staff attached to the surgery were available for advice and support. Staff supported people to attend appointments and had good relationships with health professionals. Specialist equipment such as walk-in baths, hoists, frames and wheelchairs were available and were used appropriately. Health Action Plans had recently been introduced. Staff had worked with the residents to complete these documents, but as the staff had not received the training to use them they were not currently particularly beneficial. We looked at the medication records for the residents whose care we were tracking. In Care Homes for Adults (18-65 years) Page 17 of 29 Evidence: both instances the Medications Administration Record (MAR) sheets were all appropriately completed with signatures and omission codes, and the reverse of the sheets had been completed as necessary. We were able to correctly reconcile the medications held in the home. staff had their own audit process for medication which identified any problems at an early stage. Care Homes for Adults (18-65 years) Page 18 of 29 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. The service had a complaints procedure that was clear and easy to understand. There were policies and procedures for safeguarding adults that gave specific guidance to those using them. Evidence: The home had a satisfactory complaints policy that was accessible to residents and visitors. There could be some confusion as residents were made aware of how to complain to Fremantle as their care providers, the housing association about their home, and the local authority. There had been no complaints made to, or about, the service to us or the service. The staff had been trained to deescalate situations so there were few service user incidents. Staff had undertaken safeguarding as part of their induction and as mandatory training. We have evidence that staff are aware of how, and to whom, to report possible safeguarding incidents involving residents and/or staff. The manager had checked all recruitment files to ensure that staff had been safely recruited. Care Homes for Adults (18-65 years) Page 19 of 29 Evidence: Service users had money held in the home on their behalf. We looked at the documentation supporting this and ensured that the money reconciled, which it did. Staff had reduced the amount they were checking money into and out of the home to once a day, and they acknowledged that this decrease in checking had not identified any concerns. Care Homes for Adults (18-65 years) Page 20 of 29 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. The home provided an environment that was appropriate to the needs of the people who lived there. The home was pleasantly decorated throughout. All bedrooms provided single accommodation but none had en-suite facilities. Evidence: The home was clean and tidy throughout and since our last visit had been redecorated. The home met the needs of the people living there. Currently there was one vacancy which, because of the corridors, would not be suitable for a person using certain mobility aids. We suggested that the Statement of Purpose should reflect this as part of the suitability of the home section. The bedrooms had been decorated to the tastes of the individual and there was evidence of personal belongings in bedrooms and throughout the home. The manager wrote in the AQAA bedrooms reflect individuality. Service users are able to bring their own furniture and have a key to their room, giving them ownership of their own space. We saw that people had chosen the furniture and the furnishings for their own bedrooms and chose to lock their bedroom doors when they were out of the home. Care Homes for Adults (18-65 years) Page 21 of 29 Evidence: There was an exit to the garden via the laundry room which had a steep step which was a problem for two of the current residents. This would benefit from having a ramp. Service users were encouraged and supported to help with the household chores, which encouraged independent living skills. The aim of any chores was clearly documented in their care plan. Since the last inspection the front garden had been fenced in, allowing residents unrestricted access to the front or the back garden. A bell had been fitted to the front gate as a safety feature, so that cars did not drive in to the premises without announcing themselves. Care Homes for Adults (18-65 years) Page 22 of 29 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. A variety of training was offered to all of staff to ensure that collectively, they had the skills and experience, to meet the needs of the people living at the home. Evidence: Each of the residents was allocated a key worker and we witnessed good relationships between residents and their key workers. Rotas were produced ensuring that the skill mix of the staff team met the need of the residents. 10 of the 16 care staff had a care qualification or were working towards one. Recruitment of staff had in the past been difficult, but recently the home had taken on two new carers to fill the staff vacancies. We examined the personal files of three members of staff, including one of the new starters. All were well-kept and contained fully completed application forms, appropriate references, and training records and certificates. Criminal Record Bureau (CRB) checks had been carried out on all staff, and home office paperwork was present where required. It was clear that the manager had followed up on anomalies between references and the application form. Both new staff had completed the homes induction course, but to date, because of Care Homes for Adults (18-65 years) Page 23 of 29 Evidence: course dates and availability, only one had completed the companies corporate induction. Each member of staff was included in the training plan and there were plans for the computer to have an electronic reminder of the need for training to be updated. The manager had a supervision plan that highlighted a supervision date for each member of staff each month. This allowed the occasional session to be missed because of sickness, holiday or prior appointments, and the member of staff to receive the required six sessions in a 12 month period. Care Homes for Adults (18-65 years) Page 24 of 29 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 manager supported the staff team to provide a good quality of care. She was committed to improving the service. Evidence: The manager had the required qualifications and experience and had proved herself competent to run the home. She kept herself updated with regular training and also covered shifts at times. The staff told us that she was supportive of them. She was supported by a deputy who took responsibility for some areas of management, such as training. The manager had completed the AQAA and it indicated that she was aware of the areas that needed to be developed. There was a quality audit system in place that ensured the home provided a good quality of care. An audit had recently been undertaken by the operational manager and a manager from another home. In addition the manager sought the views of families that visited. This could be built on to include a greater variety of stakeholders. The staff team had regular staff meetings at which minutes were taken. Staff had a Care Homes for Adults (18-65 years) Page 25 of 29 Evidence: meeting on the day of the inspection, this took place in the dining room so residents were not deliberately excluded. Appropriate policies and procedures were in place. Health and safety checks including, fire call point and equipment testing and hoist servicing were carried out and correctly documented. The shift leader on a Wednesday was responsible for the fire checks so the responsibility was shared around the staff team. Care Homes for Adults (18-65 years) Page 26 of 29 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 27 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 Risk assessments must include more information as to how risk should be managed. This ensures that staff are aware of how to support people correctly. 01/09/2009 2 13 12 There must be more evidence that people using the service have the opportunity to spend their free-time as they wish and in a way that will benefit them. This ensures people experience a variety of activities. 01/09/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 28 of 29 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. 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