Care Home: Blake Court

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What the care home does well The vast majority of the comments we received from the customers and staff at Blake Court was in the main very positive about the quality of the service provided there. Typical comments, included, - `i like living here... i think i would like to stay`, `most of the staff are great`, and `staff morale has definitely improved now we have a permanent manager and deputy on site again.` It was evident from all the comments we received from customers and staff about the way Scope dealt with the recent and unexpected death of a customer that this tragic event was handled extremely sensitively and in accordance with this individual and their next of kins wishes. All the staff we met, including the team coordinator and visiting area manager, were observed interacting with the customers in a very kind, respectful, and professional manner. The atmosphere also remained extremely friendly and relaxed throughout the course of this four hour site visit. What has improved since the last inspection? The single biggest barrier to improvement Blake Court has faced in recent years has been the long term absence of its former registered manager. For reasons often beyond the providers control Scope ended up using four different managers over a nine month period as temporary cover. The different leadership styles and approaches of these generally very experienced and competent temporary managers, and the short periods of time they were in charge, ultimately meant none of them were able to significantly improve customer and staff morale, or the overall quality and consistency of the care and support provided at Blake Court. It was therefore positively noted that as we had required in the services last inspection reports a new suitably qualified, competent and experienced manager and team coordinator are now in permanent day-to-day charge of Blake Court. It was evident from all the feedback we received from customers and staff that the new management team has had a very positive impact on the life and morale of all the people who both live and work at Blake Court. Typical feedback we received, included -`we like the new managers, you can talk to them about anything`, and `ther place has definitely improved in the last six months.` All six of the outstanding requirements made in the services previous two inspection reports have been met in full and the vast majority of good practice recommendations implemented: The services statement of purpose has been reviewed and up dated to reflect all the changes that have occurred within Blake Court in the past six months. Care plans have been significantly improved and are now much more person centred and contain far greater detail regarding the support customers require from staff to ensure their unique personal and social needs and wishes are always met. The way the service consults and ensures customers views are taken into account when decisions about how Blake Court is run on a day-to-day basis have improved (e.g. customers have one-to-one meetings with their keyworkers every month and are invited to complete satisfaction surveys every year). The new health care action plans have been introduced for staff to record the health care needs, preferences, and outcome of all the appointments each customer attends with various community based health care professionals. This ensures anyone authorised to inspect these records can determine whether or not a customers health care needs and wishes are being properly monitored and met. The service almost has a full compliment of staff, which includes a manager and hos deputy, which ensures Blake court is no longer over reliant on temporary agency staff who are not so familiar with the customers needs and preferences. Sufficient numbers of staff have now attended preventing and managing infection control, Mental Capacity Act, and complaints resolution training. Furthermore, one hundred of the permanent staff team have now achieved an National Vocational Qualification in care - level 2 or above. The new team coordinator has also received training from Scope in respect of her new management role and responsibilities. The way the staff duty roster is planned has been made more flexible and is clearly based on the needs and wished of the customers and not staff needs lead. Finally, the service has improved the support staff receive by increasing the number of opportunities they have to attend one-to-one supervision sessions with their new manager and/or Team Coordinator, as well as group meetings with their fellow peers. What the care home could do better: All the positive comments outlined above about all the improvements made by the new manager and the team coordinator in the past six months the providers do accept the service remains far from perfect. We have made one new requirement for the service to address and four good practise recommendations for them to consider implementing: The providers must ensure all staff that work at Blake Court participate in at least one fire drill every six months or receive instruction in how to evacuate the service safely and quickly. This will ensure all the staff who work at Blake Court have all the knowledge and skills they need to keep the customers and their guests safe in the event of fire. The services Guide should be written in plain language and generally made easier to read to ensure customers and their representatives can access all the information they need to know about the services and facilities provided at Blake Court, including fees charged for them. Person centred care planning training should be provided to all staff that work at the service. This will ensure support to customers is provided in a person centred way which meets their unique needs, strengths and preferences. This good practice recommendation was made in the services last key inspection report, but was not implemented. All the customers who are willing to look after their own medication should be encouraged to do so within an appropriate risk framework, the outcome of which should be recorded and kept in an individuals care plan. This will ensure the rights of the customers to make informed choices and to live their life as independently as they can are respected. The providers should establish a time specific action plan to redecorate the office. Key inspection report Care homes for adults (18-65 years) Name: Address: Blake Court 5a Barrow Road Flat 5 Waddon Croydon Surrey CR0 4EZ     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: Lee Willis     Date: 2 6 0 5 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 29 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 29 Information about the care home Name of care home: Address: Blake Court 5a Barrow Road Flat 5 Waddon Croydon Surrey CR0 4EZ 02086882682 02086882682 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): www.scope.org.uk Scope Name of registered manager (if applicable) Mrs Carol Jones Type of registration: Number of places registered: care home 6 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 8 The registered person may provide the following category of service only: Care Home Only (CRH - 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 - Code LD Date of last inspection Brief description of the care home Blake Court provides accommodation and personal support for up to seven adults with Cerebral Palsy and associated physical disabilities. The five self-contained flats that make up Blake are owned by Croydon Churchs Housing Association, but are managed and staffed by the registered charity Scope. Care Homes for Adults (18-65 years) Page 4 of 29 Over 65 0 6 Brief description of the care home The services new permanent manager Dan Lipscoombe, who is also responsible for running another Scope service in the area, has been in operational day-to-day charge since being appointed in September (2009). Located in the Waddon area of South Croydon the service is relatively close to a wide variety of good leisure and community facilities. The service is also close to a number of very good bus, and rail links with excellent connections to London and the areas surrounding Croydon. The five self-contained flats that make up Blake all have there own front doors which open out onto a well maintained old converted church courtyard. Each flat has a large open plan lounge/kitchen area, separate bedroom, and en-suite toilet and bathing facilities. The flats have also been suitably adapted to meet the individually assessed needs and wishes of everyone who lives at Blake Court, as well as maximise their independence. All the flats are wheelchair accessible. There is a separate office located within the complex, which has its own kitchen, toilet and shower facilities, and sleep-in room for staff. All the people who use the service, which we refer to as customers throughout this report, have all been provided with copies of a Statement of Purpose and Guide that tells them what services and facilities they can expect to be offered at Blake Court and how much they will be charged for them. Fees currently range between £39,000£63,200 a year for each placement. Care Homes for Adults (18-65 years) Page 5 of 29 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 quality of life for the customers who live at Blake court has significantly improved in the past six months since the appointment of a new permanent manager and his deputy (referred to as the team coordinator throughout the rest of this report). As a result we have increased this services quality rating from one star adequate to two star good. From all the available evidence gathered during the inspection process it was clear Blake Court now has more strengths than areas of weaknesses, and we our confident the new management team will continue to recognise where further improvement is required and take the appropriate action where necessary. We spent four hours at the service, during which time we spoke at length to two of the customers, the new team coordinator, two support workers, and a visiting area manager who was also carrying out an internal quality assurance inspection for Scope. We also looked at various records and documents, including the care plans, risk assessments, and health action plans for the two customers we met. The remainder of Care Homes for Adults (18-65 years) Page 6 of 29 the visit was spent visiting flats. We would like to thank all the stakeholders who took the time and trouble to participate in the inspection process and and feedback to us. Care Homes for Adults (18-65 years) Page 7 of 29 What the care home does well: What has improved since the last inspection? The single biggest barrier to improvement Blake Court has faced in recent years has been the long term absence of its former registered manager. For reasons often beyond the providers control Scope ended up using four different managers over a nine month period as temporary cover. The different leadership styles and approaches of these generally very experienced and competent temporary managers, and the short periods of time they were in charge, ultimately meant none of them were able to significantly improve customer and staff morale, or the overall quality and consistency of the care and support provided at Blake Court. It was therefore positively noted that as we had required in the services last inspection reports a new suitably qualified, competent and experienced manager and team coordinator are now in permanent day-to-day charge of Blake Court. It was evident from all the feedback we received from customers and staff that the new management team has had a very positive impact on the life and morale of all the people who both live and work at Blake Court. Typical feedback we received, included -we like the new managers, you can talk to them about anything, and ther place has definitely improved in the last six months. All six of the outstanding requirements made in the services previous two inspection reports have been met in full and the vast majority of good practice recommendations implemented: The services statement of purpose has been reviewed and up dated to reflect all the changes that have occurred within Blake Court in the past six months. Care plans have been significantly improved and are now much more person centred and contain far greater detail regarding the support customers require from staff to ensure their unique personal and social needs and wishes are always met. The way the service consults and ensures customers views are taken into account when decisions about how Blake Court is run on a day-to-day basis have improved Care Homes for Adults (18-65 years) Page 8 of 29 (e.g. customers have one-to-one meetings with their keyworkers every month and are invited to complete satisfaction surveys every year). The new health care action plans have been introduced for staff to record the health care needs, preferences, and outcome of all the appointments each customer attends with various community based health care professionals. This ensures anyone authorised to inspect these records can determine whether or not a customers health care needs and wishes are being properly monitored and met. The service almost has a full compliment of staff, which includes a manager and hos deputy, which ensures Blake court is no longer over reliant on temporary agency staff who are not so familiar with the customers needs and preferences. Sufficient numbers of staff have now attended preventing and managing infection control, Mental Capacity Act, and complaints resolution training. Furthermore, one hundred of the permanent staff team have now achieved an National Vocational Qualification in care - level 2 or above. The new team coordinator has also received training from Scope in respect of her new management role and responsibilities. The way the staff duty roster is planned has been made more flexible and is clearly based on the needs and wished of the customers and not staff needs lead. Finally, the service has improved the support staff receive by increasing the number of opportunities they have to attend one-to-one supervision sessions with their new manager and/or Team Coordinator, as well as group meetings with their fellow peers. What they could do better: All the positive comments outlined above about all the improvements made by the new manager and the team coordinator in the past six months the providers do accept the service remains far from perfect. We have made one new requirement for the service to address and four good practise recommendations for them to consider implementing: The providers must ensure all staff that work at Blake Court participate in at least one fire drill every six months or receive instruction in how to evacuate the service safely and quickly. This will ensure all the staff who work at Blake Court have all the knowledge and skills they need to keep the customers and their guests safe in the event of fire. The services Guide should be written in plain language and generally made easier to read to ensure customers and their representatives can access all the information they need to know about the services and facilities provided at Blake Court, including fees charged for them. Person centred care planning training should be provided to all staff that work at the service. This will ensure support to customers is provided in a person centred way which meets their unique needs, strengths and preferences. This good practice recommendation was made in the services last key inspection report, but was not implemented. All the customers who are willing to look after their own medication should be Care Homes for Adults (18-65 years) Page 9 of 29 encouraged to do so within an appropriate risk framework, the outcome of which should be recorded and kept in an individuals care plan. This will ensure the rights of the customers to make informed choices and to live their life as independently as they can are respected. The providers should establish a time specific action plan to redecorate the office. 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 10 of 29 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 11 of 29 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. The services Statement of Purpose has been improved to include all the information the customers need to know about the services and facilities provided at Blake Court. The services Guide should be made more accessible by ensuring its written in easy to read and plain language. This will ensure existing and potential customers have all the information they need to help them and their representatives decide whether or not the Speakers Court is the right place for them. The services arrangements for managing new referrals reflect professionally agreed best practise in this area thus ensuring prospective new admissions, their representatives, and the home can be sure the placement is right for all concerned, which includes existing customers. Evidence: The team coordinator showed us a copy of the services Statement of Purpose, which as required in Blake Courts last inspection report had been reviewed in the past six months and up dated accordingly to reflect all the changes that had occurred within the service in that time. The services Guide also contains all the information any Care Homes for Adults (18-65 years) Page 12 of 29 Evidence: potential and existing customers would need to to know about Blake Court. However, we recommend the Guide is made available in a more easy to read format that is written in plain language which all the customers and their representatives can understand. The new team coordinator demonstrated a good understanding of what constituted best practice regarding assessing the suitability of new referrals. The team coordinator assured us the services most recent referral had been invited to visit Blake Court and view their flat before any decision about moving in is taken. Care Homes for Adults (18-65 years) Page 13 of 29 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. Care plans have been significantly improved and are now far more person centred and detailed in respect of the support each customer requires to ensure their unique needs and wishes are met. The service has also introduced some excellent arrangements to enable the customers to be consulted on, and participate in, all aspects of their life at Blake Court, and is committed to actively encouraging and supporting people to do as much for themselves as they are willing and capable of doing safely. Evidence: The team coordinator showed us the new care plan format that had been introduced as we had required in the services last inspection report. The coordinator also told us the process of up dating all the customers care plans was a work in progress, but she hoped to have them all transferred over to the new care plan format within the next month. A care plan we looked at which had recently been converted contained detailed information about the support the individual for whom the plan was intended needed Care Homes for Adults (18-65 years) Page 14 of 29 Evidence: to receive in order for them to achieve their personal goals and maximise their independence. The two care plans we looked at had both been reviewed in the past six months and up dated accordingly to reflect all the changes in these individuals needs and circumstances. All the staff we met, including the team coordinator, confirmed that despite us recommending in the services last key inspection none of them had received any training in person centred care planning. The services manager recently told us during an inspection of the other service he runs that he was currently in the process of negotiating with senior representatives of Scope for person centred care planning training to be arranged. This good practice recommendation is repeated at the end of this report and progress made to achieve this aim will be closely monitored by us. The two care plans we looked at in depth both contained comprehensive sets of risk assessments and associated risk management strategies that showed us the service enable the customers to do as much for themselves as they are willing and able to do safely. These risk assessments had also been developed with the individual in mind and were clearly based on each customers unique needs, strengths, and wishes. The team coordinator told all the customers risk assessments have been reviewed in 2010 and that she planned to carry out financial risk assessment for everyone within the next fortnight. The team coordinator told us the customers had expressed an interest in having oneto-one meetings with their keyworkers every month instead of having peer group meetings. Staff maintain good records regarding the outcome of these monthly keyworker sessions and the customers we met told us they preferred to have these face-to-face meetings than large group meetings. It was evident from all the comments we received from customers and staff that as we had recommended in the services last report better arrangements for ascertaining stakeholders views had been developed in the past six months. Care Homes for Adults (18-65 years) Page 15 of 29 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 customers have the right to choose what social activities they participate in, both within their flats and in the wider community, and when they engage in them. Customers can also choose what they eat and drink, and are actively encouraged and supported to shop for their own food and prepare their own meals. Evidence: A customer we met told us they often went shopping and for walks with staff and felt they lived active and fulfilling lifes. The team coordinator told us she believed the number and variety of social activities the customers could now choose to participate in each day had improved in the past six months. Care plans we looked contained detailed information about customers social interests and daily diary notes we inspected indicated that customers regularly choose to participate in them. A customer we met told us staff encourage them to attend local church services by themselves Care Homes for Adults (18-65 years) Page 16 of 29 Evidence: and to prepare a lot of their own meals. The team coordinator told us she believed current staffing levels at Blake Court were sufficient to ensure all the customers that currently reside there have their social care needs and wishes met. All the customers we spoke with about visiting times told us they were not aware of any restrictions placed on times their relatives and/or friends could visit them in their flats. During this site visit we observed a customer go out with staff for a prearranged food shop. The team coordinator told us all the customers are actively encouraged to draw up their own food shopping lists for the week and then go shopping for it with staff. A customer we met told us staff always help them prepare the meals they have chosen each day. Staff maintain up to date daily records of all the meals customers consume each day. Care Homes for Adults (18-65 years) Page 17 of 29 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. Suitably robust arrangements are in place to ensure customers who use the service receive personal support in the way they prefer and require, and that their unique mobility and health care needs and preferences are continually recognised and met. The services medication recording, handling, and monitoring arrangements have significantly improved in the past year and are now sufficiently robust to keep the customers safe, although more should be done to ensure any customers who are willing and capable of looking after their own medication are able to do so. The service has excellent arrangements in place for dealing with dying and death thus his ensuring such an event is handled in a very sensitive and respectful manner in accordance with the spiritual needs and wishes of the deceased and their next of kin. Evidence: All the customers we met were suitably dressed in well maintained clothes that were both age and seasonally appropriate for the time of year. The team coordinator showed us copies of the new health care action plans the service has developed for each of the customers as we had required in their last key inspection report. These Care Homes for Adults (18-65 years) Page 18 of 29 Evidence: new plans contained detailed information regarding the dates and outcomes of all the appointments customers had attended with various health care professionals in the past six months. It was evident from the comments made by the staff we met and the information contained in the new health care plans that customers remain in regular contact with their GP, district nurses, physiotherapists, speech and language therapists, dentists, and opticians. Services accident and incident books indicate staff continue to record and appropriately deal with any falls involving the customers. No recording errors were noted on any of the Medication Administration Record sheets we sampled at random. The coordinator told us no medication handling errors had occurred within the service in the past six months and that she was responsible for auditing the services medication handling practises on a regular basis. The team coordinator also told us none of the customers who currently resided at Blake Court were either willing or capable of looking after their own medication. However, no evidence could be produced on request that showed us he wishes of the customers and their capacity to self-medicate safely had been properly risk assessed. We recommend customers needs and wishes on this matter are thoroughly risk assessed and the outcome recorded in their care plans. It was evident from all the comments we received from customers and staff we met that the recent and unexpected passing away of a customer was handled sensitively and in accordance with this individuals and their relatives wishes. Care Homes for Adults (18-65 years) Page 19 of 29 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. The services arrangements for dealing with complaints are sufficiently robust and understood by the customers to ensure they feel any concerns they may have about Blake Court will be taken seriously and dealt with in a timely manner. Customers are kept safe because staff understand what constitutes abuse and know what to do if they witness or suspect it. Evidence: A customer we met told us staff always listened to them and they knew who to speak to if they were unhappy about anything at Blake Court. The services complaints log revealed one concern had been raised within them in the past six months, which the team coordinator told us they had taken seriously and were in the process of investigating. The coordinator went onto say the complainant would be notified about the outcome of their internal enquiry as soon as their investigation was complete. The team coordinator demonstrated a good understanding of what constituted abuse and what their responsibilities were if they suspected or witnessed it within the service. There have been no safeguarding incidents since the last inspection. The coordinator also confirmed that both herself and the services new manager had recently attended an advanced safeguarding training course run by Scope. Care Homes for Adults (18-65 years) Page 20 of 29 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 interior decoration, soft furnishings, fixtures, and fittings in both the selfcontained flats we viewed were of a reasonable standard ensuring the customers who occupied them lived in a relatively homely and comfortable environments. The services arrangements for controlling infection are sufficiently robust to ensure customers also live in a very clean and safe environment. Evidence: The team coordinator told us there had been no significant changes made to the physical environment of any of the flats in the past twelve months. New curtains have been hung in some flats. Two customers we met told us their flat contained everything they needed, and were decorated to a reasonable standard in the style they had chosen. A senior representative of Scope wrote in a report they compiled following a recent unannounced visit to Blake Court that the services offices needed redecorating. We agree with this statement and recommend the service establishes a time specific action plan to repaint this space. Both the flats we viewed were clean and smelt fresh. Customers we spoke with told us staff were good at helping them keep their flats clean and tidy. Care Homes for Adults (18-65 years) Page 21 of 29 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. The service ensures enough suitably competent staff are on duty at all times who are familiar with the customers unique needs and wishes, listen to what they have to say, and keep them safe. The training and supervision the staff receive has significantly improved in the past six months ensuring the team has the right mix of knowledge, skills, and on going peer and management support to meet the customers needs and wishes. The services arrangements for recruiting and assessing the suitability of new staff are sufficiently robust to ensure it continues to employ the right sort of people who are fit to work in social care. Evidence: All the staff we met during this site visit were observed interacting with the customers in a very caring and respectful manner, as well as seen knocking on the doors of flats to ask the customers permission to enter before doing so. The team coordinator and all the other staff we met told us team morale had significantly improved in the past six months and everyone who feedback to us agreed the service had benefited from having a more stable management team in place. Care Homes for Adults (18-65 years) Page 22 of 29 Evidence: When we arrived at Blake Court we noted two support workers and the team coordinator were all on duty. The team coordinator confirmed that a minimum of at least two staff always work across the day, which she assured us was sufficient to meet the needs of all the customers, as well as keep them safe. The team coordinator was able to show us numerous examples of when she had adapted a flexible approach to planning the duty rosters and ensured an additional third member of staff was on shift to enable the customers to attend prearranged community based activities. The team coordinator told us the service almost had its full compliment of staff and was therefore no longer so reliant on temporary agency staff who were not so familiar with the customers needs. Duty rosters we sampled at random revealed agency staff were being used no more than twice a week. The team coordinator told customers are always asked what they think about the suitability of any prospective new staff and their opinions are always taken into account when deciding whether or not to recruit someone new. As required in the services last inspection report the manager provided us with evidence that showed us all staff that worked at Blake Court had received up to date training in preventing and managing infection control. Other training records we looked at showed us one hundred percent of the current staff team had either achieved a National Vocational Qualification (NVQ) in care (Level 2 or above) or were enrolled on an NVQ course. The coordinator told us sufficient numbers of the current staff team have also attended up to date training in fire safety, first aid, food hygiene, moving and handling, safeguarding vulnerable adults, equality and diversity, handling medication, communication, complaints resolution, record keeping, and the Mental Capacity Act. Personal files we looked at in respect of the two support workers who were both on duty at the time of this inspection revealed they had each received three one-to-one supervision sessions with either the services manager or the team coordinator in the past five months. Furthermore, the team coordinator told us in addition to these regular supervision sessions all the staffs training strengths, needs, and overall performance had been appraised in December 2009 and an action plan established to address any gaps identified in an individuals knowledge and skills. Minutes of the services last three staff meetings showed us these were now being held approximately once a month, and were being well attended by staff. Care Homes for Adults (18-65 years) Page 23 of 29 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. The customers now benefit from living within a service that is well run by a very experienced and competent new management team. The quality assurance systems the providers have developed ensure the customers and their representatives to have their say and affect the day-to-day running and future develop of Blake Court. Overall, the services health and safety arrangements remain sufficiently robust to safeguard the welfare of all the customers, although fire drills need to be carried out at more frequent intervals to ensure staff are fully aware what to do in the event of fire. Evidence: Since the services last inspection Scope have appointed a new suitably experienced, qualified, and competent manager to be in operational day-to-day control of Blake Court. The new manager in turn recruited a new suitably competent team coordinator to help him oversee the place, especially in his absence. We received a lot of positive Care Homes for Adults (18-65 years) Page 24 of 29 Evidence: feedback from the customers and staff about the new leadership approach of the services relatively new management team. The new team coordinator was very clear about her senior role and responsibilities and told us she had recently attended additional managerial training courses run by Scope. Staff we met all told us the service is now much better run because either the manager and/or the team coordinator are on to offer their advice and support. The coordinator also told us she feels she gets all the support she needs from the services manager, who she mets on a regular basis, and that they work well together as a team. During this visit we met a senior manager representing Scope who was in the process of carrying out an unannounced quality assurance inspection on half of the provider. The team coordinator told us all the customers had recently been invited to complete an internal satisfaction survey about Blake Court, which the service intended to analyse and publish when the results came back. The coordinator provided us with documentary evidence on request that revealed staff continue to maintain up to date and accurate records of all the fire drills and fire alarm tests conducted within Blake Court. However, these records revealed that while the fire alarm system is being tested on a weekly basis in line with recommended good fire safety guidelines, fire drills are not being undertaken at regular intervals (i.e. at least twice a year). Consequently, not all the services staff have been involved in a recent fire drill. Certificates of worthiness were produced on request that revealed the services fire detection and alarm systems, fire fighting equipment, emergency call bell system, and mobile hoist/overhead tracking equipment had all been serviced as recommended by the manufacturer or regulatory bodies. The new management team had also noticed the services portable electrical appliances were well over due there annual check and had recently made arrangements with a qualified engineer to rectified this health and safety shortfall. It was possibly noted that a member of staff responded to an emergency call bell being activated within thirty seconds of it being activated. Care Homes for Adults (18-65 years) Page 25 of 29 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 26 of 29 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 42 23 The providers must ensure all staff that work at Blake Court participate in at least one fire drill every six months or receive instruction in how to evacuate the service safely and quickly. This will ensure all the staff who work at Blake Court have all the knowledge and skills they need to keep the customers and their guests safe in the event of fire. 01/07/2010 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 1 1 The services Guide should be written in plain language and generally made easier to read to ensure customers and their representatives can access all the information they need to know about the services and facilities provided at Blake Court, including fees charged for them. Care Homes for Adults (18-65 years) Page 27 of 29 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 2 6 Person centred care planning training should be provided to all staff that work at the service. This will ensure support to customers is provided in a person centred way which meets their unique needs, strengths, and preferences. This good practice recommendation was made in the services last key inspection report, but was not implemented. All the customers who are willing to look after their own medication should be encouraged to do so within an appropriate risk framework, the outcome of which should be recorded and kept in an individuals care plan. This will ensure the rights of the customers to make informed choices and to live their life as independently as they can are promoted and respected. The providers should establish a time specific action plan to redecorate the office. 3 20 4 24 Care Homes for Adults (18-65 years) Page 28 of 29 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. © 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. 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