Care Home: April Cottage

Similar services:

• Flint House
• Hillview Farm
• Dalewood Respite Care
• Orchard,The
• REACH Upton Court Road
• The Cotswold Home
• Fairways
• Treloar College

What the care home does well The quality of information within guests care plans provides clear information and guidance for staff about guest`s care and support needs. Guests are supported to take part in a variety of meaningful activities. A healthy diet is offered. The personal, health care and medication needs of guests are well met in order to promote their welfare and well being. Staff in the home are suitably trained and in sufficient numbers to support the guests in their care. Safe vetting practises have been maintained to ensure the protection and safety of guests. What has improved since the last inspection? The Statement of Purpose and the Service Users guide has been updated to include more photographs and pictorial information. The staff have developed more individual person centred plans. Reviews have taken place involving Day Centre Services and April Cottage guests and staff. Professional relationships with general practitioners and the local district nurses have been strengthened. The home has provided more activities both in the service and within the community. This has included day trips to the seaside and visits to local amenities using public transport and the April Cottage vehicle. Improved fund raising has enabled the purchasing of leisure items for example games, sensory equipment, toys, DVDs and Cd`s that guests have said they would like to have available. The garden is being further developed with a new area of plants and herbs. A recruitment group has been formed which guests are involved in and have a say about who is employed on the homes staff team. Seeking guests opinions and thoughts about the service has been expanded to include the use of a suggestion box, newsletter, meetings and Friends of April Cottage group. Staff have received further training regarding safe administration of medication and a change in the medication procedures further ensure guests safety and well being. The staff have improved some of the environmental aspects of the home which include a new television in the lounge, all the bedrooms have new co ordinating linens, towels and art work that were chosen with some of the guests and communal spaces have been decorated with paintings by the guests. Staff have received further training in Intensive Interaction, Makaton and Essential Lifestyle Plan facilitation and team days and supervision of staff have been strengthened. What the care home could do better: Arrangements must be made that the Statement of Purpose and Service User Guide be updated to include all details outlined within the Care Homes Regulations 2001 in order to ensure that any person has up to date information regarding the services and facilities offered by the home. Failure to comply with the requirement is an offence and may lead to enforcement action being considered. Arrangements must be made that the process of reviewing and documenting guests care and support needs and risk assessments each time they stay at the home must be reviewed and strengthened in order to ensure that guests current support, care needs and risk assessments are more robustly recorded to promote the guests welfare and well being. Arrangements must be made that guests rights to privacy, confidentiality are promoted at all times in order to further promote guests rights to privacy and respect. Arrangements must be made that the homes complaints procedure includes the name, address, and telephone number of the Care Quality Commission and any complaint or concern received by the home is clearly documented and actions taken to ensure that people`s views about the home are listened to and acted upon. Arrangements must be made that the home`s safeguarding procedures, including the home`s whistle blowing policy, be strengthened in order to ensure that guests rights to protection from abuse and harm are more fully promoted. Arrangements must be made that suitable provision for storage for the purposes of the care home and suitable storage facilities are provided for the use of guests. Arrangements must be made that the current bathing facilities be reviewed, for example the installation of a separate shower, in order to ensure that the premises provide sufficient numbers of baths and showers to meet the needs of guests, and facilities are fitted with a appropriate supply of hot and cold water to ensure the safety, well being and welfare of guests at the home. It has been required that the home must forward to the commission an improvement plan detailing how the home intends to improve the services provided to guests to ensure their safety and well being. Key inspection report Care homes for adults (18-65 years) Name: Address: April Cottage Ducklington Lane Witney Oxfordshire OX28 4TJ     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: Suzanne Magnier     Date: 2 7 0 1 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 35 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 35 Information about the care home Name of care home: Address: April Cottage Ducklington Lane Witney Oxfordshire OX28 4TJ 01993773832 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: jules.mckim@ridgeway.nhs.uk Oxfordshire Learning Disability NHS Trust care home 4 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability physical 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) Physical disability (PD). Date of last inspection Brief description of the care home April Cottage is a purpose built four bedroomed bungalow situated at the end of a private drive about a mile from Witney town centre. The home provides a short term respite care service for people with learning and physical disabilities who live with their families in the local area. The home is run and managed by the Ridgeway Partnership,(previously Oxfordshire Learning Disability NHS Trust) and is accessed only through referrals from the local authority care management. Care Homes for Adults (18-65 years) Page 4 of 35 2 3 0 2 2 0 0 9 4 4 Over 65 0 0 Brief description of the care home The bungalows communal facilities comprise of a dining room, lounge, kitchen, laundry and a bathroom. Each guest has their own private bedroom. The rooms are equipped with adaptations to assist with guests with physical difficulties and the home is fully accessible for guests who use wheelchairs. The home currently offers a weekly day care service to specfic guests during specfied times during the day. Care Homes for Adults (18-65 years) Page 5 of 35 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: The Quality rating for this service is 1 star. This means that the people who use the service experience adequate quality outcomes. The last inspection of the service was completed on the 23rd February 2009 This inspection of the care home was an announced Key Inspection. Ms S Magnier Regulation Inspector carried out the inspection and arrived at the service at 08.00 and left the service at 14.00. The service was represented by the person in charge who has been managing the home over the last four months due to the career break of the registered manager. The inspection was a thorough look at how well the service was meeting the Key National Minimum Standards for Care Homes for Younger Adults and has in this report made judgements about the standard of the service. For the purpose of the report the people using the service are referred to as guests. Surveys were sent from the Care Homes for Adults (18-65 years) Page 6 of 35 commission to the home to gain the views and opinions of guests and others associated with the home. The commission received eight completed written surveys written on behalf of the guests, four from guests relatives, four from staff and five from health care professionals. The comments of which have been included within the report. The person in charge had completed the Annual Quality Assurance Assessment AQAA which had been received by the commission within the timescales set. The information within the AQAA was discussed with the person in charge prior to the inspection, formed part of the inspection process and references from the AQAA have been included within this report. Additional information contained in this report was gathered from speaking with a number of guests and staff during the inspection. A tour of the premises was undertaken and documents sampled during the inspection included the homes Statement of Purpose and Service User Guide, two guests care plans, daily records and risk assessments, medication procedures, health and safety records, staff training and recruitment processes, and some of the homes policies and procedures. The final part of the inspection was spent giving feedback to the person in charge about the findings of the visit. No formal complaints have been received by the home about the services and facilities provided since the previous inspection. One safeguarding referral has been made which was satisfactorily concluded at the planning meeting stage. From the evidence seen by the inspector it is considered that the home would be able to provide a service to meet the needs of guests who have diverse religious, racial or cultural needs. The commission have noted that all requirements made during the last inspection in February 2009 have been complied with to improve the services to the guests receiving care and accommodation at the home. Care Homes for Adults (18-65 years) Page 7 of 35 What the care home does well: What has improved since the last inspection? The Statement of Purpose and the Service Users guide has been updated to include more photographs and pictorial information. The staff have developed more individual person centred plans. Reviews have taken place involving Day Centre Services and April Cottage guests and staff. Professional relationships with general practitioners and the local district nurses have been strengthened. The home has provided more activities both in the service and within the community. This has included day trips to the seaside and visits to local amenities using public transport and the April Cottage vehicle. Improved fund raising has enabled the purchasing of leisure items for example games, sensory equipment, toys, DVDs and Cds that guests have said they would like to have available. The garden is being further developed with a new area of plants and herbs. A recruitment group has been formed which guests are involved in and have a say about who is employed on the homes staff team. Seeking guests opinions and thoughts about the service has been expanded to include the use of a suggestion box, newsletter, meetings and Friends of April Cottage group. Staff have received further training regarding safe administration of medication and a change in the medication procedures further ensure guests safety and well being. The staff have improved some of the environmental aspects of the home which include a new television in the lounge, all the bedrooms have new co ordinating linens, towels Care Homes for Adults (18-65 years) Page 8 of 35 and art work that were chosen with some of the guests and communal spaces have been decorated with paintings by the guests. Staff have received further training in Intensive Interaction, Makaton and Essential Lifestyle Plan facilitation and team days and supervision of staff have been strengthened. 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. Care Homes for Adults (18-65 years) Page 9 of 35 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 10 of 35 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 11 of 35 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective guests who wish to have a short stay at the service are provided with some information to help them make an informed choice yet some information is not up to date. The assessment process of reviewing and documenting the care and support needs of guests each time they stay at the home must be reviewed and strengthened in order to ensure that the guests current support and care needs are more robustly recorded to promote guests welfare and well being. Evidence: The person in charge advised that the homes Statement of Purpose and Service Users Guide are available to prospective guests and their representatives. The documents were sampled and it was noted that they had been improved since the previous inspection and contained the written word, photographs and pictures to assist prospective guests and their representatives to make an informed choice about using the services and facilities offered by the home. During the previous inspection in February 2009 the commission were advised that the Care Homes for Adults (18-65 years) Page 12 of 35 Evidence: home were developing a video version of the Service Users Guide to support people who would prefer to use a video rather than a written document. The person in charge confirmed that this had not yet been completed. The Statement of Purpose evidenced during the inspection did not contain the current information regarding the change of the management arrangements. The Service User Guide was also sampled as not up to date and referred to the previous commission details. It has been required that arrangements must be made that the Statement of Purpose and Service Guide must be updated to include all details outlined within the Care Homes Regulations 2001 in order to ensure that any person has up to date information regarding the services and facilities offered by the home. Failure to comply with the requirement is an offence and may lead to enforcement action being considered. It was confirmed with the person in charge that all guests have a Community Care Assessment prior to using the service and guests allocation is undertaken equitably by following the Fair Access to Care guidelines. There was evidence to support that prospective guests and their representatives meet with staff to ensure that the care and support needs of the guest are undertaken in order to ensure that home has the appropriate facilities and staff are appropriately skilled and trained to support the guest during their stay at the home. Two care and support plans sampled of guests who regularly use the service were sampled. There was some evidence to indicate that the staff had reviewed the care needs of the guests yet the documents sampled were not well managed regarding clear documented review dates and included minimal information regarding any changes in the guests welfare and well being. This shortfall was discussed with the person in charge and it has been required that arrangements must be made that the process of reviewing and clearly documenting the care and support needs of guests each time they stay at the home must be strengthened in order to ensure that the guests current support and care needs are clearly documented to promote their welfare and well being. Care Homes for Adults (18-65 years) Page 13 of 35 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. The quality of information within guests care plans has improved and provides clear information and guidance for staff about guests care and support needs. The reviewing and updating procedures regarding guests risk assessments needs to be reviewed to further promote their safety and well being. Guests rights to confidentiality and respect need to be further promoted. Evidence: Two guests person centred care plans were sampled and it was noted that each contained well documented agreed working practises and guidelines for staff on how the guest liked to be addressed, their lifestyle preferences and what care and support they needed from staff during their stay at April Cottage. The person in charge advised that the staff have made efforts to involve guests in developing their care plans with staff and this was evidenced during the inspection with one guest showing the inspector their care plan which they had helped staff to create. Care Homes for Adults (18-65 years) Page 14 of 35 Evidence: During the previous inspection it was highlighted that the standard of information recorded to support all guests to use the service was inconsistent and a number of guidelines viewed had no date of completion, did not indicate whether they had been reviewed or whether they were relevant to individuals current needs. It was considered that the requirement had been met yet the home must sustain robust and accurate recording of guests support and care needs which includes the staff members full name regarding entries in guests daily living notes. Throughout the inspection it was observed that guests were supported and encouraged to make their own decisions about matters affecting their daily lives and one guest decided to stay in the home rather than go shopping. They confirmed that they enjoyed staying at April Cottage and had made a do not disturb sign for their bedroom door as they didnt like other people going into their room. The AQAA advises that guests can choose who they want to come in to stay with, who they wish to avoid as well as what they want to do while staying at April Cottage and if they have a favourite bedroom, this is recorded in their file. It was observed that some guests written information regarding their dietary requirements and also specific guidance for staff to adhere to when supporting the guest were displayed in the home either on the guests bedroom wall or adhered to the back of the kitchen cabinets. It was noted that one guest in the home knew about others specific needs. It has been required that the home review some of the current practises in order that arrangements are made that guests rights to privacy, confidentiality are promoted at all times. Documented risk assessments were sampled regarding hazards that had been identified in the guests daily life and what measures staff had put in place to ensure the guests safety as far as reasonably practicable. It was noted that where risk assessments had been reviewed and updated there was minimal information recorded and the review dates were not clear. It has been required that arrangements must be made that the process of reviewing the risk assessments of guests each time they stay at the home must be reviewed and strengthened in order to ensure that the guests safety and well being is promoted through a robust risk assessment process. Care Homes for Adults (18-65 years) Page 15 of 35 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. Guests are supported to take part in a variety of meaningful activities yet more scope of meaningful activities needs to be considered. A healthy diet is offered yet consistent recording of meals taken by guests needs to be strengthened. Evidence: All the guests appeared calm, happy and relaxed during the inspection and the atmosphere in the home was welcoming. Three guests went out with two of the care staff whilst another guest decided they wanted to stay at home and be part of the inspection and watch their favourite DVD on the television. The AQAA advises that the staff support guests to continue to take part in their interests and participate in attending local clubs and community settings which include visits to the shops, cafes and supermarkets and attending church services. Several Care Homes for Adults (18-65 years) Page 16 of 35 Evidence: guests continue to attend college, work place or day service. The commission received written comments from guests, some of which had been written on their behalf about the services provided by the home which included They look after me when mum is not there. I can meet my friends that stay at April Cottage and I can talk to my key worker. It would be better if they had more transport as I cant always go out if there is no driver, it would be good to do more in the evening like go to the pub. I like going to April Cottage everyone is very friendly and I have a good time there. . Its like staying in my own home, they keep me safe, theres good food, and I like having my own room to chill out in. The day time activities could be better and evening outings would be good. I like April Cottage and the staff. My relative thinks that the food has improved and thinks the staff are welcoming and caring. Cooks good food, makes me coffee and lets me watch good DVDs Comments from guests friends, health care professionals and relatives about the home stated They make the clients very welcome and treat them like friends visiting and staying over. Any requests for dates for respite care are given. Careful consideration is given to fix up for the times requested. April Cottage provides a safe and caring environment for respite care with opportunities for choice and activities. What they could do better is communication for carers to meet with staff to discuss individual needs and feedback concerns and information on the cared for persons stay. Also communication that is provided by email should be blind copied as not all carers will want their contact details shared and when a carer is requesting care it should be made clear not to reply to all by email. My relative loves it at April Cottage and calls it a second home, likes having their own room and the food, maybe getting a shower would be good. Our relative is very happy at April Cottage for their respite care. Usually three nights once a month. I would like to see more choice in activities on offer and the option of opt out or do something different people dont always want to go out en masse or do the same things. On arrival one guest was having their breakfast in the dining room. During the inspection no meal was prepared as only one guest was at home at the lunch time. The guest had a snack meal as they stated that is all they wanted and this was shared, in part, with the inspector whilst looking at the guests care plan with them. The person in charge advised that the home does not have a formal menu as the guests can choose what they would like and due to the transient nature of the service having a formal menu may result in food wastage as not all people may like the food on the menu. Staff advised that guests and staff continue to have their meals together and regular drinks and snacks are available and guests special dietary needs are Care Homes for Adults (18-65 years) Page 17 of 35 Evidence: catered for. It was observed, in the kitchen area, that the cereals were stored on top of a kitchen cabinet and were not accessible to guests and the person in charge advised that they would consider an alternative arrangement in order that guests could have access to the cereals and support if needed. The inspector sampled the documentation to describe what meals guests had had the previous day and the chart had not been consistently completed. Staff are reminded that records of all food provided for guests must be in sufficient detail to enable any person inspecting the record to determine whether the diet is satisfactory in relation to nutrition and any special diets prepared for individual guests. Care Homes for Adults (18-65 years) Page 18 of 35 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The personal,health care and medication needs of guests are well met in order to promote their welfare and well being. Evidence: Whilst speaking with one guest they told the inspector that they felt well looked after when they come to stay at April Cottage. Whilst sampling two care plans it was evident that the guests received personal and health care support using a person centred plan approach and that the guests wishes and feelings were taken into account regarding their lifestyle preferences. There was documented evidence to support that the guests relatives and friends had been consulted regarding the guests needs and specific requests for example gender specific care had been taken into consideration. Each guests personal health care needs were clearly documented and evidence of health care appointments were documented to evidence that the guest had received specific health care when necessary to promote their well being and welfare. Written comments from guests and their relatives about the care they receive at April Cottage Care Homes for Adults (18-65 years) Page 19 of 35 Evidence: included The care and well being for me is good, and everything I need seems to be catered for.My relative is always happy to go to April Cottage, they are always welcomed with a happy greeting and when I collect them they are always fed and clean and most important to me smiling. I always feel happy and confident to leave my relative in the care of April Cottage staff The person in charge advised that over the last several months the staffing rotas have been reviewed in order to provide a service which is led by guests needs rather than the guests fitting around the service which has offered guests a flexible, consistent person centred reliable service. The service has continued to have professional working relationships with a variety of health care professional including general practitioners, district nurses, dietitians and speech and language therapists. Written comments from health care professionals included The home is very responsive to the needs of individual, there is good liaison with other professionals and they provide a welcoming and friendly atmosphere and cope well with emergency placements. The home do well in the monitoring of guests well being and seeking clarification of information if staff are unclear. The home is accommodating to last minute or emergency respite care. I found the homes staff to be helpful in recently setting up some urgent day time support for a client whilst their family was away. I have found April Cottage to be positive and proactive in setting up support. The home pays attention to the specific health needs of the individuals who use April Cottage. What they could do better is to enhance working relationships with key stake holders. I have worked alongside April Cottage mostly involving emergency respite being required. On each occasion I have found the manager and her predecessor to be very helpful and accommodating. Staff continue to help guests to look after their medication. Guests medicines are held securely in locked medicine cabinets located in each bedroom and specific medicines kept in a locked fridge within the homes kitchen. It was confirmed that no controlled medication was stored within the home. The home continues to use a standard medication administration record (MAR) which is handwritten and signed by the guests general practitioner. The person in charge confirmed that staff are trained and assessed to ensure they are competent to administer medication. One notification regarding a medication error had been notified to the commission and action taken immediately to safeguard the guest. Care Homes for Adults (18-65 years) Page 20 of 35 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Guests or others associated with the home do not have up to date information about how to make a complaint to be assured that there concerns or complaints would be acted upon. Guests are not fully protected from abuse or harm through robust safeguarding protocols. Evidence: The complaints procedure sampled during the inspection was colourful and in large print to inform the complainant how to raise a complaint if they were dissatisfied with the service provided. It was noted that the complaints procedure referred to previous regulation commissions and did not offer the complainant up to date information regarding the contact details of the Care Quality Commission. The person in charge confirmed that the home had not received any concerns or complaints. There was no documented process available to summarise how a concern or complaint, received by the home, would be logged to indicate the nature of the concern or complaint, what actions would be taken to address the concern or complaint or the outcome should one be received. It has been required that arrangements must be made that the homes complaints procedure includes the name, address, and telephone number of the Care Quality Commission and any complaint or concern received by the home is clearly documented and actions taken to ensure that peoples views about the home are listened to and acted upon. Care Homes for Adults (18-65 years) Page 21 of 35 Evidence: The person in charge confirmed that one safeguarding referral had been made to the local authority which had been closed at the planning meeting stage. Whilst sampling a care plan a staff member had identified a guests unexplained bruising and it was concluded that the home had not completed an accident or incident form or reported the observation in accordance with the homes accident and incident reporting procedures. The person in charge confirmed that the home does have robust reporting systems yet these had not been undertaken at the time of the observation. The training matrix supplied to the commission following the inspection evidenced that staff receive safeguarding vulnerable adults training. The safeguarding flowchart for reporting allegation was out of date and there was no clear and concise documentation available within the home during the inspection, to illustrate what actions staff should take if they had concerns about an allegation of abuse or harm. The person in charge confirmed, following the inspection, that the home have guidance within a staff booklet yet it was their view it would benefit from being made simpler for staff to follow. No staff were readily available to speak with during the inspection regarding their understanding of protection issues and how to respond to allegations. The homes whistle blowing policy and procedure was dated 2006 and indicated to be reviewed in 2008. It has been required that arrangements be made that the homes safeguarding procedures, including the homes whistle blowing policy, be strengthened in order to ensure that guests rights to protection from abuse and harm are more fully promoted. Care Homes for Adults (18-65 years) Page 22 of 35 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service provides a homely environment for its guests. Arrangements regarding suitable storage facilities in the home and the current bathing facilities and water supply in the home must be reviewed in order to ensure the comfort and safety of all guests who use the service. Evidence: Guests have continued to be offered a comfortable and homely place to stay during their respite care. One guest showed the inspector their room and said they like to have that room when they stay because they like the colour. They said they would like to have a waste paper bin in their room and would also like to have a calendar in the kitchen. The communal areas of the home were comfortable, well maintained and clean. The home has specialist adaptations including overhead hoists and profiling beds in three of the four individual bedrooms. Wash hand basin facilities are available in the guests bedrooms and all the rooms sampled were well furnished and offered a comfortable private space for each guest with a locking facility on each bedroom door. During the previous inspection in February 2009 a recommendation was made that the Care Homes for Adults (18-65 years) Page 23 of 35 Evidence: storage facilities of the home be reviewed and it was noted that storage space in the home remained limited for example in the kitchen area where food stuffs and equipment were stored on top of cupboards, and portable hoists and wheelchairs were not stored appropriately causing a potential hazard. It has been required that suitable provision is made for storage for the purposes of the care home and suitable storage facilities are provided for the use of guests. Written comments from people associated with the home included The cottage is often cold overnight especially and quite often there isnt sufficient hot water for my relative to have a bath. Although the cottage is generally clean the soft furnishings and furniture are rather tired looking could do with a make over.More space would be good. During the previous inspection in February 2009 a recommendation was made that the layout of the bathroom should be reviewed to ensure that all guests who stay at April Cottage can use the bathing facilities. It was noted that the home has one bathroom which consists of a bath, incorporating a hand held shower facility and a toilet. The bath is positioned close to a wall to offer access on either side and has an overhead tracking system. The guests who reside for short respite care breaks at April Cottage have generally complex individual needs and the current bathing facilities do not offer immediate access, choice or promotion of guests independence. Additionally several staff and a guest told the inspector that there wasnt enough hot water when they had a bath and they had to wait for the hot water to be available at certain times during the day. It has been required that the current bathing facilities be reviewed, for example the installation of a separate shower, in order to ensure that the premises provide sufficient numbers of baths and showers to meet the needs of guests, and which are fitted with a appropriate supply of hot and cold water to ensure the safety, well being and welfare of guests at the home. During the tour of the home it was noted that staff had placed soiled laundry on the laundry floor which when brought to their attention was promptly placed within a laundry basket. Staff were reminded of their duty to ensure that the control of infection in the home is well managed and records indicated that staff had received control of infection training. Hygiene equipment was available within the home and health and safety records maintained. Care Homes for Adults (18-65 years) Page 24 of 35 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 in the home are suitably trained and in sufficient numbers to support the guests in their care. Safe vetting practises have been maintained to ensure the protection and safety of guests. Evidence: The person in charge advised that no new staff had been employed by the home following the previous inspection in February 2009 and the home has nine care staff. The staffing levels at the home during the inspection were appropriate to meet the needs of the current guests staying at the home. Staff demonstrated open and professional relationships with guests and were knowledgeable regarding the support, lifestyle and communication styles of guests. Written comments received by people associated to the home regarding the staff included The staff are very understanding and approachable at all times. The staff are very good and its a warm welcoming place to stay. Guests spoken with during the inspection confirmed that the staff were nice and that the guests felt happy staying at the home. Staff comments The service users that use April Cottage love being here and the staff Care Homes for Adults (18-65 years) Page 25 of 35 Evidence: are very dedicated. There is a lovely home environment and all the food is freshly cooked and they are fed well. The staff are supportive of each other which makes for a good team and we always try to take service users out on a weekend. The problem with April Cottage is that it is too small we would like additional facilities for example more storage space, a sensory room. I like working at April Cottage. We provide good quality care and promote independence and we do not discriminate against anyone who uses the service, we provide a home from home and teach living skills, we receive positive remarks from friends and families of service users and keep them informed, We keep thorough care plans to give the best care we can. It would be good to have more time to review files and to give one to one support, better bathroom facilities especially a shower and funding for service users to give more staff who are more in need of support regarding their complex needs. The home is small and we are in desperate need for expansion especially for a bathroom. The home has a homely feel, relaxed for guests, its clean, theres good teamwork. If we had more budget we could achieve more for example a sensory room, storage for equipment, the staff ratio to clients would be better so clients could have more choice in what they do, we could also have more stationary and arts and crafts so clients would not have to be reliant on staff providing such things. The home is very person centred and we try to make people feel at home and relaxed. We listen to families and try to work alongside their routines. We need more storage space for equipment. The home have set up a guest recruitment group in order that guests are involved in the recruitment of staff to the home. No recruitment files were sampled during the inspection as no new staff had been employed. The person in charge confirmed that an agreement had been established with the provider to ensure that the service has retained a checklist of information to demonstrate that appropriate information had been received in relation to the employment all staff to ensure the safety and well being of guests. The staff training matrix supplied to the commission following the inspection indicated that staff receive appropriate mandatory training in order to support the guests in their care and refresher training remains ongoing. Care Homes for Adults (18-65 years) Page 26 of 35 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 generally well managed and staff work as team, which benefits all guests who use the service. The home has systems in place to monitor the quality of care and to ensure that standards are being maintained. The health and safety of all persons in the home is promoted through general health and safety checks. Evidence: The commission had been advised that the registered manager has taken a career break and was due to return to the service in January 2010 and was currently working in another setting within the organisation. The person in charge is currently managing the home on a day to day basis and has been in post for four months. They advised that the organisation is undergoing some managerial restructuring and another manager will be deployed to the home to offer additional support. It was uncertain during the inspection of the intentions of the registered provider regarding the ongoing management arrangements of the home and these details will be required as part of the improvement plan requested by the commission to demonstrate a robust management structure in order to continue to offer a well managed and planned Care Homes for Adults (18-65 years) Page 27 of 35 Evidence: service to guests. One guest told the inspector that they liked the person in charge and would like them to stay. It was observed that staff were professional in their response to the person in charge and staff supervisions and team meetings ensured ongoing professional relations. There was evidence to support that guests have a forum where they can raise any concerns or ideas for improvement in the home. Documentation sampled evidenced that an external manager to the home visits the home and undertakes a monthly quality assurance audit which looks at aspects of the service provided. Whilst sampling the documentation it was noted that there was no evidence to support that guests were spoken with at this time and their views and opinions of the home sought. There was a limited section within the audit to detail any shortfalls in the quality of the service and improvements could be considered regarding the documentation of the action taken to rectify the shortfalls and how the shortfalls are relayed to the registered provider. It was observed during the inspection that all staff maintained the correct procedures that chemicals were stored appropriately and safely under the control of chemicals hazardous to health guidelines. It was noted that fire fighting and moving and handling equipment had been regularly serviced and fire and water temperature safety records had been maintained. Some accident and incident records were sampled which indicated that events which affect the well being and welfare of guests are reported to the commission under the Regulation 37 notification and the service were reminded of their responsibility to report events without delay. It has been acknowledged by the commission that some overall improvements have been made in the home yet as recorded throughout the report a number of aspects of the home are potentially putting the health, safety and welfare of guests at risk. The shortfalls include the lack of an up to date Statement of Purpose and Service User Guide, the lack of a clear process of reviewing and documenting the care, support needs and risk assessments of guests each time they stay at the home, lack of promotion of guests rights to privacy, confidentiality at all times, lack of a clear and up to date complaints and safeguarding policy and procedure and lack of suitable storage provision, inadequate water supply and suitable bathing facilities to meet the range of guests needs. Care Homes for Adults (18-65 years) Page 28 of 35 Evidence: It has been required that the home must forward to the commission an improvement plan detailing how the home intends to improve the services provided to guests to ensure their safety and well being. Care Homes for Adults (18-65 years) Page 29 of 35 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 30 of 35 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 1 6 Arrangements must be 31/03/2010 made that the Statement of Purpose and Service Guide be updated to include all details outlined within the Care Homes Regulations 2001. In order to ensure that people have up to date information regarding the services and facilities offered by the home. Failure to comply with the requirement is an offence and may lead to enforcement action being considered. Arrangements must be made that the process of reviewing and documenting the care and support needs of guests each time they stay at the home must be reviewed and strengthened. In order to ensure that guests current support and 30/06/2010 2 2 14 Care Homes for Adults (18-65 years) Page 31 of 35 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 care needs are more robustly recorded to ensure the guests welfare and well being. 3 9 13 Arrangements must be made that the process of reviewing and documenting the risk assessments of guests each time they stay at the home must be reviewed and strengthened. In order to ensure that the guests safety and well being is promoted through a robust recorded risk assessment process. Arrangements must be made that guests rights to privacy and confidentiality be further promoted at all times. 30/06/2010 4 10 12 31/03/2010 In order to further promote guests rights to respect and privacy. 5 22 22 Arrangements must be 30/06/2010 made that the homes complaints procedure includes the name, address, and telephone number of the Care Quality Commission and any complaint or concern received by the Care Homes for Adults (18-65 years) Page 32 of 35 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 home is clearly documented and actions recorded. To ensure that peoples views about the home are listened to and acted upon. 6 23 13 Arrangements must be made that the homes safeguarding procedures, including the homes whistle blowing policy, be strengthened. In order to ensure that guests rights to protection from abuse and harm are more fully promoted. 30/06/2010 7 24 23 Arrangements must be 30/06/2010 made that suitable provision for storage for the purposes of the care home and suitable storage facilities are provided for the use of guests. In order to ensure that the homes environment is well managed and safe for guests at all times. 8 27 23 Arrangements must be made that the current bathing facilities be reviewed, for example the installation of a separate shower. In order to ensure that the premises provide sufficient 30/06/2010 Care Homes for Adults (18-65 years) Page 33 of 35 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 numbers of baths and showers to meet the needs of guests, and which are fitted with a appropriate supply of hot and cold water to ensure the safety, well being and welfare of guests at the home. 9 42 24A The home must forward to the commission an improvement plan. Detailing how the home intends to improve the services provided to guests to ensure their safety and well being. 30/06/2010 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 34 of 35 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 35 of 35 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!