Care Home: Beech Gardens

What the care home does well Provides an excellent standard of care for service users. Provides a safe and homely environment for service users. Supports and encourages service users to lead an independent life according to their needs and strengths and to fulfil their potential as far as possible. Service users benefit from a committed and competent staff team that ensures continuity of care. Provides excellent opportunities for service users to experience an extensive range of activities and leisure pursuits. The manager and staff fully involve service users in all aspects of the running of the home. What has improved since the last inspection? Communication between staff and staff morale has improved which has further improved the care for service users. Service users are now more systematically involved in menu planning. What the care home could do better: Carry out periodic reviews of the staffing levels to ensure that the needs of service users are always paramount. Involve a dietitian to provide healthy eating instruction for service users. Ensure all staff feel valued by the organisation. To increase the availability of drivers to ensure that activities are not cancelled. Key inspection report Care homes for adults (18-65 years) Name: Address: Beech Gardens 1 Salmond Road Shinfield Park Reading Berkshire RG2 8QN     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: Sally Newman     Date: 1 2 0 5 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 26 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 26 Information about the care home Name of care home: Address: Beech Gardens 1 Salmond Road Shinfield Park Reading Berkshire RG2 8QN 01189868863 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Residential Community Care Limited Name of registered manager (if applicable) Mrs Dionne McGlinchey Type of registration: Number of places registered: care home 8 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 accomodated is: 8. 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 Beech Gardens is a detached house situated in a quiet residential area on the outskirts of Reading. It is on a main bus route and is close to local shops, pubs and leisure facilities. Beech Gardens is one of three homes in the local area owned by Residential Community Care. It provides accommodation and care for up to eight men and women aged between 18 years and 65 years whose main need for care arises from a learning Care Homes for Adults (18-65 years) Page 4 of 26 Over 65 0 8 Brief description of the care home disability. The home caters for people from various cultural and religious backgrounds. It has an equal opportunities policy in place. Fees for the home are £88,647.52 per annum. Care Homes for Adults (18-65 years) Page 5 of 26 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 an inspection conducted over the course of just short of 4 hours duration. Time was spent in discussion with the manager, two members of staff were spoken to in private and conversations were held with two service users. Observations of activities within the home were conducted and other staff and service users were spoken to briefly. A tour of the communal areas was undertaken, and a range of documentation was seen. Information provided by the service prior to the visit has been used in the evaluation of outcomes for service users. Four outcome areas were judged as excellent with the remaining four being considered as good. No recommendations or requirements were made as a result of this inspection. The provider has a range of policies and procedures relating to equality and diversity. From the evidence seen the inspector considers that this service would be able to provide a service that meets the needs of individuals of various religious, cultural and Care Homes for Adults (18-65 years) Page 6 of 26 racial needs. No complaints have been received by the Commission about this service since the last inspection. Care Homes for Adults (18-65 years) Page 7 of 26 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 26 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 9 of 26 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective service users and their representatives can be confident that they will be provided with the information necessary to determine whether the service will meet their needs. Evidence: Evidence was provided from examination of documentation, from information provided by the service prior to the visit and from discussion with the manager, staff and service users. 3 files were seen that were used to document information for service users admitted to the service within the last 12 months. These were detailed and provided sufficient information to enable staff to meet their needs. All 3 of these recent admissions were internal to the company and were already known to the service and the staff. However, each were individually assessed as to their needs and preferences to ensure that the process of transfer caused the least anxiety for each service user. The assessment process included regular meetings between managers to ensure that any changing needs were acted upon without delay. The manager confirmed that the assessment for any future external referral would be thorough to ensure that the service could meet that persons needs and that the transfer would be Care Homes for Adults (18-65 years) Page 10 of 26 Evidence: undertaken with the full involvement of the service user taking account of their wishes. The manager together with staff have implemented a DVD that includes images of the home, the staff and service users that can be used to provide visual information about the service for prospective service users and their representatives. Care Homes for Adults (18-65 years) Page 11 of 26 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. Individual service users are fully involved in decisions about their lives, and play an active role in the care and support they receive. Evidence: Information was obtained from examination of care plans and associated documentation, from information provided by the service prior to the visit, from discussion with the manager and staff and from talking to and observing service users. There are comprehensive care plans in place for each service user and 3 of these plans were reviewed in detail. There was evidence of clear goal planning involving the individual in their wishes and aspirations. Monthly reports are kept to monitor progress and to note any changes. All service users have a nominated key worker who takes responsibility for ensuring that their needs are met and that appointments and commitments are adhered to. Two of the current service users have an advocate who visits them on a periodic basis and who attends review meetings. Care Homes for Adults (18-65 years) Page 12 of 26 Evidence: There are regular service user meetings where individuals are encouraged to share their views and to comment on the running of the home. An example was provided where a service user had not felt comfortable with the term day care and had asked that this be changed to adult activities. This request had been acted upon without delay and evidence of this change in terminology was evident in paperwork seen. Service users are encouraged to participate in the recruitment of staff and are asked for their views formally through the use of satisfaction surveys. Risk assessments were seen within care plans and provided clear and useful direction for staff in relation to risks associated with individual service users. These were regularly reviewed with the involvement and participation of service users. Care Homes for Adults (18-65 years) Page 13 of 26 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. Individuals who use the service are supported to make choices about their lifestyle and are encouraged to develop their life skills. Social, educational, cultural and recreational activities are extensive and offer individual choice and meet aspirations and expectations. Evidence: A range of evidence was provided by the service to demonstrate that positive outcomes for individual service users is aspired to by the manager and staff in respect of their lifestyle. This evidence included information provided prior to the visit, a range of documentation maintained within the home, together with discussions with the manager, staff and service users. All service users have an individual timetable of activities that is reviewed together with the service user on a regular basis. The range of activities participated in is Care Homes for Adults (18-65 years) Page 14 of 26 Evidence: extensive and includes voluntary work, college attendance, day service attendance outside the home, day trips, individually tailored holidays and a wide range of leisure pursuits. An activities organiser employed by the provider visits the home twice per week in order to conduct activities and was present in the home and working with service users during the course of the inspection. Service users are supported to maintain family links and evidence of contact details and family information was clearly recorded within those care plans seen. The service does have access to its own vehicle and the home is situated close to local bus routes, which are used regularly by several service users. It was clear from observations and from discussion with staff and service users that the routines in the home are flexible and meet with individual preferences. There are no hard rules about about bedtimes or meal times and service users are able to decide for themselves whether to engage in activities or not. There are rules about smoking as a number of service users do smoke. However, these are agreed to by individual service users and are kept under review through the use of service user meetings. All service users can have a key to their bedroom if they wish and several do take advantage of this offer. Throughout the course of the visit staff were seen to address and interact with service users in a respectful and appropriate manner. The kitchen facilities were seen and were found to be clean and tidy. The kitchen is currently kept locked due to the risk it posed to one particular individual. This had been discussed and agreed with by the entire service user group and appropriate risk assessments were in place. Menus are planned on a monthly basis with service users. However, the manager confirmed that this was not rigidly adhered to if service users had changed timetables or collectively or individually wanted to eat an alternative. All service users had the opportunity to plan, shop and cook themselves a meal on a weekly basis. There were currently no specific dietary needs within the service user group but healthy eating and portion control was promoted. The last food safety report was seen, which had resulted in a 4 star award rating. Further documentation confirmed that regular checks are undertaken on food temperatures, fridge and freezer temperatures and food dates. Care Homes for Adults (18-65 years) Page 15 of 26 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 health and personal care needs of service users are met. The arrangements for medication are robust and protect service users. Evidence: The health and personal care needs of service users are clearly documented in their care plans. The range of health care professionals called upon to assist with meeting individual health care needs was provided within information made available by the service prior to the visit and included a wide range of health care professionals. This information was in evidence from examination of 3 care plans seen. The plans detailed individual needs comprehensively and recorded health care contacts. The advice given was incorporated into individual plans of care and where appropriate guidelines for staff had been provided. The medication storage facilities were seen within the staff office. An audit of the medication arrangements had been undertaken by the Primary Care Trust and standards relating to the storage, disposal and administration of medication had been consider to be met. All staff undertake medication training and the manager confirmed that within the service all staff are supervised and are signed off as competent before Care Homes for Adults (18-65 years) Page 16 of 26 Evidence: becoming administrators of medication. Care Homes for Adults (18-65 years) Page 17 of 26 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users can be confident that their views and concerns will be listened to and acted upon and that they are protected from abuse and neglect. Evidence: Information provided by the service prior to the visit confirmed that no complaints had been made about the service since the last inspection. The Commission has received no complaints or concerns about the service. It was apparent from discussion with service users that they felt able to raise concerns and that staff and the manager would respond without delay. The manager confirmed that service users are encouraged and supported to air their views both on an individual basis and within service user meetings. There is a robust complaints procedure that is made known to the respresentatives of service users and is available to service users in a range of formats to meet there particular communication needs. The manager confirmed that all staff had received instruction in the safeguarding of adults. This was confirmed by the two staff spoken to in private who demonstrated a sound understanding of the principles of safeguarding and the potential for abuse. The inter-agency policy on safeguarding adults was available in the home and the manager was clear about the action that needed to be taken should an allegation or suspicion of abuse come to her attention. Care Homes for Adults (18-65 years) Page 18 of 26 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users benefit from a well maintained and comfortable environment that is safe, clean and hygienic. Evidence: A tour of the communal areas was undertaken. All areas seen were tidy and clean. The manager confirmed that there is a rolling programme of replacement in place for furniture, fittings and decoration. There are two dedicated maintenance personnel employed by the organisation who provide a responsive and efficient service when maintenance issues arise. The home is well situated close to bus routes that provides access to the town centre and places of interest. There is a comprehensive cleaning schedule in place in which service users participate. Laundry facilities were seen and were considered to be adequate to meet the needs of the current service users. The manager confirmed that the principles for the Control of Substances Hazardous to Health are adhered to and are supported by comprehensive policies, documentation and staff training. Care Homes for Adults (18-65 years) Page 19 of 26 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. Service users benefit from the support of well trained and competent staff and are protected by the organisations policies on recruitment. Evidence: Information provided by the service indicated that all staff are subject to an extensive recruitment programme that complies with the regulations. This was confirmed by the manager who also stated that no current staff were subject to disciplinary procedures or had a criminal conviction. All prospective staff must complete an application form and are subject to written references and formal interview. All staff have individual training profiles and the manager confirmed that all staff had received training in core activities such as fire training, food hygiene and health and safety. 4 staff currently have achieved NVQ 2 qualifications and 1 member of staff has achieved an NVQ 3. The owner of the organisation is a qualified Psychologist. He provides staff training in a range of areas including challenging behaviour. More specialised training is provided for the Psychology graduates who work as care staff within the home. Overall the arrangements for staff training were described by those staff spoken to as very good. Staff spoken to confirmed that the staff team work well together, are supportive of Care Homes for Adults (18-65 years) Page 20 of 26 Evidence: each other and communicate and share the needs of service users efficiently. It was reported that staff handovers and the use of a single communication book ensured that important information was passed on. The home currently runs with a minimum of two staff on shift. It was reported that this number is generally sufficient but staff can feel stretched when issues arise or individual service users need extra attention. The manager confirmed that the deployment of staff is under constant review and that there are plans to fill the current two staff vacancies as soon as possible. Care Homes for Adults (18-65 years) Page 21 of 26 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. Service users benefit from a well run home where their views are taken into account with regard to the development of the service. Service users are protected by the homes policies and procedures for health and safety. Evidence: The manager has been in post since September 2008 and is now registered with the Commission. She has achieved an NVQ 4 and is currently working towards her Registered Managers Award. It was apparent from available evidence that she is competent, is well qualified and experienced in managing the home and has proved to be a valuable asset to the service. Staff found her to be supportive, approachable and felt that positive improvements to the home were in evidence since her appointment. The manager reported that she felt well supported by the organisation and was provided with sufficient resources to run the service and to ensure that service users needs were met. A quality assurance exercise is undertaken by the service on an annual basis. This takes the form of questionnaires that a distributed with professionals involved with the Care Homes for Adults (18-65 years) Page 22 of 26 Evidence: home, service users and their families or advocates. Results had recently been collated and indicated overall satisfaction with the service and these findings will be incorporated into the development plan for the service. There are robust health and safety practises within the home that are underpinned by comprehensive policies and procedures. A range of checks are undertaken and documentation was seen in respect of fire safety checks, hot water outlets, weekly electrical appliance checks and records that confirmed the regular changing of hand towels and cleaning schedules. Care Homes for Adults (18-65 years) Page 23 of 26 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 24 of 26 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 25 of 26 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. 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