Care Home: 4a Telegraph Road

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What the care home does well The home has an assessment procedure in place if the home was to look for another service user to move in. Each service user has a support plan in place which gives clear details about how to support service users` individual needs. We saw that service users can enjoy activities of their choice and staff were aware of what people liked to do. Service users enjoy their food and staff meet individual needs, such as cutting food up. Records showed that good links were maintained with healthcare professionals and staff consulted with them about healthcare needs. The home has a complaints procedure and staff have received training about safeguarding adults. The home is well maintained and service users have personalised their rooms. Staff and management have responded well to changing needs of service users and have made changes to the environment to promote their well being. The home has robust recruitment procedures in place and service users are involved in the selection of new staff. New staff complete an induction programme, and all staff undertake training. The home is managed with regard to health and safety issues, such as hazardous substances being locked away. What has improved since the last inspection? The last inspection report did not identify any changes necessary. However, since that inspection, there have been changes within the service which meant that improvement was necessary. The new manager has made changes such as improving the support plans and improving the way the space is used by service users. What the care home could do better: The staff must be able to audit medication kept in the home which means an improved system is needed. The manager must apply for registration to enable her to comply fully with the regulations. The provider needs to undertake monthly visits to ensure quality assurance. Key inspection report Care homes for adults (18-65 years) Name: Address: 4a Telegraph Road 4a Telegraph Road West End Southampton Hampshire SO30 3EJ     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: Beverley Rand     Date: 0 3 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: 4a Telegraph Road 4a Telegraph Road West End Southampton Hampshire SO30 3EJ 02380462123 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: jbunce@people-potential.org.uk People Potential (UK) Ltd care home 4 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 4. 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 4a Telegraph Road is a detached family house located in a residential area of mixed properties in Westend on the outskirts of the city of Southampton. Ther are local amenities and access to public transport is good. The use of the building as a care home is not obvious and it is domestic in scale. It is registered to accommodate and provide personal care and support for up to four people with learning disabilities. The fees are based on individual assessed need and current service users are funded Care Homes for Adults (18-65 years) Page 4 of 25 Over 65 0 4 Brief description of the care home by health or social care authorities. Fees do not include toiletries; newspapers and magazines; confectionary; hairdressing; podiatry and the entrance fee to places of interest or entertainment 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: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced key inspection. Before we visited the home we looked at the last inspection report and information which the home had sent to us since the last inspection. The manager completed the Annual Quality Assurance Assessment, (AQAA) and sent it to us on time. The AQAA contained the information we asked for. We received four of our own surveys which had been completed by staff. During the inspection we spoke with the manager and staff and watched how staff and service users spoke with each other as well as how staff supported service users. We looked at records such as support plans and staff files. 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. 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 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 8 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. There are systems in place which would ensure service users would not move into the home without their needs being assessed. Evidence: The home has not undertaken any assessments since the last inspection as there have not been any new service users. However,we spoke with the manager and she told us that she would visit any prospective service users and gather information from professionals involved in their care. This standard was met at the last inspection. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users have their needs met consistently and in ways which they prefer. Evidence: We were told that staff were in the process of improving the support plans, and we were shown one which was the new version. We saw one other support plan, and both showed a good level of detail regarding the support needed to meet individual need. There was information for staff which showed how service users liked to manage their personal care as well as how they preferred to communicate, both verbally and non verbally. We spoke with staff who confirmed that the support plans were very helpful to staff and that they followed the guidelines within them to ensure that support was given consistently. We also saw that the files contained risk assessments for activities enjoyed by service users. There is a system in place whereby new risk assessments are written in draft Care Homes for Adults (18-65 years) Page 10 of 25 Evidence: and staff are consulted on the content. When staff have read them and agreed them, the risk assessment is considered to be a working document. Risk assessments were kept under review. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users enjoy a range of activities and are supported with their family relationships. Staff continue to improve mealtimes for service users. Evidence: We saw that service users have an activities timetable in their support plans. On the day of the inspection we saw some service users going out or otherwise doing what they wished to do. The manager told us that activities outside of the home included horseriding, trampolining, day services, hydrotherapy, bowling and going to pubs. Some of the service users enjoy doing activities together but individual activities are also in place. Service users have been on holiday this year. Whilst at home, service users like footspas, watching television, listening to music and cooking, where possible. Staff and the manager had a good knowledge of what the service users liked to do Care Homes for Adults (18-65 years) Page 12 of 25 Evidence: and said that the current staffing levels enabled them to support service users on an individual basis. We saw staff responding well to situations as they arose, for example, putting on some music which they knew a particular service user liked. Staff support service users in their family relationships, for example, by taking a service user in the car to visit their parents. We spoke with staff about the food provided at the home. We were told that there is a seven week rolling menu which is based on service users likes. The home uses a pictorial menu and staff are gradually building up photographs of the food which is cooked at the home, rather than a general picture. We were told that service users enjoy their food and that they would communicate with staff if they did not want the food prepared that day and they would be offered something else, depending on the situation, for example, it may be that the person is not hungry at all. The staff told us that they cut up food for some service users and that some also have specialist crockery, such as plate guards or melamine plates. Care Homes for Adults (18-65 years) Page 13 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The physical and emotional needs of service users are well met. Medication systems need closer monitoring to ensure medication risks are reduced. Evidence: The manager told us in the AQAA that all service users had support plans, healthcare support plans and new, comprehensive medication files. We looked at support plans and found them to be detailed.They gave information about specific healthcare needs and records showed that service users had seen doctors, dentists, nurses and other healthcare professionals. Medication files gave details of individual medicines prescribed as well as how to administer medication given when needed. Procedures are in place which staff follow which involves two senior staff agreeing when medication should be given in these circumstances, as well as discussing the situation with a more senior person, before administering to the service user. We looked at the administration records and found no gaps. Care Homes for Adults (18-65 years) Page 14 of 25 Evidence: The manager told us that she had already identified that a better auditing system was needed in the home and has asked the local pharmacy to visit the home to give them guidance. We looked at the audit trail for three service users medication which was prescribed as when needed. We found that the record for one service user regarding two types of medication was correct. However, records for two service users did not match with the number of tablets in the home and it appeared that tablets may be missing. The manager re-iterated that she would be asking again for the audit training from the pharmacy. The home does not currently hold any controlled drugs. Staff who administer medication have completed training in, Safe Handling of Medication as well as training about the system used in the home. 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 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 this service can be confident that their views would be listened to and acted upon, complaints would be logged and responded to appropriately. The homes policies and procedures help to protect people from abuse. Evidence: The home has a complaints procedure that has been made more accessible to people who use the service. We saw a copy of the procedure on display in the hallway. We were told that there have not been any complaints since the last inspection and we saw some letters with positive feedback. The home has a copy of the Hampshire Adult Protection procedure and has a whistle blowing policy in place. Staff sign to confirm they have read the homes own procedure. Staff also receive training with regard to adult protection and the protection of vulnerable adults as part of their induction and we saw that all staff had undertaken training in June of this year. We spoke with staff who were aware who they should report any suspicion or allegation of abuse. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users live in a well decorated and clean home. Evidence: The home has a communal lounge area where there is a television and music centre. There is a second, smaller room which has some sensory equipment which service users use as a quiet lounge. The two rooms are connected with doors and used to be one large room, where there was a dining area. However, staff responded to the observation that service users were choosing to eat in the kitchen area instead. The kitchen has been decorated and some new flooring has been fitted since the last inspection. We saw that adaptations have been made to the home to meet individual service users needs. As we walked around the home we could see that service users had personalised the home, with photographs of them involved in activities and ornaments. A board in the hallway showed which staff were on duty. The home has a maintenance book and the manager follows up issues to ensure they are attended to as soon as possible. Service users assist staff with cleaning the home. There is a laundry which is separate Care Homes for Adults (18-65 years) Page 17 of 25 Evidence: from the kitchen. Staff told us that there was always a good supply of protective clothing such as gloves and aprons. 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. Recruitment systems are robust which ensures service users are not put at risk. Service users are supported by staff who are well trained and are qualified. Evidence: We observed how staff and service users spoke with each other as well as how staff responded to individual needs. Staff were calm, respectful and knowledgeable and were able to communicate with service users. We saw them responding to incidents in ways which were described in the support plans. The rota showed that temporary, agency staff are being employed and the manager explained that she always tried to use the same staff and that the need was in response to current individual assessments. The manager felt that the staffing levels allowed staff to work in a person centered way with individuals. Three of the staff surveys returned to us confirmed that they thought there was, usually enough staff to meet individual needs and one thought there was, always enough staff. We spoke to the manager about the recruitment procedure for new staff and she told us that applicants who are shortlisted spend about an hour in the home to see how they interact with the service users. Views are sought from the staff working the shift and from the service users. Staff and the manager use their knowledge of the service users behaviour and communication styles to assess their reactions to potential new Care Homes for Adults (18-65 years) Page 19 of 25 Evidence: staff, if they are unable to verbalise their opinions. We looked at the recruitment files for two new staff and found they had the necessary pre-employment checks including references and Criminal Record Bureau checks. New staff undergo a general induction during the first week and are on the rota as additional staff for the first three weeks, or longer if necessary. Staff then start working towards completing the Common Induction Standards, which lasts around six months. The organisation has a training manager and there is a rolling programme of training. The manager told us that two or three staff undertake a training course each week, which is built into their hours. We saw training had covered autism, positive approaches to managing behaviour, strategies for crisis intervention and prevention, introduction to the Mental Capacity Act and Deprivation of Liberty, infection control, safeguarding, principles of moving and handling, fire safety, understanding learning disabilities and Makaton. We saw staff records which showed that staff had undertaken training. Staff have also received training at staff meetings which address individual needs. The completed staff surveys confirmed that staff felt they had enough support, experience and knowledge to meet the different needs of people living at the home. The home supports staff to complete National Vocational Qualifications in care, (NVQ). The home employs nine support staff and five have achieved NVQ level 3, two are currently working towards NVQ3 and one has achieved NVQ2. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well run but service users would benefit by the home having a registered manager and having regular quality assurance visits. Evidence: The home has had a change in manager since the last inspection and the current one has been in post since January 2009. She has not yet applied to be registered with the Commission. We discussed this with the manager during the inspection and she told us that she has started the process and will soon be making an application. The manager told us that she has worked in social care for twenty years and has worked with people with learning disabilities for fourteen of those years. She has been in management positions for twelve years. The manager has completed the NVQ4 in care and is working towards NVQ4 in Leadership and Management. She continues to update relevant training. The manager completed the AQAA on time and gave us the information we requested. Care Homes for Adults (18-65 years) Page 21 of 25 Evidence: All of the completed staff surveys confirmed that staff felt supported by the manager. We found that service users experience generally good but some adequate outcomes. The AQAA stated that monthly visits were undertaken by an appropriate senior staff member in line with regulations, which monitor how the home is run on a regular basis. However, we asked to look at the written reports for these visits and found there was only five completed since November 2008. Those which were there were seen to be detailed and identified areas which could be improved. We asked the manager how the home seeks the views of service users and their families. The home has started to hold parents forums, where people can socialise and can put forward any ideas or requests to improve the home. Staff meetings are held regularly and the manager has started monthly internal audits. The home ensures that potentially hazardous substances are locked away. We saw that equipment is serviced and maintained. Staff test and record the temperature of the water on a weekly basis. The home is run with due regard to health and safety. 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 1 20 13 The home must have 29/10/2009 appropriate audit systems in place for prescribed medication. To ensure that all medication can be accounted for which means that the home can evidence that service users have received medication as prescribed. 2 39 26 The registered provider must undertake monthly visits as detailed in the regulation. To ensure quality assurance for service users. 30/09/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 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. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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