Care Home: Bethia Cottage

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What the care home does well People who use the service are assessed before they receive a service of care and support in the home, and they are provided with information about the home and support workers in order to decide whether or not their needs can be met there. People have their needs and changing needs recorded in a plan of care, which takes into consideration their individual differences. They are encouraged to make their own decisions about daily life as much as possible, which may involve taking risks in order to achieve independence. However these risks are reduced where possible. People take part in appropriate community based activities and pastimes within the home or in the community, they enjoy relationships of their choosing with good advice coming from support workers, and have their rights and responsibilities as citizens upheld wherever possible. People also enjoy a variety of meals, usually of their choosing, and assist in the provision of and preparation of food wherever possible. People enjoy a lot of outings where meals feature as part of the activity or entertainment. People are unable to say they receive the help and support with personal care and with physical and emotional health needs in a way that suits them, but they demonstrate satisfaction with the support on a daily basis by interacting with support workers and accepting the care on offer while using body language to inform support workers of their preferences and choices. People are well protected by the homes systems for controlling and administering medication. They have their views in the form of body language or cooperation, listened to and they can make representations or concerns and complaints known to support workers or the manager in this way. Family members are confident they can represent people any time. People live in a very homely environment that is clean and suits their preferences. Competent and qualified support workers care for people in their daily lives and in sufficient numbers to meet their needs. Support workers are well recruited so people are cared for by safe staff. The home manager is newly registered since the last key inspection and provides consistent leadership. There is a good quality assurance system in place which self-monitors the service provided. The health, safety and welfare of people and support workers are well promoted and protected. What has improved since the last inspection? Reviews of care plans are now more regularly carried out and multi-agency meetings are now better used for agreeing any limitations recorded in care plans. There has been some recent health screening for people and new health action plans are being compiled for everyone with input from the district nursing services. There are now written protocols in place for when people require as and when medication, and all staff are receiving competence assessments regarding their ability to administer medications safely on a regular basis with the company`s `L-Box` computer training systems. One of the en-suite baths that was broken at the last key inspection has been repaired, there is a maintenance and renewal plan in place now and individual staff training and development plans are also in place. What the care home could do better: The service could make sure only one body map form is used each time an injury or a rash etc. to a person is detected. The form should also contain information about any known accident that has caused the injury. This is so the manager or senior staff can decide if the information warrants an alerter being made to the safeguarding adults team, and so people are confident they are being protected from abuse. The service could consider deciding in line with the Hull & East Riding safeguarding protocols in use, on when the information recorded on body map forms is to be passed to the appropriate safeguarding adult`s teams on an alerter form, so people are confident they are protected from abuse, neglect or self-harm. The service could consider using the spare land to the rear of the house to make it more interesting and less of an eye sore. The garden surface could be more even and the gate onto the car park could be more secure so everyone can have unsupervised safe access to the grounds. Finally the service could ensure a three yearly legionella bacteria test is carried out on the hot water storage system, so people are confident they are protected from the risk of infection. Key inspection report Care homes for adults (18-65 years) Name: Address: Bethia Cottage Lelley Road Preston Hull East Yorkshire HU12 8TX     The quality rating for this care home is:   two star good 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: Janet Lamb     Date: 2 9 0 7 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 30 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 30 Information about the care home Name of care home: Address: Bethia Cottage Lelley Road Preston Hull East Yorkshire HU12 8TX 01482891108 01482891781 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): www.milburycare.com Milbury Care Services Ltd Name of registered manager (if applicable) Mr Carl Ince Type of registration: Number of places registered: care home 5 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: Registered for 5 service users in category LD, some or all of whom may have a physical disability Date of last inspection Brief description of the care home Bethia Cottage is a purpose built home situated a mile or so outside the village of Preston, which itself is some 6 miles from the City of Kingston upon Hull. There is no public transport service to or from the premises. The site where Bethia Cottage stands is also where Garfield Grange and Ashlyn, a twobuilding respite service, is located. Bethia Cottage provides care and accommodation for longer term placements, however. Bethia Cottage, opened in August 2005, provides permanent care and accommodation Care Homes for Adults (18-65 years) Page 4 of 30 Over 65 0 5 Brief description of the care home to a maximum of five people. The large detached building has five single bedrooms, one with an en-suite facility. People in the other four bedrooms share bathing and toilet facilities between two. There are sufficient communal areas and a large garden provided with outdoor seating. All facilities are on the ground floor. The small upper floor accommodation is used for staff purposes only. Specialist lifting, moving and safety equipment is provided as necessary throughout the entire home. Bethia Cottage is for adults with a learning disability and associated health and behavioural problems, including some challenging behaviour. The staff seek to provide an holistic regime offering personal care, help, advice and guidance with daily living skills and activities, a catering service, a laundry service and domestic and cleaning services. Activities are offered both on and off site. The property is owned by Voyage who also provide the care input. The weekly fees for living at Bethia Cottage are around £1,500.00 per person. This information was obtained from the manager at the time of the site visit. Information on the service, in the form of a statement of purpose and a service user guide can be obtained from the manager upon request. Care Homes for Adults (18-65 years) Page 5 of 30 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: two star good 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 Key Inspection of Bethia Cottage has taken place over a period of time and involved sending a request to complete an annual quality assurance assessment (AQAA) in May 2009, containing information about people who use the service and support workers and details of the homes policies, procedures and practices. The Commission received the requested information at the beginning of June 2009 and survey questionnaires were sent to all five people living in the home, to three health care professionals and five support workers working there. Of these surveys none were returned from the people in the home, but all five support worker surveys and one health care professional survey was returned. All of the information obtained from surveys, from notifications received and information already known from having had contact with the home since the last key inspection was used to suggest what it must be like living there. Care Homes for Adults (18-65 years) Page 6 of 30 Then on 29th July 2009 Janet Lamb made a site visit to the home to test these suggestions and to interview people, support workers, visitors and the home manager if available. Some documents were viewed with permission from those people they concerned and some records were also looked at. The communal areas of the home were viewed along with all five bedrooms. There were no people who use the service interviewed but the manager was interviewed and three support workers were spoken to during the site visit to seek information. What was said was checked against the information obtained through questionnaires and details already known because of previous information gathering and contact with the home. Judgements were made using the information and some of the evidence used at the last inspection to say what it is like living in the home. This report shows those findings and judgements. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated it is likely that enforcement action will be taken. Care Homes for Adults (18-65 years) Page 7 of 30 What the care home does well: What has improved since the last inspection? Reviews of care plans are now more regularly carried out and multi-agency meetings are now better used for agreeing any limitations recorded in care plans. There has been some recent health screening for people and new health action plans are being compiled for everyone with input from the district nursing services. There are now written protocols in place for when people require as and when Care Homes for Adults (18-65 years) Page 8 of 30 medication, and all staff are receiving competence assessments regarding their ability to administer medications safely on a regular basis with the companys L-Box computer training systems. One of the en-suite baths that was broken at the last key inspection has been repaired, there is a maintenance and renewal plan in place now and individual staff training and development plans are also in place. 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 9 of 30 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are well assessed before they move into the home, received good information on what it is like living there, and have good security of tenure in a contract of residence, so they know their needs will be met. Evidence: Discussion with the registered manager, staff and two visitors and viewing of peoples case files, records and documents shows the home continues to have suitable systems for providing information about the home, assessing needs, and providing contracts of residence. Since June 2008 there has been a new pre-assessment of need document in place, which is in pictorial format. However, this is yet to be used as no new admissions to the home have been made since before then. What is available as evidence of assessments being carried out is a company care assessment form and the placing local authority community care assessment form. The home gathers information on personal care, preferences and daily routine, Care Homes for Adults (18-65 years) Page 11 of 30 Evidence: activities, likes, significant people, mobility, social skills, communication, health, medication, diet, allergies, finances etc., in order to devise a support plan. Two files were viewed in which this was evidenced. A relative spoken with confirms they received information in the form of a statement of purpose and a service user guide from the home and that they were able to look around and spend time in the home before committing to letting their daughter live there. Contracts of residence with Voyage are available and held in peoples bedrooms. Care Homes for Adults (18-65 years) Page 12 of 30 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. People are well supported through the use of good care and support plans. They are fully included in decision making and take well managed, reduced risks to realise their potential and meet their needs. Evidence: Discussion with the manager and staff and viewing of case files, records and documents and observation of interactions between people and between people and staff shows people make their own decisions, have helpful support plans and take reduced risks. There are good support plans in evidence in case files that cover personal details, preferences and daily routine, significant people, professional support workers involved, likes and hobbies, a weekly plan of activities, communication passport, health, medication, allergies, diet and finances. Also there are individual support plan risk assessments in place attached to the support plans. These cover physical health, communication, mobility, personal care, relationships, friends, medicines, social skills, Care Homes for Adults (18-65 years) Page 13 of 30 Evidence: finances, activities and holidays, living skills, culture, spiritual experiences, behaviour, decision making, mental health and ageing, illness and death. Daily diary notes show what care and support has been given on a shift by shift basis. Once a shift has ended staff sign support plans and risk assessment documents to show they have adhered to them, though there are some 80 risk assessment sheets to sign each time, and this is a somewhat cumbersome task. There are also review log sheets for each area of the support plan, which staff sign on a monthly basis to show plans are reviewed regularly. Everyone in the home was seen making choices about the food on offer. There had been a plan to go out for the day to a market in Hull and have lunch out, but the weather being extremely wet and the arrival of a Commission Inspector resulted in a change of plan, so lunch became fish and chips from the local take away, with a selection of yogurts, fruit and cereal bars, and fudge for one person, for dessert. People were seen making refusals and asking for help with opening packets or peeling fruit etc. Risks were discussed and though risk assessments are used to reduce risk for people they sometimes cannot be reduced. For example one person likes to walk around the garden but parts of the path are sloping and her mobility is unable to cope with this. In the section on environment Voyage is asked to consider making the garden and paths more suitable for use by everyone. Care Homes for Adults (18-65 years) Page 14 of 30 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. People enjoy good opportunities to take part in varied activities and pastimes in the home and in the community. They are well supported to make and enjoy appropriate relationships, and to exercise their rights. They benefit from good nutritious meals of their choosing. Evidence: Discussion with the manager, staff and visitors, viewing of records and observation of interactions between people shows there are good opportunities for being involved in the community, building and maintaining relationships, and keeping routines flexible. People also have varied opportunities to enjoy food in different settings. No one living in the home undertakes any formal education or has a job, but they do take full advantage of community life. People visit shops and pubs in Hedon and Preston, and visit markets, shopping centres, cinema, theatre, bowling, parks etc. in Care Homes for Adults (18-65 years) Page 15 of 30 Evidence: Hull. They also go to York for the lavender fields, Goole for the Sobriety Project, Pickering and Goathland for rides on the steam railway, and Sewerby Park and such as Knowsley Safari Park to see the animals. People go out to somewhere and do something every day. People are encouraged to maintain good relationships with family and friends and staff will facilitate contact between them. There is a regular interaction group held during which people and staff have fun together, playing music, dancing, dressing up maybe, and generally enjoying themselves. One visitor spoken with confirms she is always told of events and happenings for her daughter, and is made very welcome any time she calls in to see her. She is also happy with the opportunities for outings and activities, wherever they are carried out. She says people have an opportunity to take a holiday away or spend several day trips out, as has been the case for people in the home this year. She says her daughter is very lucky as she gets to go away each year with her family as well. Routines tend to follow support plan needs at the beginning of the day in respect of rising, bathing, having breakfast and so on. Then people usually go out for the day for pleasure activities, to have lunch or to browse round the shops. While at home people are encouraged to join in with some household tasks, polishing, removing plates from table, tidying rooms, but all of this is done spontaneously if people feel like helping. Bedrooms are usually locked to prevent people going in the wrong room, but people are given access to their own room whenever they request it. People are offered opportunities to develop living skills and personal skills by joining in with some of the tasks staff carry out or by enjoying an activity that requires such skills. All events, activities and pastimes, and celebrations are captured in photographs, which are currently on the homes computer, but are soon to be in photograph albums for people to view. Daily diary records and activity records also show where people go and what they do. Meal provision is very relaxed and a social event. Breakfast is usually at home and taken once a person has risen and prepared for the day, lunch is very often taken out at cafes, restaurants etc. and tea is also taken at home. One hot cooked meal a day is provided either in the home at tea time or while out on activities. Menus are decided daily, spontaneously and nothing is set in stone. People eat together in the large kitchen dining room and are supported by staff throughout, who sit at table with them. The lunch of fish and chips brought in from a local take away, because of the poor weather and short notice of cancellation of the days plans, was eaten in a very relaxed atmosphere. Care Homes for Adults (18-65 years) Page 16 of 30 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. People receive good personal care and support to meet their needs and have good, relevant support and health care plans in place to assist staff in meeting their needs. People benefit from robust and safe systems for handling medication. Evidence: Discussion with the manager and staff and viewing of support plans, health action plans and some records, and observing medicines administered shows people receive good support with their personal and health care and that medication is appropriately handled. Staff follow support plans that record peoples individual wishes regarding their daily routine and how they prefer care and support to be given. Support plans are based on the person centred model of care and are reviewed monthly on paper and six monthly in conjunction with people that also have an interest in the person they refer to. There are also person centred health care plans being compiled at present, though only one persons is completed so far. The home used to use a Healthy Me document to record and monitor health care needs, but these are being replaced. There is also a hospital admission pack for each person should they need to be admitted to hospital, a medical Care Homes for Adults (18-65 years) Page 17 of 30 Evidence: card, a health visitor record, a general health check record, and monthly reports on health, held in files. Staff are observant when assisting with personal care and with detecting health problems. They complete a body map form to show any detected rashes, bruises or marks, but they use only one form for several problems that are detected at different times and date them. Not all rashes, bruises, marks were dated on the form viewed. There should be a separate form completed for every time a problem with a persons body is detected and it must be dated. Information could also be listed on the body map form and refer readers to the accident record if the injury ties in with a known accident. This is a recommendation of this report. Medication is well handled. The home uses a monitored dosage system supplied by East Riding Pharmacy in Hedon. Most people take medicines in liquid form due to their disabilities, and sometimes it is thickened for even easier swallowing. Practice of giving out medicines follows procedure, the person and the tablets to be taken are identified, tablets are popped out of their pack or liquids are measured from their bottle, items are taken to the person, the person is assisted to take them, with a spoon usually, and then staff sign the medication administration record sheets. The cupboard in the office where medicines are taken from is locked each time one persons medicines are removed from it, and unlocked again for the next person. Medicines to be returned, if any, are recorded in the home and signed for on collection. Staff have been trained in medication administration through the Mulberry House system in the past, but new training is being delivered via Voyage computer systems at the moment and so new medication administration competence checks are being carried out. This will be evidenced with new training certificates. Care Homes for Adults (18-65 years) Page 18 of 30 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have good opportunities to make their complaints known and to have them properly resolved. People are well protected from abuse, neglect or self-harm because of good systems in place to refer any incidents or allegations to the appropriate safeguarding teams. Evidence: Discussion with the manager, staff and a visitor, and viewing of the homes documents and records shows there are satisfactory systems in place for people to make complaints and to have safeguarding referrals made. Voyage has a complaint policy, procedure and guidelines in place and the procedure is also in easy read pictorial format for people in the home. There is a record of all complaints held and only one has been received at the home since the last key inspection. It concerned one of the pieces of hoist tracking equipment in a persons room that was awaiting a new part. The complaint was satisfactorily resolved. Staff say they are confident about passing on concerns to the manager or a senior and that they would instigate the formal complaint procedure for any serious complaint made to them. One visitor spoken with is well aware of the complaint procedure, would discuss issues with the manager first and would not hesitate to make a formal complaint if needed. She says information has been supplied to her in writing about making complaints, though she cannot recall the document it was supplied in. Care Homes for Adults (18-65 years) Page 19 of 30 Evidence: Voyage also has a safeguarding policy, procedure and guidelines in place that adheres to the Hull & East Riding Safeguarding Adults Board protocols. Staff have completed safeguarding training in the past with the Mulberry House training package, but Voyage has a new computer training system that delivers protection of vulnerable adults awareness and this has been completed on line by all but two of the staff now. It is planned that staff will complete the Voyage training on safeguarding every two years. Records of this training must be kept as evidence of staff competence in understanding, handling and referring safeguarding issues. There has been no safeguarding referral to the local authority in the last twelve months according to records held. The Commission would just ask the registered provider and manager to consider deciding, in line with the established and agreed Hull & East Riding safeguarding protocols and guidelines in use, on when the information recorded on body map forms is to be passed to the appropriate safeguarding adults team on an alerter form, as there looks to be some information about bruises and grazes seen on one form that maybe ought to have been referred. Care Homes for Adults (18-65 years) Page 20 of 30 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. People live in good environment, that is homely, comfortable and safe. It is also clean and hygienic. Evidence: Discussion with the manager and staff and viewing of some records and inspection of the premises shows the standards in this section continue to be met. There is a minor recommendation made about the land to the property and about access to the garden for all people living in the home. The premises are purpose built on ground floor level and are suitable for providing care and accommodation to people with a learning disability, and some mild physical disability. The service caters for long term care only and people have lived there since the home opened, a number of years ago. Rooms are all single with a shared en-suite bathroom between two people, and one person is lucky enough to have their own bathroom. There is also a large shower room that meets the standards of the Disability Discrimination Act 1995. Space clearly meets required standards of the Commission. The home is safe, comfortable, bright, clean and free from odours. There is no easy Care Homes for Adults (18-65 years) Page 21 of 30 Evidence: access to local shops or amenities as the home is built a couple of miles outside of the town of Hedon and the village of Preston, and apart from one other property very close by there are no immediate neighbours. The setting is very rural. There is shared car parking space with the property next door for approximately nine cars. The home is accessible internally to people using wheelchairs, but the grounds are not so good because of narrow paths and some uneven ground to one side of the house, which makes the garden unsafe for one person in particular. This person is also able to open the gate on the path to the side of the house, again making it unsafe for her to go in the garden unaccompanied. People can access the car park in their wheelchairs of course and with the support of staff, and so they are able to leave the premises by vehicle. There is a planned maintenance and renewal programme in place, as recommended at the last key inspection, and the plan is to redecorate the home internally and to create a sensory area within the garden in the near future. There is a very large area of land belonging to the property that is fenced off for safety, but which still looks untidy and is disused, as mentioned at the last key inspection. It would be very beneficial to people living in the home if the land could be used as livery for ponies, or to hold other livestock, chickens, goats, rabbits etc. The land would then be suitably used and less of an eye sore, and be an area of interest to people. The home is clean and free from odours and the laundry is in sound condition with suitable equipment for sluicing and drying. It meets the Water Supply (Water Fittings) Regulations 1999. Staff have done infection control training and the Voyage computer training now has a new infection control package for staff to complete on a two yearly basis. Care Homes for Adults (18-65 years) Page 22 of 30 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. People benefit from sufficient numbers of staff on duty at all times to meet their needs, and from well recruited, qualified and trained staff. Evidence: Discussion with the manager and staff and viewing of staff files and some records shows the staff team are appropriately recruited, trained and qualified and work in sufficient numbers to meet peoples needs. Staff employed are of mixed ages, though all female apart from the manager. This is appropriate though as all people living in the home are females. New staff undertake an induction programme and complete Skills for Care recommended mandatory training. Staff also undertake NVQ level 2 and 3, there now being 75 of them with the award. Staff interviewed confirm they have NVQ qualifications. There are usually a minimum of three care staff on each shift with the manager available to assist as necessary. From observation of people looking relaxed, clean, comfortable and content, and no one making any specific demands, peoples needs seem to be satisfactorily met. Staff were constantly busy over the lunch time meal assisting people to eat, fetching and clearing etc., but everyone in the home received the time and attention they needed to satisfy them. There is one care staff vacancy at Care Homes for Adults (18-65 years) Page 23 of 30 Evidence: the moment and this is soon to be filled, as recruitment is underway. There hasnt been any increase in staffing levels for some time, but the manager is confident levels are good and peoples needs are being met. There is a recruitment policy, procedure and practices in place and these are followed. One staff file seen in detail has evidence of a job application form, two references, an initial security check and a full security check clearance number. The security clearance had no date recorded so another file was viewed and again no date. These files are from a previous time period when just the clearance number and a name was kept. Two more recent files had checklist records that showed the date of the security clearances. Practice has clearly improved with the new manager. There is dated evidence of induction done and a start date. The manager is tightening up on maintaining of recruitment records. Training opportunities are improving with the introduction of Voyages L Box training programme, which is done on line. It requires staff to go through a series of steps to demonstrate competence and knowledge in a subject, but staff report there are some flaws in the programmes. They say a fail is recorded if there is a spelling mistake in an answer, something they were initially unaware of. They say the L Box programmes are making people anxious and causing them stress at times. Maybe some reading should be done by staff or a talk be given to them before they work on the programmes. Training done via the L Box covers health and safety, food hygiene, medication administration, first aid, induction, infection control and safeguarding adults. The medication course is also followed by an observation of the staff giving out medications three times before they are signed off as being competent. L Box competence checking is to be done every year. Other courses to be checked every two years are flagged up by the system. There is also a training matrix in the office, which shows identified training needs and when courses have been completed. Care Homes for Adults (18-65 years) Page 24 of 30 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have an experienced and soon to be qualified registered manager managing the home, who does so in the best interests of the people living there. People benefit from an effective quality assurance system and have their health, safety and welfare well promoted and protected. Evidence: Discussion with the manager and staff and viewing of some of the homes records, documents and certificates shows the home is still well managed, there are still good systems in place to monitor performance, and the health, safety and welfare of people and staff are still promoted and protected. There is a new registered manager in post since February 2009. He has several years managerial experience with people with a learning disability. He has NVQ level 3 and 4 in Care and is to begin the Leadership and Management course in Health & Social Care in September 2009. People say in surveys that he is approachable and has an open door policy at all times. He says of himself that he often joins in with hands-on care and support for people and would not ask any carer to do what he would not do. Care Homes for Adults (18-65 years) Page 25 of 30 Evidence: There is a quality assurance system in place that is operated from Voyage head quarters. There have been no changes to the systems since the last key inspection in 2007. It involves the carrying out of regulation 26 visits and reports, holding a monthly service review and an annual service review, sending out of surveys to relatives and other stakeholders, and monthly audits of the actual service delivery. Areas covered in surveys to seek peoples opinions are environment, personal care, activities, relationships, cleanliness, privacy, choices and decisions. There are systems in place to monitor and maintain the overall safety within the home. Some areas sampled for this inspection include lifting equipment, fire safety, gas and electrics, water storage and outlets, and accidents and reporting of them. There is tracking system lifting equipment installed all through the house, and bath hoists, electrical beds, and hydraulic Hi-Lo baths are available and used. There is no passenger lift, as home is all on ground floor level. A contract lifting safety company, Arjo Mecanaids, last maintained all tracking system lifting equipment, hoists and Hi-Lo baths in June 2009. Staff are instructed in the use of lifting aids via a lifting and handling trainer. The fire safety system was last checked March 2009. The electrical hard wiring safety check was last done Dec 2005 and is due again in Dec 2010 on a five year cycle. The last portable appliance testing, PAT, was carried out on equipment in October 2008. Pinnacle last checked the oil fuelled systems in June 2009, as there is no gas supply on the site. All hot water outlets have thermostatic control valves and these are tested regularly. There is a legionella risk assessment in place since July 2007, but no evidence of a water test having been carried out. This is a recommendation of this report. The building is only four years old and so there is no asbestosis on site. Shower heads are descalled every three months and recorded and the tank water temperature is checked and the tank is chlorinated every six months. Accidents are recorded on Data Protection Act compliant records. RIDDOR is followed when necessary and the last reported accident was in June 2007 when one of the people living in the home fell at the bowling alley and their hit face on the alley guide rails, breaking her jaw. The same person had a more recent accident in March 2009, which was reported under a regulation 37 notification. She fell against a plastic plant pot and sustained a cut to her eye. Care Homes for Adults (18-65 years) Page 26 of 30 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 27 of 30 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 1 19 The registered provider should make sure only one body map form is used each time an injury or a rash etc. to a person is detected. The form should also contain information about any known accident that has caused the injury. This is so the manager or senior staff can decide if the information warrants an alerter being made to the safeguarding adults team, and so people are confident they are being protected from abuse. The registered provider and manager should consider deciding in line with the Hull & ER safeguarding protocols in use, on when the information recorded on body map forms is to be passed to the appropriate safeguarding adults teams on an alerter form, so people are confident they are protected from abuse, neglect or self-harm. The registered person should consider using the spare land to the rear of the house to make it more interesting and less of an eye sore. The garden surface could be more even and the gate onto the car park could be more secure so everyone can have unsupervised safe access to the grounds. The registered provider should ensure a three yearly Page 28 of 30 2 23 3 24 4 42 Care Homes for Adults (18-65 years) 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 legionella bacteria test is carried out on the hot water storage system, so people are confident they are protected from the risk of infection. Care Homes for Adults (18-65 years) Page 29 of 30 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. 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