Care Home: 62 Wright Street

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What the care home does well People living at Wright Street require a great deal of support so that their health and personal care needs are met. This is done by a staff team that has been trained to a high standard and who are clearly able to do their job. Each of the residents seen during the visit appeared happy, relaxed and well cared for. As most of the residents are not able to express their needs and wishes verbally, the staff team make sure that they clearly communicate with each other so that they support each resident in a way they feel suits them. This information is also recorded within each of the care plans so that the way in which the support is to be provided can be clearly understood. Overall, the residents are provided with an excellent standard of care, having their needs well met. What has improved since the last inspection? The team continues to receive training in areas of care and support. This has included courses specific to the needs of the residents so that staff have clear and up to date information and guidance about how to support each person fully and safely. What the care home could do better: The manager continues to monitor the quality of the service and ensures people receive support in the way they need and prefer. Key inspection report Care homes for adults (18-65 years) Name: Address: 62 Wright Street Mencap Homes Foundation 62 Wright Street Horwich Bolton Lancashire BL6 7HY     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Rukhsana Yates     Date: 0 1 0 4 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 24 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 24 Information about the care home Name of care home: Address: 62 Wright Street Mencap Homes Foundation 62 Wright Street Horwich Bolton Lancashire BL6 7HY 01204694286 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): h6007@mencap.org.uk www.mencap.org.uk Royal Mencap Society Name of registered manager (if applicable) Ms Janice King Type of registration: Number of places registered: care home 4 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: Date of last inspection Brief description of the care home 62 Wright Street is a domestic property providing support and accommodation for up to 4 people with a learning disability, each have complex and multiple disabilities. Staffing is provided throughout the day and night. The property provides 4 single bedrooms, living and dining rooms and kitchen. The home is internally connected to the bungalow next door. Additional aids and adaptations are provided throughout the home to meet the needs of the service users. The home is situated close to Horwich town centre and has good access to local shops and bus routes. There is a small front and back garden, mainly paved. Parking is available on the street. The home also has its own vehicle. 4 Over 65 0 Care Homes for Adults (18-65 years) Page 4 of 24 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The inspection visit was unannounced and took place over half a day. We looked around the home, viewed records, observed interactions with people and talked with the manager and staff. As part of the inspection the manager was asked to complete the Annual Quality Assurance Assessment, AQAA, and feedback surveys were sent out to people living at the home and to staff. The AQAA was well completed and survey responses were positive. Care Homes for Adults (18-65 years) Page 5 of 24 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 24 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 7 of 24 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The admissions process gives an assurance that a resident will only be admitted if the home can meet their needs. Evidence: There have been no changes with regards to the residents living at the home. Mencap has a clear process, which is followed when assessing and resettling prospective residents. Information is gathered from a number of sources, which enables them to make an informed decision about the suitability of the placements. Prospective residents and/or their representatives are also provided with information and opportunities to meet the staff team and other residents they may be living with. This too informs the decision about whether placements are made. Once agreed, information gathered would be used to inform the development of the care plan. Placements are reviewed following an initial settling in period. Care Homes for Adults (18-65 years) Page 8 of 24 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Comprehensive information about residents assessed and changing needs as well as areas of risk are included within their care plan detailing how each individual chooses to live their life. Evidence: Care plans and assessments have been completed for each of the residents and explore all aspects of their daily life including areas of risk. Due the health and physical needs of the residents living at the home great importance has been placed on ensuring that a consistent approach is followed by staff. In light of this comprehensive information and assessments have been completed for staff to refer to. These have been developed by the team as a whole as well as accessing the support and advise of professionals where necessary. Care plans are presented in the first person and focus on how each individual chooses to live their life, what their preferences are, their daily routine, what support they need and how they would like it to be provided. Information is provided in an easy to Care Homes for Adults (18-65 years) Page 9 of 24 Evidence: read format and includes pictures. Information was examined for two residents.The plans of care had been updated on a regular basis due to the changes and action taken providing a good overview of the person, their needs and what intervention had taken place. Reviews are also carried out with the Local Authority reviewing team and minutes are held on file. Risk assessments are also completed and focus on any area where a potential concern has been identified. Assessments have been completed with regards to epilepsy, rescue medication, personal care, using the vehicle, hoisting and bed guards. These too provide guidance for staff in ensuring the safety of residents. Further records are made with regards to daily reports, medication and finances, these are monitored on a regular basis. Staff members have a good understanding in relation to the running of the home and the needs of the residents. Each felt that they were all able to bring individuals skills and strengths to the team, which enabled them to work well together. The home continues to utilise the intercom system, which is provided in each of the bedrooms. This is only used during the night shifts to monitor the health needs of residents. Risks assessments have been completed taking privacy into consideration. The home also has an on call system in place, which offers support throughout the day and night. Care Homes for Adults (18-65 years) Page 10 of 24 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Social and leisure opportunities are made available to residents enabling them to lead a full and active lifestyle as possible. Dietary needs of residents continue to be closely monitored ensuring their health and nutrition is maintained. Evidence: At present daily activities vary depending on individual routines. Due to the physical needs of residents much of the morning time is spent supporting residents with rising, addressing their personal care needs and preparing and assisting with breakfast. The rest of the day is spent at leisure following activities both in and away from the home. Since the last visit residents have continued to enjoy a number of activities, which have included theatre trips, football matches, shopping, and holidays. Sufficient staffing is provided so that each person is able to pursue his or her individual activities Care Homes for Adults (18-65 years) Page 11 of 24 Evidence: and interests. Due to restrictions in their mobility residents are fully supported by staff. The home has access to a vehicle, which enables residents to access the wider community more easily. Relationships with family and friends are also encouraged and maintained with regular visits taking place. Choice of meals is based on individual preferences. Each resident has their own particular support need in this area. One resident is fed through a peg, for which all staff have received training. Each resident is offered a balanced diet, which includes an occasional takeaway or meal out. Records are maintained of meals and of weights, so that this area can be monitored as part of their health care plan. Care Homes for Adults (18-65 years) Page 12 of 24 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Personal, emotional and health care support is provided in way that safely and effectively meets the individual needs of residents. Evidence: Much of the support provided at Wright Street focuses on maintaining the physical wellbeing of residents due to their high physical needs. Three of the rooms are provided with a ceiling tracking hoist so that safe support can be provided when providing care. Additional aids and adaptations are also available throughout to enable staff to support residents safely when accessing all areas of the home as well as providing comfort and relaxation. As already identified additional support is provided in relation to peg feeds, rescue medication and mobility. Training and guidance has been provided by the community nurses and physiotherapist so that the team can promote the health and wellbeing of residents. Active monitoring and intervention, where necessary is maintained by the staff within the home. Ongoing health intervention is provided with access to all health professionals Care Homes for Adults (18-65 years) Page 13 of 24 Evidence: including GPs, district nurses, epilepsy clinic, dietician etc. Staff continue to provide support to all appointments away from the home. Where visits take place in the home residents are seen in the privacy of their own rooms. The staff team consists of both male and female support, therefore where possible same gender support is provided. The medication system was also examined. The home continues to use the monitored dosage system, which is supplied by BOOTS pharmacy. No issues were noted. All medication is administered by staff due to the needs of residents. Each has received relevant training. Detailed information is recorded about each resident with a pen picture and medical and health history about their support needs. Medication is reviewed regularly with health professionals. Care Homes for Adults (18-65 years) Page 14 of 24 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. Robust procedures and training are in place ensuring that residents are listened to as well as being protected. Information is also provided to residents in a way that they can understand. Evidence: As previously identified the home has clear robust policies and procedures covering complaints and protection. The manager and staff have received training in this area relevant to their role and responsibilities ensuring residents are protected. A user friendly document covering adult abuse and protection has been provided to each of the residents. Appropriate recording systems are in place should any concerns or complaints be raised. No complaints have been raised with us or the home. Three of the residents are unable to verbally communicate and therefore would rely on relatives or an appropriate advocate to act on their behalf. The home also has further written policies and procedures for adult protection. These include dealing with whistle blowing, aggression, service users finances and missing persons. All staff have a Criminal Record Check in place. Finances are managed appropriately. Records continue to be made of all transactions along with regular checks ensuring balances accurately reflect money held. Monthly Care Homes for Adults (18-65 years) Page 15 of 24 Evidence: audits are carried out by the managers to ensure that the information held is correct. Care Homes for Adults (18-65 years) Page 16 of 24 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. Wright Street continues to provide a comfortable homely environment for those that live there. Aids and adaptations have been provided to enable the necessary support required in meeting the complex needs of residents. Evidence: Accommodation within the home comprises of a lounge, large open dining room and kitchen. There are four single bedrooms, 2 bathrooms and 2 separate toilets. The home also has a designated laundry area and a staff office. The environment has been well adapted to meet the needs of residents whilst still maintaining a homely feel. Each of the rooms were looked at. Where required, bedrooms are fitted with a ceiling tracking hoist to assist in moving and handling. Rooms are individually decorated and furnished. In the lounge, space is provided to accommodate specific seating for each of the residents. The home continues to use a monitoring system, which is used at night due to the health needs of residents. Information is recorded with regards to its use to ensure the rights and privacy of residents are protected. The home has a separate laundry, which is sited away from the kitchen. Care Homes for Adults (18-65 years) Page 17 of 24 Evidence: Sufficient equipment is provided and includes a sluicing facility. Adequate provisions are in place with regards to protective clothing and the management of clinical waste. During the visit the home was found to be clean, tidy and free from odour. Care Homes for Adults (18-65 years) Page 18 of 24 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. Staff employed by the home have been appropriately recruited and trained ensuring that the needs of residents are supported by competent and efficient staff. Evidence: Mencap has clear procedures in line with legislation and good practice guidance with regards to the recruitment of new staff. Staff members have qualifications at NVQ Level 2 or above. The Manager has completed the NVQ 4 Registered Managers Award. An ongoing programme of training is offered, which explores areas specific to the needs of residents living at the home. This includes safe swallowing, peg feeds, epilepsy, risk assessments, as well as mandatory refreshers. Staff confirmed that a lot of training had been provided. Team members also discussed how duties are allocated drawing on individuals skills and abilities, which enabled them to work effectively as a team. Care Homes for Adults (18-65 years) Page 19 of 24 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management and conduct of the service ensures the safety and well being of residents. Evidence: The management arrangements for the home have remained consistent with regards to the Registered Manager and Service Manager, with clear lines of responsibility and accountability in place. As already stated the Registered Manager has completed the NVQ 4 and Registered Managers Award along with other training and development relevant to her role. As part of the homes quality assurance, ongoing evaluation and review takes place to ensure that the aims of the home are met. The Service Manager completes monthly visit reports of which copies are held within the home. Regular supervision with the manager is also undertaken. Staff confirmed that they too have received supervision and appraisals where areas of training and development are discussed. Meetings are also held for Care Homes for Adults (18-65 years) Page 20 of 24 Evidence: staff and minutes are recorded. Due to the needs of residents, formal meetings are not held. Members of the team also have delegated responsibilities to carry out regular checks ensuring the health and safety of residents is maintained. Environmental ealth and safety checks continue to be carried out and addressed. Care Homes for Adults (18-65 years) Page 21 of 24 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 24 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 23 of 24 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). 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. Care Homes for Adults (18-65 years) Page 24 of 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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