Care Home: 31 King Edwards Grove

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What the care home does well People are happy living at the home. They feel well supported and feel that they are able to live the lives they want which include doing a range of activities at home and in the community. The staff have the training and information they need to care for and support people. The environment is spacious and attractive. Records are accurate and up to date. What has improved since the last inspection? A new manager is in post and he has introduced changes which include better record keeping, better systems for making sure people are well cared for and safe and better communication. What the care home could do better: The staff need to make sure everyone who lives at the home feels safe. There needs to be some improvements to medication management to reduce the risks to people. The manager needs to apply to be registered with the Care Quality Commission. Key inspection report Care homes for adults (18-65 years) Name: Address: 31 King Edwards Grove 31 King Edwards Grove Teddington Middlesex TW11 9LY     The quality rating for this care home is:   two star good 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: Sandy Patrick     Date: 1 2 0 5 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 26 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 26 Information about the care home Name of care home: Address: 31 King Edwards Grove 31 King Edwards Grove Teddington Middlesex TW11 9LY 02089434555 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): www.gcpcare.com Grove Care Partnership Ltd Name of registered manager (if applicable) Gregory Ernest John Anstead Type of registration: Number of places registered: care home 8 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 8 The Registered Person may provide the following categories of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Learning Disability - Code LD Date of last inspection Brief description of the care home 31 King Edwards is a registered care, providing personal care and accommodation for up to eight people with learning disabilities. Five people currently live there. 31 King Edwards is owned by Grove Care Partnership Ltd. The home is in a residential area in Teddington, close to public transport and local amenities. Accommodation is provided over three floors with large single ensuite bedrooms. There is a separate toilet on the ground floor as well as the staff sleep in room. People who use the service have access to a large garden. A lift is available but on the day of the inspection was not in use. Care Homes for Adults (18-65 years) Page 4 of 26 Over 65 0 8 Brief description of the care home The home is staffed twenty- four hours a day. The current fess start from 1,750 per week, and will vary depending on peoples assessed needs. The inspection report will be made available in the home and details of CSCI are included in the Statement of Purpose and Service User Guide. Care Homes for Adults (18-65 years) Page 5 of 26 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: We made an unannounced inspection of the home on 12th May 2010. We met the people who live there, staff on duty and the manager and spoke to them about the service and their experiences. We looked at records and the environment. We spoke to the local authority where the home is based. We looked at all the information we have received about the home since the last inspection. Care Homes for Adults (18-65 years) Page 6 of 26 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. 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 7 of 26 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 8 of 26 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 given the information they need to help them decide if they want to live at the home. They have their needs assessed to make sure the home is the right place for them. Evidence: No one has moved to the home since the last inspection. We saw that people had their needs assessed before they moved to the home and that copies of these assessments were available. We saw that information from assessments was used to help create plans of care and support. People who live at the home told us that they were able to visit and spend time there before making a decision to move and that they were given information about the services and facilities offered. Care Homes for Adults (18-65 years) Page 9 of 26 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 have their needs recorded in clear plans so that the staff know how best to support them. They contribute their own ideas and wishes so that these plans reflect their opinions and aspirations. People contribute their ideas to the day to day running of the home and the selection of the staff who work there. Evidence: Everyone who lives at the home has their needs recorded in a care plan. These record the support they need. We saw that care plans were clear, accurate and up to date. The people who they were about had signed their plans as a record of their agreement to them. We spoke to some of the people who live at the home and they told us that they received the support and care agreed in their plan. Care plans included information on peoples different needs including cultural, religious and social needs. There was information on peoples likes and dislikes. We saw that information was regularly reviewed and that people who live at the home had met with staff to discuss goals that they would like to achieve. We saw that they were Care Homes for Adults (18-65 years) Page 10 of 26 Evidence: given support to work towards these goals. One person told us about changes they would like to make in their lives. The manager told us about how this person was being supported to work towards these changes and to understand the impact of their choices. We saw evidence of this in their care plan and how other relevant professionals were offering support and guidance to help this person. We saw that assessments were made where people are at risk and that these assessments record how people will be supported to make choices and take risks. People who live at the home told us that they travelled independently in the community and the staff discussed some of the things they did to help keep people safe, such as agreeing times of return, contact via telephone and knowing where people had gone. People told us that they were able to contribute their ideas about daily activities and the way the home is run. We saw that there were regular meetings for people who live at the home to discuss issues and plan events and menus. The manager told us that people who live at the home attended job fairs run by the organisation and designed to recruit staff. He also told us that potential staff visited the home and met with people who lived there before they were recruited. Newly appointed members of staff told us that they had experienced this. Care Homes for Adults (18-65 years) Page 11 of 26 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. People who live at the home are supported to do a variety of activities at home and in the community and to learn skills which help them in their daily lives. Evidence: People who live at the home told us that they were supported to learn new skills and to be involved with daily activities such as cooking and shopping. We saw that the kitchen was accessible to people and that they helped themselves to snacks and drinks and were involved in planning and preparing meals. We saw that care plans recorded objectives for people to learn community living and household skills. One person told us that they were developing new skills with the aim of living more independently in the future. Throughout the day of our inspection we saw that people were free to go out when they wanted and use the local community. They told us about groups they were Care Homes for Adults (18-65 years) Page 12 of 26 Evidence: involved with, for example a local football team, and places they visited including church, pubs and local shops. One person told us that they had friends who lived locally and that they saw these regularly. The manager told us that people were supported to stay in touch with friends and family as they wanted and that visitors were welcome at any time. One person showed us photographs of them spending time with friends and family. Everyone has a planned programme of activities which has been developed to reflect their needs and choices. These include some formal activities, such as groups and college, and other activities such as swimming and shopping. People who live at the home know what their planned weekly programme is and one person showed us a pictorial timetable of this. We saw that these timetables were available for staff to help plan each days events. We saw that the kitchen was well stocked with fresh food. There is a planned menu of meals which people who live at the home help to choose and prepare. Care Homes for Adults (18-65 years) Page 13 of 26 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 are given the support they need to stay healthy and have their personal needs met. They are supported to take medication they need and there are good systems to make sure this is well managed. However, these systems are not always followed and poor recording and storage of some medication may put people at risk. Evidence: Peoples health and personal care needs are recorded in their care plans. We saw evidence that people saw their doctor and other health care professionals as needed. During our inspection two people who live at the home met with professionals from the local community team. The manager told us that he had recently made links with the local primary care trust to get regular support for the home, including training and information for staff and assessing everyone who lives there to make sure they are getting the right support for them. We saw that medical consultations and appointments were appropriately recorded and action from these was included in care plans and guidelines for staff. We saw evidence that staff regularly monitored health care needs and action where Care Homes for Adults (18-65 years) Page 14 of 26 Evidence: concerns were identified. People who live at the home told us that they had the support they needed to stay healthy and to have the medication they needed. There is an appropriate procedure for managing medication and all staff have been trained in this area. We saw that medication was stored securely. There are systems to make sure medication administration, storage and records are regularly checked and audited. Some people are supported to manage their own medication and we saw that this had been properly assessed and was monitored. In general medication records were accurate, however we saw that some administration records had not been correctly completed and there were gaps which did not show administration details. The administration record for one person did not record known allergies. In general we saw that medication was appropriately stored. However, we found one box of pain killers which was not labelled with the name and administration details for the person they belonged to. We found that some medication had been removed from its original packaging and had been stored in different packets. Care Homes for Adults (18-65 years) Page 15 of 26 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. There are procedures at the home which are designed to protect people and to allow them to make complaints. People who live there feel able to voice their concerns however not everyone who lives at the home feels safe. Evidence: Some of the people who live at the home told us that they felt bullied and intimidated at times. We spoke to the manager about this. He told us that they were aware of issues at the home and offered support to help people cope with threatening situations and to report bullying. We saw that care plans and risk assessments included information on this. We also saw that there were tools to help staff check that people who were at risk from others were kept safe and their wellbeing was regularly monitored. The manager told us that he felt further work was needed in this area and he had arranged for training for the staff team and people who live at the home to look at the issues of bullying and how to prevent this. The training was planned for shortly after the inspection. The organisation has procedures for the protection of vulnerable people and for whistle blowing. The home also has a copy of the local authority safeguarding procedure. The local authority informed us about a number of safeguarding alerts at the home, which they felt put people who live there at risk. We discussed these with the manager. He told us about measures that had been put in place to help keep people safe. We saw evidence of these measures, which included better security for Care Homes for Adults (18-65 years) Page 16 of 26 Evidence: peoples money, more thorough checks on staff during recruitment and close monitoring of people who were considered at high risk of harm from others. We saw that staff had been well informed about these new measures through meetings and communication from the manager. We saw that records for money held on behalf of people who live at the home were accurate and balances were regularly checked. However, on the day of our inspection the staff were not fully following the procedures for checking money held on behalf of people who live there. The manager needs to make sure that they always follow procedures to help keep peoples finances safe. There is an appropriate complaints procedure for the home. People who live there told us that they knew what to do if they were unhappy about anything. They told us that they felt confident in making a complaint. We witnessed a number of interactions where people who live at the home told staff when they were not happy about things. We saw that formal complaints and concerns were recorded and that the action taken to investigate these was also recorded. Care Homes for Adults (18-65 years) Page 17 of 26 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 live in an attractive, clean and generally well maintained environment which gives them a good amount of private and communal space. Evidence: The building is generally well maintained. There are some areas of damage which need to be repaired. These include damage to some bedroom doors. The home is spacious and attractively furnished and decorated. Everyone has a large bedroom with en suite shower, toilets and wash basins. There are a number of communal rooms, some with TVs and music equipment and some used as quiet rooms or for meetings. There is a well equipped kitchen, a staff and managers office, dining area and laundry room. There is also a well kept garden. People told us that they liked the environment and their bedrooms. One person showed us their bedroom which they had personalised. The home was clean and fresh throughout on the day of our visit and bathrooms were equipped with hand soap and paper towels. Care Homes for Adults (18-65 years) Page 18 of 26 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 people who live at the home are cared for by appropriately recruited, well trained and supported staff. Evidence: People told us that they liked the staff and were treated with kindness. The staff told us that they felt supported by the new manager but some staff felt that changes in management left them feeling a bit uncertain about their roles. The new manager should therefore make sure all staff feel supported and feel that they have clear direction and information to help them support the people who live at the home. We saw that there were good systems for communication amongst the staff team, including regular team and individual meetings, communication books and notice boards of information. The organisation has an appropriate procedure for recruiting staff. We looked at records for recently employed members of staff and also for potential staff who the manager had interviewed shortly before the inspection. We saw that records contained appropriate checks, information on recruitment interviews and all required documents relating to the person. Care Homes for Adults (18-65 years) Page 19 of 26 Evidence: The staff on duty told us that they had regular training opportunities. We saw that staff training was recorded and that the manager monitored this to make sure everyone had the training they needed. We saw that staff training was appropriate for their roles and the manager told us about additional training which had been organised to help staff understand about specific issues regarding the people who live at the home. Care Homes for Adults (18-65 years) Page 20 of 26 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 live in a home which is well managed and there are systems to ensure the smooth running of day to day operations. Evidence: The registered manager left the home in 2009. There has been 2 different managers since then and this has had an effect on the day to day operations at the home. The staff told us that they have felt unsettled and have lacked clear direction and support. However, a manager has been in post since February 2010, and he has created more stability and a clear leadership. The manager has worked at another home for the organisation and is appropriately qualified. He had not applied to be registered with the Care Quality Commission at the time of the inspection and needs to do this. The staff and people who live at the home told us that they liked the manager and that he had brought about positive changes. We saw that he had introduced new records, procedures and systems which had improved the support of people who live there. We saw evidence that he gave clear direction to staff and monitored their performance and competencies through working alongside them and regular individual Care Homes for Adults (18-65 years) Page 21 of 26 Evidence: and team meetings. We met the area manager. She told us that she regularly visited the home and monitored the service. We saw that she wrote monthly reports of her visits and spent time talking to people who live at the home and the staff. The organisation arranges for annual surveys to be completed by people who live at the home so that they can share their views and any concerns they have about the service. We saw records which showed that the staff made regular checks on health and safety, including fire safety. We saw that records of hot water temperatures showed that water delivery temperatures from some showers were unacceptably cold over a period of a few months. There was no indication in the records that this issue had been referred to the appropriate maintenance department. Records for health and safety checks should indicate where remedial action is taken. The staff need to make sure showers water temperatures are at a warm and comfortable temperature. Care Homes for Adults (18-65 years) Page 22 of 26 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 26 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 20 13 The registered person must 30/06/2010 make sure medication is accurately recorded, stored and labelled according to the procedure. The registered person must 30/06/2010 make sure staff always follow procedures designed to keep peoples money safe and secure. The registered person must make sure people who live at the home feel safe and protected from harm, abuse or bullying. The registered person must make sure damage to the environment, including damage to bedroom doors and locks, is repaired. 30/06/2010 2 23 13 3 23 13 4 24 23 30/06/2010 Care Homes for Adults (18-65 years) Page 24 of 26 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 5 37 8 The registered person must make sure the manager applies to be registered with CQC. The registered person must make sure appropriate action is taken and recorded following concerns identified in health and safety checks. 30/06/2010 6 42 13 30/06/2010 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 36 Giving consideration to the recent changes in management at the home and a number of incidents, the manager needs to make sure all the staff feel supported and have the information they need to help them care for and support the people who live at the home. Care Homes for Adults (18-65 years) Page 25 of 26 Helpline: Telephone: 03000 616161 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. 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