Care Home: 30 Richmond Road

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What the care home does well The service at 30 Richmond Road creates a comfortable, fresh, clean and homely environment for the people who live there, and supports residents to live a fulfilled and valued lifestyle in keeping with the choices they make. The home has a staff team who are committed to meeting the needs of the residents, and keeping those residents safe. Staff always treat residents with dignity and respect. Staff receive good training to support and meet the needs of the residents who live there. Residents and their representatives are given all the information they need to complain should they be unhappy about the quality of the care and support provided, and know that staff and managers within the home would listen and act upon any concerns or complaints that they may have. Resident views are listened to by management and this helps the home to decide what works best for the people who use the service. What has improved since the last inspection? The service has a new home`s manager who is in the process of registering with the commission to become the registered manager of the home. The home has recently recruited senior care staff to promote the choices and lifestyle of the residents. What the care home could do better: Residents privacy should be promoted when using the sensory room to enable them to fully enjoy the experience without noise distractions. All prescribed medication dispensed by the pharmacist and administered by staff must be recorded on the official record supplied by the contracted pharmacist. This will ensure a clear audit trail within one record. The service should look to find NVQ training courses for those staff who do not have a care qualification. This will ensure the service is meeting the governments target to have at least fifty percent of care staff employed by the service with a qualification in care. The home should identify the full name of staff and hours worked on their staff rota. This is to ensure accurate records are made. Key inspection report Care homes for adults (18-65 years) Name: Address: 30 Richmond Road 30 Richmond Road Caversham Reading Berkshire RG4 7PR     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Yvonne Souden     Date: 0 1 0 4 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 25 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 25 Information about the care home Name of care home: Address: 30 Richmond Road 30 Richmond Road Caversham Reading Berkshire RG4 7PR 01189463282 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): www.voyagecare.com Milbury Care Services Ltd Name of registered manager (if applicable) Ms Louise Samantha Collins Type of registration: Number of places registered: care home 5 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users to be accommodated is 5. 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 Brief description of the care home 30 Richmond Road is a residential care home providing care and accommodation for five adults with learning and physical disabilities. The home is close to Reading town centre and the shopping and recreational facilities that the town has to offer, and is close to public transport facilities. Parking is available within the grounds of the home. Care Homes for Adults (18-65 years) Page 4 of 25 Over 65 0 5 Brief description of the care home Fees for this service range from £1049.37 to £1435 per week at time of this inspection. Care Homes for Adults (18-65 years) Page 5 of 25 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: three star excellent 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: The quality rating for this service is 3 stars. This means the people who use this service experience excellent quality outcomes. The service completed an Annual Quality Assurance Assessment (AQAA), which is a legal document provided, by the commission. The AQAA was used by the manager and provider to review their service and inform the commission of their findings. The AQAA was used as part of the evidence to inform this report. Other evidence used to inform the report included a four hour site visit to the service by one inspector. This enabled the inspector to observe care practises and speak to people who use the service, staff and management of the home. Other evidence used to inform this report was documentation viewed by the inspector during the site visit. Care Homes for Adults (18-65 years) Page 6 of 25 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. Care Homes for Adults (18-65 years) Page 7 of 25 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 8 of 25 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 9 of 25 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who want to live in the home have their needs assessed prior to their admission, and have their health and social care needs reviewed regularly following admission to the home. Evidence: The service has had two new admission since their last key inspection in April 2007. We viewed the files of one, and the files of a person who has being using the service for several years. Records demonstrate that health and social care assessments were completed by the persons placing authority and by the service prior to the persons admission. This gave the home the information they needed to make a decision on whether they could meet the persons health and social care needs. Records demonstrate that residents who have lived in the home for several years continue to have their personal, health and social care needs reviewed to make sure they continue to receive the support they need to live a valued and fulfilled lifestyle. Care Homes for Adults (18-65 years) Page 10 of 25 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 have a care plan that promotes their independence and decision-making, whilst risk assessments promote their safety within the decisions they have made. Evidence: Records that we viewed demonstrate that residents have an up to date written support plan detailing how their health, personal and social care needs and goals are to be met. Care staff spoke knowledgeably of residents health and social care needs, and of reviews undertaken with involvement of the resident and their representative. Records of care planning were well written clear and concise that included, for example, details of the persons day to day preferences and routines, and a relationship map that identifies the people who are involved in the persons life, for example family, friends and health and social care professionals. Care Homes for Adults (18-65 years) Page 11 of 25 Evidence: Care plans and risk assessment demonstrate that the service promotes the residents chosen lifestyle around the decisions they have made. Risk assessments clearly outline how staff can support the person whilst minimising associated risks. It was evident from observation of staff assisting residents that they support choices made by the residents within a risk management framework. Daily records written by staff demonstrate that residents chosen daily activities are promoted. Care Homes for Adults (18-65 years) Page 12 of 25 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 excellent 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 are supported to maintain contact with family and friends, and are supported to maintain their chosen lifestyle. Evidence: The range of activities available to people who use the service remain commendable as had been identified at the services last inspection in April 2007. Staff and residents spoke of holidays and day trips, one resident was very excited over the prospect of going on another Centre Park holiday. We observed a very relaxed and friendly atmosphere between staff and residents throughout the morning and at lunch time, with positive verbal and non-verbal communication. Three residents had returned with staff at lunch time from a organised walk that is regularly undertaken with other people in the community. Care Homes for Adults (18-65 years) Page 13 of 25 Evidence: Records made within the homes diary and the residents daily records demonstrate various activities undertaken by the residents that were planned with clear support plans in place to enable the resident to fully participate within their chosen activity, for example, attending religious service, shopping, group meetings and private aromatherapy sessions that had taken place on the afternoon of the inspection by a visiting therapist. Menus are completed weekly and are discussed at the residents meetings using pictures for those who cannot verbally communicate, to ensure residents have choice and are involved in menu planning. Chosen meals were observed to be nutritionally balanced and fresh fruit and vegetables were used. There is a sensory room within the home that the service should improve to ensure those residents who use the room can do so in privacy, and without the distraction of the general noise created by kitchen appliances and people within the home. This would promote the residents well being by enabling them to fully benefit from the equipment provided within the sensory room. The home has a private rear garden that has been designed to enable residents to fully enjoy the garden in the warmer months. For example, a water feature, sensory chimes, raised borders with sensory plants, a summer house, and patio area with table and chairs. The home has its own vehicle and makes full use of public transport to support residents to access activities within the community. Residents are supported to maintain contact with family and friends. Care Homes for Adults (18-65 years) Page 14 of 25 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 excellent 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 receive support from staff to meet their health, psychological and personal care needs in a dignified and respectful manner, and as identified within their care plan. Evidence: Information within each file clearly records the persons health care needs and details the support they require to ensure their health care needs are met, for example, diaries record residents health appointments. Care support plans and a key worker system supports and enables residents to receive personal care in the way they prefer. Adaptations as recommended by appropriate health and social care professionals following assessment were in place and evidently used, for example, hoists and walking aids. Staff have received training so that they have the skill and knowledge to support the resident within their personal and health care needs, for example, training within, first aid and administration of medication. Staff were observed to be polite, caring and respectful toward the residents and residents appeared well cared for and comfortable with staff. Care Homes for Adults (18-65 years) Page 15 of 25 Evidence: It was evident from records viewed and discussions with staff that staff follow the homes medication policies and procedures to minimise the risk of mistakes happening within the administration of residents medication. The last key inspection by the commission in 2007 required the home to ensure that accurate records are consistently maintained of medication administered to service users, to ensure that they receive the medicines they require. At this inspection good records are generally maintained. However, all prescribed medication dispensed by the pharmacist and administered by staff must be recorded on the official record supplied by the contracted pharmacist. This will ensure a clear audit trail within one record. Care Homes for Adults (18-65 years) Page 16 of 25 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. People who use the service are listened to and know how to make a complaint should they have a concern. Policies, procedures and staff training protect the people who use the service from abuse. Evidence: The home has a complaint procedure that is accessible to the residents, and is in a format that they can understand. Residents were observed to communicate verbally and non verbally to staff at ease, and staff were observed to listen. The service has not received any complaints about the service provided and the commission have not received any complaints by people who us the service about the quality of care provided. Staff said that they would not hesitate to protect residents from abuse, and know the procedures to follow to protect residents from abuse. The home has a copy of Berkshire Safeguarding Adults Policy and Procedures, and a whistle blowing policy. Staff have received training to protect the people who use the service from abuse. Care Homes for Adults (18-65 years) Page 17 of 25 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 excellent 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 live in a comfortable, homely and hygienic environment that has adaptations to meet their diverse needs. Evidence: On the day of the inspection a tour of the premises took place. The home is very spacious and is easily accessible for those with walking aids, wheelchairs and motorised vehicles. The home offers a safe and comfortable environment for residents that is bright, fresh, homely and clean throughout. Television and music facilities are fitted in the lounge area and residents are able to access a paved and furnished patio area from the kitchen and dining room. Residents have personalised their bedrooms; two have en suite facilities. Infection control is promoted, for example, protective clothing was available for staff to use when assisting residents with personal care, and to use within the laundry and kitchen. Staff have received training within food handling, infection control and fire safety. Regular checks of fire extinguishers, fire alarms and emergency lighting takes place. Care Homes for Adults (18-65 years) Page 18 of 25 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 home has a trained staff team who are caring, enthusiastic and sufficient in numbers to support and meet the needs of the people who use the service. The homes recruitment procedures protect the people who use the service. Evidence: Staff were observed to be very caring and attentive toward the people who use the service that contributed to a happy and homely atmosphere. Care staff were knowledgeable of the residents health and social care needs and records demonstrate that staff receive relevant health and safety training to promote the safety and well being of the residents. Training and supervision records of staff identify that care staff are supported to meet their training and development needs by accessing internal and external training. The homes annual quality assurance assessment (AQAA) as required by the commission acknowledges that improvement to increase the number of staff with a care qualification is needed to meet government targets to have at least fifty percent of staff with a care qualification; twenty-five percent of the permanent staff employed by the service have a National Vocational Qualification in care. Care Homes for Adults (18-65 years) Page 19 of 25 Evidence: The home does not have a full complement of staff. Care staff and bank staff cover vacant shifts to promote continuity of care. We looked at the files of four staff. Records within each file demonstrate that the service follows a thorough recruitment process that includes a criminal record bureau check (CRB), and references from previous employers to evidence the persons suitability as a carer, and to protect the people who use the service. The staff rota identifies three staff on duty throughout the day, and sleep in staff at night. The manager is aware that the rota needs to clearly identify the full name of staff on duty, to include sleep and waking night staff, and confirmed they will undertake to amend the rota to demonstrate staff on shift over a 24 hour period. Care Homes for Adults (18-65 years) Page 20 of 25 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 is a competent and caring manager who has the qualifications and experience to ensure the safety of the people who use the service and staff team, and to promote continual improvement of the service provided. Evidence: A new manager was appointed in 2009 and has the qualifications and experience to effectively manage a care service. The manager is in the process of registering with the Commission to become the registered manager. The manager said that she receives the support she needs from her line manager to manage the service well, and spoke of plans to improve the service provided. Records show that regulation 26 inspections have been undertaken regularly as part of the homes quality assurance monitoring. Other quality assurance procedures are in place to gain the views of the people who use the service and stakeholders to ensure the views of the residents are listened to, Care Homes for Adults (18-65 years) Page 21 of 25 Evidence: for example, residents meetings. Policies and procedures are regularly reviewed and an annual development plan is in place to promote the aims and objectives of the service provided. Health and safety checklists are completed to ensure the safety of residents, staff and visitors that include fire safety. Staff attend health and safety training and training within for example, non-violent crisis intervention, minimal handling, food and hygiene and fire and extinguishers training. Care Homes for Adults (18-65 years) Page 22 of 25 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 23 of 25 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 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 11 Consideration should be given to make the sensory room private when in use. This is to enable people who use the room to enjoy the experience in a relaxed environment without the distraction of noise created by kitchen appliances and people within the home. All prescribed medication dispensed by the pharmacist and administered by staff must be recorded on the official record supplied by the contracted pharmacist. This will ensure a clear audit trail within one record. The service should facilitate NVQ training for care. This will ensure the service is meeting the governments target to have at least fifty percent of care staff employed within the service with a qualification in care. 2 20 3 32 Care Homes for Adults (18-65 years) Page 24 of 25 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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