Care Home: 44 Monks Close

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What the care home does well This is a service that provides support to just one person, and is run on very domestic lines. They have lived in the home for many years and receive support that is very person centred. Support is given by the provider, with occasional help from a member of their family. The person receiving support told how well they are looked after, and about the facilities that are available to them, and activities and pursuits that they enjoy. The package of care commissioned, includes day care support and respite care, and the person receiving the support is able to spend several periods in a respite home, spread throughout the year. The respite facility is close to their family home, enabling them to maintain strong links with their natural family. What has improved since the last inspection? New care plans and risk assessments have now been introduced since the last inspection. The property has been redecorated, with some new furniture provided. This has improved the home environment and the facilities available to the person living there. What the care home could do better: Although, as detailed above, new care plans and risk assessments have been introduced, they need to be developed further to ensure that all the care needs of the person supported in the home are detailed, and show that the person they relate to has been included in the preparation of these care plans. The home environment has improved, but the odours of tobacco and pet smells must be eliminated. Other records in the home, including financial and medication records must be kept up to date and be available at all times. This will ensure that there is sufficient evidence that the best interests of the person living in the home are protected at all times. Key inspection report Care homes for adults (18-65 years) Name: Address: 44 Monks Close 44 Monks Close Bircham Newton Norfolk PE31 6RD     The quality rating for this care home is:   one star adequate 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: Alan Buttery     Date: 3 0 0 9 2 0 0 9 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) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 25 Information about the care home Name of care home: Address: 44 Monks Close 44 Monks Close Bircham Newton Norfolk PE31 6RD 01485576062 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mrs Yvonne Asbury care home 1 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: That the home is registered for one named individual only. Date of last inspection Brief description of the care home The service provides care and accommodation to one adult with a learning disability who has lived with the family for over twenty years. The package of support includes external day services and regular respite periods to enable the resident to see family members. It is likely that the service could be eligible to be registered as part of an Adult Placement Scheme and this may be explored by the provider in the future. The package is commissioned by Birmingham Social services, and a weekly cost of 500 GBP. 2 7 0 3 2 0 0 9 1 Over 65 0 Care Homes for Adults (18-65 years) Page 4 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: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and health care support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced visit, during which we discussed the service with the provider, and met with the person who lives in the home and receives support. We also spoke to the commissioning authority on the telephone, to seek their views on the service being delivered, and sent a survey form to the individuals relative, although at the time of the report this has not been returned. The local authority will be arranging to review both the care package and the day care they commission in the next few weeks. We looked around the home, and at records that were available, as well as talking to the person receiving support about the service they receive, and what it is like to live in the home. Care Homes for Adults (18-65 years) Page 5 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. 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 6 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 health care 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 7 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Although lacking in formal documentation, the person living in this home is happy with the information and care they receive. Evidence: This service has been established for many years, providing a home to just one person. This is a situation that will not change. The service was established many years ago, and although it is now unclear whether the individual living in the home had any choice in where they lived, there was clear evidence from our discussions with them that they are very happy living there. Information is available in the service to the person living there, although this is not set out in formal documentation. There is no formal service user guide although the person living in the home told us that they knew of the procedures and facilities that were available in the home. It is unlikely that any changes to the service will be made in the near future, although Care Homes for Adults (18-65 years) Page 8 of 25 Evidence: the provider has looked at the possibility of moving to alternative premises. This would enable to person living in the home to access day services more easily. The local authority commissioning this package will be reviewing the service shortly, and the provider should ensure that at this time, they have an up to date contract in place, clearly showing the expectations of the commissioning authority, which will ensure that the one resident does receive the support is being commissioned, and that all their identified needs are included in this package. Care Homes for Adults (18-65 years) Page 9 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individual plans are now in place but do not show the involvement of the resident they relate to. Evidence: New care plans have been introduced since our last visit. These show the basic day to day needs of the person receiving support, and how those needs are met. However they do not show how the individual has been involved in writing the care plans, or show any input from other people who are involved in the support, such as daycare and respite services or from family members. The plans have only been introduced in the past four months, and have not yet been reviewed, but we were told by the provider that this will be done every six months. The plans also included risk assessments covering bathing, traveling and medication. Care Homes for Adults (18-65 years) Page 10 of 25 Evidence: The care plans show how the basic daily needs of the person living in the home are met, but could be enhanced as they do not include any outcomes for the person they relate to. Care Homes for Adults (18-65 years) Page 11 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A range of activities are provided and a range of home cooked and nutritional food is available. Evidence: During our visit, we were able to discuss the activities and pursuits followed with both the provider and the resident living in the home. As a service for just one person, who lives as part of the family, activities and pursuits are generally arranged within the family, including family visits, shopping, lunches out watching television and playing games. The person living in the house told how they enjoy the activities, and love watching soaps on the television. Care Homes for Adults (18-65 years) Page 12 of 25 Evidence: Structured day services are also commissioned, which are normally for one day a week, although the provider told us that they did not feel that they provide any real stimulation, and this is something the provider needs to explore with the commissioning authority and day service provision. There was no evidence that the person living in the home has any contact with their peers, other than the one day they attend day services. The provider helps the person living in the home to maintain contact with their family, and regular periods of respite care are included within the support package to enable them to spend time close to where their family live, and the person living in the home told us on the day of our visit how much they enjoy this time. A variety of home cooked food is provided, which we were told by the person living there was very good. They are able to assist in menu choices and with some kitchen tasks, although chooses not to do this very often. Care Homes for Adults (18-65 years) Page 13 of 25 Personal and health care 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individual plans show how health needs should be met, but the absence of medication records raise doubts that the required procedures and records are all in place to ensure health needs are met. Evidence: As already indicated, individual care plans are now in place, and these do incorporate health care needs. More detail is needed within the individual plans to ensure that they show how the person supported in this home wants the care provided. The local doctors surgery provides any additional health care support that is required, and medication is supplied by the local pharmacy. We discussed the medication procedures with the provider, but they were unable to provide any written record of medications administered. This is necessary to evidence to the commission that prescribed medication is taken. Although the resident is not given any choice around who provides their support, they are happy with the current arrangements, and have a strong relationship with the Care Homes for Adults (18-65 years) Page 14 of 25 Evidence: provider, which was apparent during our discussions with them. The provider must ensure that a detailed record of all the residents health visits is maintained as well as the medication records referred to earlier. Care Homes for Adults (18-65 years) Page 15 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The person living in the home is able to make any concerns known. Evidence: Although no formal complaints procedures are in place, the person living in the home has a very close relationship with the provider and their family, and is able to make known any concerns or problems that they may have. As part of the support package of support commissioned they also attend regular respite care and day services allowing them the opportunity to talk with people outside of the home, and this gives them the opportunity to make known any concerns they may have. The provider has undertaken some limited safeguarding training, and a member of their family who assists with the support has up to date training with their employer, another care service. Care Homes for Adults (18-65 years) Page 16 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Although the person living in the home is provided with a comfortable environment, they cannot be assured that their home will be free from unpleasant odours. Evidence: The service operates from a small property, which the provider rents through a local housing association. There are two bedrooms, a lounge/dining area. kitchen and bathroom. A full refurbishment of the property has been undertaken by the housing association, and a new kitchen and bathroom installed, and the property redecorated throughout. The resident has their own room, and during our visit, they showed us around the home. The provider also told us that new furniture is on order for this room, which was scheduled for delivery later that week. On the day of our visit, there were some odours noted, caused by the providers pet dog, and some tobacco smells, and these must be eliminated. The property has mains smoke detectors and fire extinguishers, but no temperature regulator on the hot water supply, which must be provided, and the provider agreed Care Homes for Adults (18-65 years) Page 17 of 25 Evidence: to speak with the housing association to arrange this. Risk assessments are in place to ensure that the water temperature is checked when supporting the person living in the home to bathe, but the temperature should be regulated in the event that they run water themselves. Although there is a garden, this is overgrown and needs attention, as at the present time, the resident would not be able to access the garden. The provider has spoken about relocating the service, which may be of benefit to the person that is supported, as the service is currently in a very remote, rural area, and transport is limited. This would give better access to day service facilities, clubs and associations that the resident may wish to attend. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Although the provider has many years of experience in meeting the needs of the person living in the home, more training would ensure that the person receiving care had the benefit of current methods. Evidence: As a very small service, domestic in style, and supporting just the one person, there are no employees. The provider undertakes all the required care and support, with occasional voluntary help from a family member who lives with them. As already indicated, this resident has lived in the home for many years, is very much part of the family, and has a strong relationship with the provider. The provider has taken some training in the past, including part of an NVQ, and is supported by a family member who does have up to date training in all areas. Care Homes for Adults (18-65 years) Page 19 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. although the person living in this home is very happy with the care and support they receive, further improvements are needed to ensure that they know the support they receive is of a satisfactory standard. Evidence: As indicated earlier, this is a service operating for just one resident, and from discussions with the resident, it was clear that they are very happy with the care and support they receive, and the facilities available. They have lived in this home for many years, and are treated as part of the family, and the resident clearly feels that the provider has taken on a maternal role. The person living in the home does spend several periods of respite care in a home close to their family, and is supported in maintaining this contact. At our previous inspection, problems with the location of the home and management of the care were discussed, and this has been dealt with by the provider with several changes made. However, as part of the last inspection, the provider was required to Care Homes for Adults (18-65 years) Page 20 of 25 Evidence: submit an improvement plan to the commission. This was not received by us. The requirements that were made as a result of the last inspection have now been met, and no further action is being taken at this stage. Further improvements to the way that this service is managed were identified during this inspection, and these must be addressed urgently. All records required within the regulations must be available and up to date, to demonstrate that the interests of the resident living in this home are protected at all times, and the provider agreed that this would be done. Care Homes for Adults (18-65 years) Page 21 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 22 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 1 1 5 A written Service User guide 31/12/2009 must be provided to the person receiving support To ensure they have details of the care and support and facilities the service is providing. 2 6 15 Individual plans must show more detail about the way needs are met and the involvement of the individual. To ensure that support is given in a way suited to the individual 31/12/2009 3 30 23 The service must ensure that the premises are free from offensive odours. To ensure the person living in the home has a clean environment around her. 30/11/2009 4 41 17 All records required must be up to date and available 30/11/2009 Care Homes for Adults (18-65 years) Page 23 of 25 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 To ensure documentation is always available. 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 5 The provider should ensure that they have an up to date contract with the commissioning authority, to ensure they are meeting the terms of the package of support, and that it includes all identified needs. The service should support the individual in more peer related activities, including local clubs and societies. 2 16 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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