Care Home: Adisham House

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What the care home does well The manager and staff team is stable and most are longstanding so they know service users well. Staffing is planned around peoples needs to ensure that people have support when they need it. People have their personal goals as well as their needs recorded and supported. There are plans in place which are reviewed regularly so staff know if they are giving the right support for people to achieve their goals. People have support to lead busy and ordinary lives and some people have jobs. Each person has a person centred plan detailing their hobbies and activity preferences. People told us that their hobbies and interests are supported. They support some complex health needs well by working closely with health professionals. The manager and staff spoke with knowledge, empathy and understanding of service users needs. The home is clean and smells fresh. There are different areas for people to spend time so they can choose privacy or to be in the company of others. There is access to the garden which is well maintained and has seating and patio areas. The home has good quality furniture and fittings and people spoken to said they are happy with their bedrooms. The manager has been managing the home for several years so knows staff and service users and their families well. The providers have been running the home for over twenty five years. The manager has experience and the required qualifications to manage the service. What has improved since the last inspection? The AQAA shows that there are lots of plans to improve the service for people. The range of activities on offer has been extended as there are more day care opportunities. Individual activities and hobbies are supported and they have improved individual person centred plans. Holidays are more individual rather than everyone going as a large group. The senior staff are being supported to learn supervisory management skills. All staff now have a personal development plan showing how the service plans to give them the training they need. The number of staff employed has been increased. Staff told us they have the training and support they need. There are long term plans to reduce one of the two double bedrooms to make it a single room. What the care home could do better: The manager has identified in the AQAA what could be better and has plans to improve outcomes for the people who use the service. The manager has also identified barriers to improvement and has some creative ideas about how to overcome these barriers so that the home continues to improve. We have made no requirements in this report. Key inspection report Care homes for adults (18-65 years) Name: Address: Adisham House Adisham House Pond Hill Adisham Canterbury Kent CT3 3LH     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: Kim Rogers     Date: 0 8 0 3 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 27 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 27 Information about the care home Name of care home: Address: Adisham House Adisham House Pond Hill Adisham Canterbury Kent CT3 3LH 01304840170 01304840170 adishamhouse@tiscali.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mr Jamie Paul Bishop,Mr William McGuinness care home 10 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 10 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 Adisham House provides personal care and support for up to ten adults with a learning disability. The home is situated in the rural village of Adisham, near Aylesham. The village amenities include two churches, a pub and a village hall. There is a main line railway station and in addition, buses provide links to the surrounding villages. There is ample parking space in front of the property. Care Homes for Adults (18-65 years) Page 4 of 27 Over 65 0 10 Brief description of the care home Accommodation is provided on three floors. There are six single rooms and two double rooms with long term plasn to reduce this to one double room. On the ground floor there is a toilet and shower room and on the first and second floors there is a bathroom. There is ample communal space consisting of a main lounge, small lounge and conservatory, which overlooks the garden. The home has extensive grounds, including an orchard and vegetable patch. The fee for the home ranges from about £479.00 to £650.00. For further information about the fees and what is included please contact the Provider. Care Homes for Adults (18-65 years) Page 5 of 27 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: This was a key inspection of the service and included an unannounced site visit by one inspector. We went to the home on a Monday morning, 08/03/10, and spent the morning talking to service users, the manager and staff and observing what was going on. We sampled records and had a look around some of the ground floor of the home. There was a very relaxed atmosphere with people choosing how to spend their day. The key minimum standards were assessed. The previous key inspection was carried on 24/04/07. This inspection was very positive with no requirements for improvement made. We have carried out two Annual Service Reviews since the last inspection. This is how we monitor services. The home is rated as excellent and we found that the home continues to provide an excellent service to the people who live there. Previous reports can be viewed on our website. We looked at the Annual Quality Assurance Assessment or AQAA that the manager Care Homes for Adults (18-65 years) Page 6 of 27 completed. This is very well completed and gives detailed information about what the home does well, what could be better and how they intend to improve. We looked at other information we have received about the home including any concerns, complaints and notifications about incidents or accidents. Care Homes for Adults (18-65 years) Page 7 of 27 What the care home does well: What has improved since the last inspection? What they could do better: The manager has identified in the AQAA what could be better and has plans to improve outcomes for the people who use the service. The manager has also identified barriers to improvement and has some creative ideas about how to overcome these barriers so that the home continues to improve. Care Homes for Adults (18-65 years) Page 8 of 27 We have made no requirements in this report. 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 9 of 27 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 10 of 27 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. Thorough assessments are carried out before a person moves in to make sure the home is right for them. People have information to help them decide about moving in and any move into the home is planned at the persons own pace. Evidence: No one has moved into the home for some time as there have been no vacancies. The current group of residents have lived together for a long time, some for twenty five years. The manager is aware of the need for a thorough detailed assessment before a person moves in. This is done to make sure that the staff have the skills needed to meet peoples needs and aspirations. The manager is aware of the need for people to be compatible so knows it is important for current service users to have a say about who might move in. Moves into the home would be planned at the persons pace. So trial stays and visits are offered with full involvement of the person and their family and friends. To help people decide, there is information available about the service. The manager said he plans to produce this in a user friendly format to make it more meaningful to future Care Homes for Adults (18-65 years) Page 11 of 27 Evidence: service users. Care Homes for Adults (18-65 years) Page 12 of 27 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. People have the support they need to lead the lives they want. People know that their needs including any risks will be supported. There are systems in place to support communication. Evidence: Each person has a service user plan that they have been involved in developing. The plan sets out peoples needs and personal goals for the future. It shows what staff need to do to give the right support. Plans are person centred in that the things people want out of life are identified, recorded and supported. People told us that staff give them the support they need. As part of the support plan, potential risks are identified and assessed. This means that staff have the information they need to reduce and where possible eliminate risks to people without restricting them. Detail about how people prefer to communicate is recorded. We observed staff Care Homes for Adults (18-65 years) Page 13 of 27 Evidence: communicating effectively with people. Staff said they know people well so they can usually tell if someone is not happy about something. Staff noticed when somebody wanted to have company and they stopped what they were doing and sat with the person talking to them and reassuring them. Care Homes for Adults (18-65 years) Page 14 of 27 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. Peoples individual hobbies and interests are supported. There are a wide range of activities on offer at home and in the community including employment opportunities. Relationships are maintained with family and friends. People enjoy a balanced healthy diet and are involved in planning and preparing meals. Evidence: People have support to take part in a wide range of activities when at home or out in the community. Support plans have peoples individual interests, hobbies and aspirations recorded with plans for staff to follow to ensure that people get the support they need. Some people go to college, day services and other community based activities. Other people go out to work and one person said they have a new job that they enjoy. People told us they lead busy lives. The manager said that staff are able to support individual interests and hobbies. Care Homes for Adults (18-65 years) Page 15 of 27 Evidence: People told us about their interests including church and clubs that they have support to attend. One person told us that they can choose how they spend their days, evenings and weekends. Individual holiday preferences are supported. Everyone has support to be involved in the running of the home and have support to take part in things like the household chores and the laundry. Service users are involved in planning and preparing meals. Special diets are catered for and people have the support they need to maintain a healthy weight. We observed one person being supported by staff discreetly and respectfully with their food and drink. There is a real feeling of inclusion with people eating and socialising together as a family. Most of the residents have known each other for a long time. People told us they are friends. There are close links with family and friends with regular visits to and from family members. People have support to keep in touch with family and friends by phone and letter. The provider and manager said they have known family members for several years and all get on very well. Care Homes for Adults (18-65 years) Page 16 of 27 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People know that their personal and health needs will be met by competent and knowledgeable staff. Medication practice is safe protecting service users. Evidence: The support people need with their personal care is recorded so that staff know how people prefer to be supported. People were dressed in clean and ironed clothes and everyone has their own style. Bedrooms and communal areas have bathrooms close by. We observed people being supported by staff discreetly and respectfully. The provider, manager and staff have good knowledge of peoples health needs and work closely with health professionals to ensure that people remain well and healthy. The provider said they have a very good relationship with the local GP practice and during the visit some people went to the doctors for a health check. Staff have training in areas related to peoples health needs. Health needs are assessed and recorded in a health action plan. This means that staff have the information they need to understand and support the various health needs that people have. We saw detailed records of the outcomes of health appointments. Care Homes for Adults (18-65 years) Page 17 of 27 Evidence: The AQAA shows that medication practice is safe. There have been no medication errors reported to us since our last review of the service. There are regular checks and audits to ensure practice remains safe. Storage is tidy and secure with systems in place to keep the keys to the medication secure. Staff have training and in house assessments before they can administer medication. Care Homes for Adults (18-65 years) Page 18 of 27 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples complaints are listened to and acted on. People are protected from harm and abuse and know who to talk to if they have a problem. Evidence: There is a complaints procedure that people can use. Monthly service user meetings give people an opportunity to bring up any issues or concerns they may have. There is an open atmosphere with the manager, provider and long standing staff available to sort out any problems. A service user told us that staff listen to them and treat them well. Staff have training in how to communicate with service users so they can find out if there is something wrong. Staff also know service users well so they can tell if there is a problem. Neither the home nor the Commission have received a complaint since the last inspection. There is a safeguarding policy and procedure that shows how they protect people from harm and abuse. Staff have training so they know how to recognise and respond to possible abuse. There are systems in place to protect peoples money. Care Homes for Adults (18-65 years) Page 19 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is clean and well maintained and continues to suit peoples needs. Evidence: We saw parts of the accommodation on the ground floor. There are different communal areas including a large conservatory overlooking the garden. This means that people have the opportunity to socialise and be together and they also have the opportunity to spend time with less people or be on their own. The communal areas are homely with photographs of residents on outings and holidays. There is access to the garden from the conservatory which has seating areas, lawn, a vegetable plot, shrubs and a patio area. Service users are encouraged to be involved in the household chores and gardening. All parts of the home are clean and smell fresh with good quality furniture and fittings that meet peoples needs. All of the bedrooms but two are single and have a bathroom and toilet close by. Bedrooms are all individual as they are all personalised. Care Homes for Adults (18-65 years) Page 20 of 27 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are enough trained and competent staff to meet peoples needs and support their goals. Recruitment checks are robust protecting service users. Evidence: Staffing at the home is organised around peoples needs. This means there are extra staff on duty when more people are at home so people get the support they need. Staff told us in the surveys we received that they think there is always enough staff on duty. Mandatory training including first aid and fire awareness is provided for all staff as well as training related to peoples needs including Dementia in people with a learning disability. There is a sound induction for new staff that gives them some underpinning knowledge of peoples needs. A new staff member told us they are working through their induction. Staff told us they have the training and support they need. Staff have the opportunity to attend regular staff meetings and one to one meetings with a line manager. This means that staff have the opportunity for some support, coaching and mentoring. There are handovers between shifts so staff know what has been happening. Care Homes for Adults (18-65 years) Page 21 of 27 Evidence: Most of the staff have worked at the home for several years and know service users well. Staff spoke to us with knowledge and understanding of peoples needs. We observed respectful and positive interactions between staff and service users. Recruitment checks are carried out before anyone starts work at the home. This ensures that people are safe to work with vulnerable adults. We received surveys from seven staff. They said, The home provides an excellent service and is very homely and safe. The staff team is knowledgeable and supportive combining youth with experience to deliver a high quality service. The food is of a high quality and choice, fresh meats and vegetables are always used and residents have a healthy varied diet. Outings and activities are done on a weekly basis. It provides an excellent home of first class facilities for comfort, safety and security. We foster and encourage choice and independence. Care Homes for Adults (18-65 years) Page 22 of 27 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 home is very well managed and is managed in service users best interests. People know that their health and safety is protected. Evidence: The same manager is in post as at the last inspection. The manager has been at the home for several years and has the qualifications and experience necessary. The manager is registered with us so he has passed our fit person process. Staff and service users said the manager is a good manager. One staff said the provider and the manager are approachable, you can always talk to them they said. The manager knows the service and the service users well. The manager spoke to us in detail and with understanding about peoples needs. There are systems in place to check the quality of the service and monitor practice. Service users views are sought and changes made based on their views. People have the opportunity to have one to one meetings with staff and meetings together so they can talk about how things are and staff know if they then need to make any changes. Care Homes for Adults (18-65 years) Page 23 of 27 Evidence: Families and friends are involved in giving feedback and airing their views about the service. Changes have been made based on peoples view including increasing the day opportunities for people. The AQAA shows that the required health and safety checks are carried out on the building and equipment. Staff have training in areas related to health and safety including first aid, food safety and fire awareness. The manager makes sure that staff are up to date with this mandatory training. Care Homes for Adults (18-65 years) Page 24 of 27 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 25 of 27 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 26 of 27 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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