Care Home: Bishop Herbert House

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What the care home does well The Home provides comfortable accommodation to the service users. Adaptations have been made to the Home over the last few years so that it provides accommodation which meets the needs of service users with a physical disability. All service users have their own, ensuite, bedrooms with overhead tracking. There are also assisted bathrooms in addition to the ensuite facilities. The Home is located close to the city of Norwich and the service users are supported to make use of the many facilities there. Service users are supported to attend day centres, adult education, employment and leisure facilities. The Home continues to provide respite care for up to three service users at a time. Many of the service users are well known by the staff as they have stayed at the Home on several occasions. The staff work hard to meet the service users needs. What has improved since the last inspection? The views of the service users are sought on a more regular basis. Service users are encouraged to speak to staff at any time if not happy about something. There are also more formal ways of doing this, such as during care plan reviews, during the service users meetings or by talking to the person appointed to carry out monthly visits to the Home. The problems with one of the bathrooms have now been addressed. The Home has been without a permanent Manager for the last 18 months although there has been an acting manager in post. A new permanent Manager has been appointed and has very recently taken up her post. What the care home could do better: There have been some difficulties in providing a consistent staff team over the last year. This has been due to a specific situation which has now been resolved. Staff report that the morale in the staff team has improved. There have been several medication errors over the last year and this situation needs to be addressed as a matter of urgency. There are several areas of training which staff have not received and this also needs to be addressed. Key inspection report Care homes for adults (18-65 years) Name: Address: Bishop Herbert House 34 Globe Place Norwich Norfolk NR2 2SG     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: Lella Hudson     Date: 0 8 1 2 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 24 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 24 Information about the care home Name of care home: Address: Bishop Herbert House 34 Globe Place Norwich Norfolk NR2 2SG 01603620710 01603623654 bishopherbert.socs@norfolk.gov.uk www.norfolk.gov.uk Norfolk County CouncilCommunity Care care home 14 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 physical disability Additional conditions: The maximum number of service users who can be accommodated is: 14 The registered person may provide the following category of service only: Care Home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Physical disability - Code PD Date of last inspection Brief description of the care home Bishop Herbert House is owned and managed by Norfolk Social Services. It provides accommodation for up to fourteen adults with a physical disability. There are currently eleven permanent places and three respite care places. The providers have informed the Commission that the Home will eventually be providing respite care only. The home is not admitting any new permanent residents. Accommodation is on the ground floor only and there is level access throughout the building. The home has recently undergone major refurbishment work. All service users in the home have en suite accommodation that is equipped and maintained to a high standard. Care Homes for Adults (18-65 years) Page 4 of 24 Over 65 0 14 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: This report contains information gathered about the service since the last inspection activity (January 2009). It includes information gathered during an unannounced visit to the Home which was carried out on the 8th December 2009. During this visit we spoke to the new Manager, to staff and to service users. We were shown around the Home and also looked at a selection of records. The Home has been managed by an Acting Manager for the last 18 months but he has now returned to his original role as Care Co-ordinator and a new Manager has been appointed. It was the Managers second day in her new role on the day of our unannounced visit. Due to unforeseen circumstances this report has been written by an Inspector who was not present during the visit to the Home. However, it has been written in conjunction with the Inspector who did carry out the visit. Care Homes for Adults (18-65 years) Page 5 of 24 Care Homes for Adults (18-65 years) Page 6 of 24 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. Care Homes for Adults (18-65 years) Page 7 of 24 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 24 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 24 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is written information available about the service provided at the Home. Prospective service users needs are assessed prior to them being offered a place at the Home. Evidence: The Home has a Statement of Purpose which is regularly updated to reflect changes in the service provided. This will now need to be updated to reflect the appointment of a new Manager. Following an enquiry for respite care a full assessment of the individuals needs is carried out. This includes gathering information from the service user, relatives if appropriate and any health/social care professionals involved in their care. Care Homes for Adults (18-65 years) Page 10 of 24 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The care plans would benefit from further detail to ensure that they provide clear guidance to staff about how to meet individuals needs. The views of the service users are sought about a range of issues. Evidence: We looked at a selection of care plans. These are put together once the initial assessments have been completed. There is evidence that these have been reviewed and updated, however we saw some areas in which this had not taken place as regularly as it should have been. For example, we saw one care plan that had not had monthly reviews completed. There was also an example within this care plan of information not being clear enough to ensure that the service user received care/support in a consistent way. The care plan stated that the service user should be monitored with no guidance about what staff should be looking for and what they should do about any concerns. Care Homes for Adults (18-65 years) Page 11 of 24 Evidence: Another care plan identified that the service user had issues relating to their nutritional needs but the monthly weight charts were not completed on a regular basis. There is evidence within the care plans that the service users are involved in the process of completing these and in the reviews. There is evidence in some of the care plans of the wishes and preferences of the service user, although this was missing in one of the care plans that we looked at. We also noted that the daily notes are not being completed on a daily basis and were told by staff that this is because they do not always have time to do so. As the Home provides a service to service users staying for short periods of respite care the staff update the care plans prior to individuals arriving at the Home with regard to any changes in the care needed. The Home has a monthly meeting for service users and minutes are kept of these. Service users told us that their views are taken into account about issues relating to their care and to the running of the Home. The Home recognises the importance of effective communication to enable service users to make their own choices and decisions. Some of the staff have completed Communication training but this was over two years ago. One of the care plans that we saw contained detailed information about the form of communication used by the service user. Care Homes for Adults (18-65 years) Page 12 of 24 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The nutritional needs of the service users are met and they are offered a choice at mealtimes. The service users are supported to take part in a range of meaningful activities. Evidence: The Home is situated in the city of Norwich and therefore is close to the amenities that are provided there. The Home does not have a vehicle but due to its proximity to local facilities this does not appear to be a problem to service users. We saw that the locality of the Home had been identified as a positive aspect of the Home during a recent Regulation 26 report. We were also told this by service users. Service users receive support from staff, if needed, to take part in a range of activities. These include adult education, attendance at day centres, leisure, hobbies and attendance at religious services. Care Homes for Adults (18-65 years) Page 13 of 24 Evidence: Within the Home there is a room used for craft and computer activities. The service users have internet access if they wish to use it. The cook has a good understanding of the nutritional needs of the service users and has information about the specific issues relating to individuals. Additional nutritional supplements are provided as necessary. Service users are involved in the planning of menus and of making choices about what they have to eat. Service users told us that they have a choice of meals and that there are always snacks and drinks available. Care Homes for Adults (18-65 years) Page 14 of 24 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service users receive personal care in a way which meets their needs. Medication is not managed safely. Evidence: As previously stated, the care plans contain information about how to meet service users individual needs but some of these would benefit from being more detailed to ensure that residents receive care/support in a consistent way. There is evidence within the care plans that the service users are supported to attend appointments with health and social care professionals involved in their care. There is evidence within the care records, and through discussions with staff, that the Mental Capacity Act and the Deprivation of Liberty Act is considered in some instances, however, very few staff have attended training about these issues. There have been at least 10 medication errors notified to the Commission in the last twelve months. Despite increased monitoring and action taken to provide additional training the errors have still occured. The new Manager is aware of the seriousness of this situation and will be discussing with senior managers to address the situation Care Homes for Adults (18-65 years) Page 15 of 24 Evidence: satisfactorarily. Care Homes for Adults (18-65 years) Page 16 of 24 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Complaints are taken seriously and action taken to address issues. Procedures and staff training are in place to provide protection to service users from abuse. Evidence: The Home has a complaints procedure which is on display. Service users are encouraged to raise concerns/complaints at any time with staff. This is also encouraged during more formal situations such as care plan reviews, service user meetings and during the monthly Regulation 26 visits. We can see from the Regulation 26 reports that the person carrying out the visit always talks to service users during this time and records their comments. Staff receive Safeguarding training during their induction and formal training every three years. Staff would benefit from more regular updates about Safeguarding and the Whistleblowing policy. Care Homes for Adults (18-65 years) Page 17 of 24 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Home provides comfortable accommodation which has been adapted to meet the needs of service users with a phsyical disability. Evidence: The Home has undergone major refurbishment over the last few years and provides accommodation which meets the needs of service users with a physical disability. Each service user has their own, ensuite, bedroom and all rooms have overhead tracking. There are two assisted bathrooms. The ongoing problems with one of the baths has now been addressed. The Home has two dining areas and two lounges. There is also a computer/craft room for service users to use. The Home does not have a garden but there are small courtyards which are enclosed. Care Homes for Adults (18-65 years) Page 18 of 24 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There have been difficulties with providing consistent staffing in the Home but this situation has now been addressed. Staff receive training but there are areas of training that are not being kept updated. Evidence: The usual staffing levels for the Home is that there are usually one care co-ordinator, two support workers and two care assistants on duty during the day. Three of the service users have 1:1 hours which are provided in addition to the usual staffing levels. The Home also has domestic and catering staff. On occasion the staffing levels may be slightly reduced if there are less service users having respite at the Home. Recently there has been a higher than usual use of bank and agency staff due to staff sickness and staff leaving employment at the Home. A situation that has caused a lot of challenges for staff has now been resolved and it is expected that the staffing situation will become more stable as a result. Staff receive induction provided by Norfolk Social Services training department and then receive updates of mandatory training as well as specialised training. According Care Homes for Adults (18-65 years) Page 19 of 24 Evidence: to the training matrix there are some areas in which staff have not yet received training, such as Fire Safety and Moving and Handling. The new Manager has plans to address this situation as a matter of urgency. Care Homes for Adults (18-65 years) Page 20 of 24 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There has recently been changes in the management of the Home and a new Manager has just been appointed. The views of the service users are sought in a range of ways. Health and safety issues are addressed. Evidence: One of the care co-ordinators has been acting as the Manager for the last 18 months but has recently returned to his original role. A new Manager has been appointed and our visit coincided with her second day in her new role. The new Manager is enthusiastic about taking on this role and is already aware of some of the issues that need to be addressed. Monthly visits take place as per Regulation 26 and the person carrying out this visit talks to staff and service users during their time at the Home. The organisation has a range of ways in which the service is audited. Regular maintenance and servicing of equipment takes place. Health and safety issues are addressed appropriately. Care Homes for Adults (18-65 years) Page 21 of 24 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 22 of 24 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 20 13 It is required that medication is managed safely To ensure that service users receive the correct medicines and at appropriate times. 26/02/2010 2 35 18 It is required that all staff receive appropriate training, both in mandatory and specialist areas. To ensure that staff have right skills and training to meet the needs of service users 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 23 of 24 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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