Care Home: Bleak House

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What the care home does well Care plans are detailed and personalised and are accompanied by appropriate risk assessments; communication passports are a summary of this information that people can take to the hospital with them to assist medical staff with communication and care. Health care needs are met including the provision of an annual health check. Health care professionals are consulted appropriately to promote a person`s physical and emotional well-being. Medication practices at the home protect people from the risk of harm. People tell us that they know who to speak to if they have any concerns and how to make a complaint. The home is well managed, including the arrangements for holding service user monies. Health and safety practices at the home promote the well-being of people living there, staff and others and, as far as is possible, protect them from the risk of harm. Quality assurance systems enable people living at the home and others to affect the way in which the home is operated. What the care home could do better: We recommend that a record be kept of any concerns or `niggles` and how these have been dealt with by the home; this evidences that any concerns have been dealt with positively. We suggest that a copy of accident/incident forms should be kept with daily care records so that staff have access to the most up to date information about each person living at the home. Random inspection report Care homes for adults (18-65 years) Name: Address: Bleak House High Street Patrington Hull East Riding Of Yorks HU12 0RE three star excellent service The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme 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 review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Diane Wilkinson Date: 1 5 0 4 2 0 1 0 Information about the care home Name of care home: Address: Bleak House High Street Patrington Hull East Riding Of Yorks HU12 0RE 01964630383 01964631243 christine.allen@bleakhouse.org Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Christine Linda Allen Type of registration: Number of places registered: Conditions of registration: Category(ies) : Bleak House Limited care home 19 Number of places (if applicable): Under 65 Over 65 0 learning disability Conditions of registration: Date of last inspection Brief description of the care home 19 Bleak House is a care home that provides care and accommodation for up to 19 people of either sex who are under the age of sixty-five and who have a learning disability. The home is privately owned and is situated on the main street in the village of Patrington, in the East Riding of Yorkshire. It is close to local amenities and within easy access to public transport. Car parking is available on the main road. The home is a large two-storey Tudor style building. Internally it retains many of its original features including a large wooden fireplace and panelled living room. There are Care Homes for Adults (18-65 years) Page 2 of 11 Brief description of the care home a number of communal areas including lounges and the dining area, and a large rear gardens. There are seven single bedrooms and six shared bedrooms; none have en-suite facilities. The home does not have a stair lift or hoist so the accommodation is not suitable for wheel chair users or people with severe mobility problems. Bleak House provides information to prospective residents and people already living at the home in its Statement of Purpose and Service Users Guide; this includes information about the current fee for residential care. Care Homes for Adults (18-65 years) Page 3 of 11 What we found: We looked at the following outcome groups: Individual Needs and Choices. At the last key inspection a recommendation was made that people should be provided with information about the home and their care in a format that is understandable to them. This was discussed with the manager, who said that people told them that they found written information that included symbols confusing, so they have made the decision that any documentation important to people living at the home will be explained to them verbally in a one to one discussion with their key worker. There is evidence in service user records that individual care plans have been developed with the agreement of the person concerned, and signed by them to evidence their agreement whenever possible. Another recommendation was made at the last key inspection i.e. the registered person should ensure that staff are provided with clear guidance on what actions to take and look out for in respect of the management of risk to people living in the home. We noted that there are clear and personalised care plans in place that are accompanied by individual risk assessments. A copy of this information is also included with daily diary record sheets so that it is accessible to staff at all times. The individual service user plan is recorded in sections (ten in total), such as to give support with personal care and appearance, to monitor health, well-being and medication, to provide a well balanced, nutritional diet and monitor weight and psychological and behavioural difficulties. Each area is accompaned by a risk assessment (where appropriate). For example, the section on nutrition includes a nutritional assessment that measures the level of risk for the individual concerned and a weight chart. We suggested that the manager may like to obtain a copy of the MUST nutritional tool to replace the one already used by the home. Service user plans are very detailed and include information that guides staff on how to offer support and encouragement for each area identified. We saw that care plans are monitored on a monthly basis to ensure that they remain up to date, and that formal reviews of care plans take place every six months. Ten people living at Bleak House returned a survey and they told us that they are able to make decisions about what they do each day. They were asked if they could do what they want during the day, in the evening and at weekends and all responded positively. On the day of the site visit we saw that people had been allocated tasks to complete within the home such as polishing and disinfecting door handles, and that they responded well to this level of responsibility. Minutes of resident meetings evidenced that tasks within the home were a regular topic of discussion and that tasks were rotated to make them fair for people living at the home. As well as information about responsible risk taking, care plans record the persons ability to make decisions and details of how any decisions have been reached. Care Homes for Adults (18-65 years) Page 4 of 11 Personal and healthcare support. Care plans record clear details of how people wish to be supported with personal care tasks, and whether people need support to undertake these tasks or can undertaken tasks themselves (with or without encouragement). We received completed surveys from eight members of staff. They told us that they are given up to date information about the needs of the people they support and that the ways they share information about the people they support work well. Care records evidence that people are supported to see health care professionals as appropriate; records include details about the reason for the contact and the outcome. The manager told us that everyone living at the home is registered with the same GP practice but that they have different GPs. Everyone has an annual health check; this was introduced last year and everyone has now had their second health check. Care records evidenced that community psychiatric nurses, district nurses, psychiatrists, psychologists and other health care professionals are involved in a persons health care when this is considered to be an area of need. We noted that communication passports (or patient passports) have been completed for everyone living at the home. These are brief documents that are designed to inform medical staff of a persons individual needs, choices, likes and dislikes should they be admitted to hospital. We also noted that information such as allergies and health concerns are highlighted in care records to ensure that all staff are aware. We saw the arrangements for the storage of medication, medication administration records and staff medication training records on the day of this site visit and all were found to be satisfactory. There were no gaps in recording on medication administration records, a record was made of the amount of medication received from the pharmacist on each occasion and any handwritten entries on medication administration records were signed by two people. Complaints and Protection. The people living at the home who returned a survey told us that they know who to speak to if they are not happy and that they know how to make a complaint. Staff also told us that they know what to do if someone expresses concerns about the home. On the day of the site visit we saw that communication between the staff and people living at the home was open and supportive, with people in and out of the office throughout our time there asking questions and sharing information with the manager. We saw the complaints policy and also checked the complaints log. This records that there have been no formal complaints made to the home over the last 12 months. The manager told us that she regularly deals with minor concerns expressed by people living at the home and we suggested that these should be recorded, as it is good practice to evidence that these have been dealt with positively. The Care Quality Commission (CQC) have been informed by the home of two safeguarding referrals that they made to the local authority - both of these issues were handled professionally by the home and CQC were kept informed of developments. Staff Care Homes for Adults (18-65 years) Page 5 of 11 have had training on safeguarding adults from abuse and minutes of staff meetings evidence that this is a regular topic of conversation. We discussed peoples financial arrangements with the manager on the day of the site visit. Two staff now audit service user monies and associated records and there is a quality monitoring system in place to ensure that these records are maintained accurately. Environment. Although these standards were not assessed on this occasion, we noted that the repairs to the bedroom ceiling damaged by bad weather (seen at the last key inspection) had been completed and that corridor areas showing signs of wear and tear had been redecorated. We also saw that there are good infecton control practices in place; one of the people living at the home was seen to disinfect all door handles during the period of the site visit. All of the people living at the home who returned a survey told us that the home is fresh and clean. Conduct and management of the home. The manager told us that she keeps her practice up to date by attending a variety of training programmes; she has recently attended training on the Vetting and Barring scheme, safeguarding and stroke awareness. She is due to attend training on epilepsy on the 17th May. In addition to this, the manager attends a variety of events relevant to care provision. For example, she recently attended an event entitled Transforming Services that was organised by East Riding of Yorkshire Council. She also uses the CQC website and belongs to a local care organisation where she is able to discuss current issues and changes in legislation with other care providers. The manager returned the Annual Quality Assurance Assessment (AQAA) when we asked for it and we noted that this was a thorough record of how the service is provided, any improvements that have been made and any future improvements planned. In addition to this, we receive regular updates on practice from the registered provider following their unannounced visits to the home. We looked at quality assurance information at the home. This includes minutes of both service user and staff meetings. We noted that one or more service users are invited to attend each staff meeting and that this is rotated so that any person wishing to attend a staff meeting has the opportunity to do so; this is excellent practice. Quality surveys are distributed to people living at the home four times a year. Recent surveys have been on recreation/occupation, the environment, care and rights. The manager told us that she (with help from another member of staff) collates the responses of surveys, takes any necessary action and feeds this information back to people at staff and service user meetings. We noted that the home also compiles a quality assurance report - the one for 2009/10 was seen on the day of the site visit. Care Homes for Adults (18-65 years) Page 6 of 11 The quality assurance folder also includes a staff appraisal and supervision schedule and a record of care plan reviews. We checked a selection of health and safety documentation. There is a current gas safety certificate in place and an annual fire test was undertaken on 27/8/09. In-house fire drills and fire tests take place on a regular basis; we advised the manager to record the frequency of these in the homes fire risk assessment, and that these should then be adhered to consistently. There is a fire risk assessment in place and we noted that it was reviewed in October 2009. We noted that, in addition to fire drills, fire safety is a regular topic of discussion at service user meetings; this is good practice. We checked the content of accident and incident reports and found these to be satisfactory. The manager retains a copy of these so that she can monitor records to identify any patterns or areas of concern. We advised the manager that a copy of these reports should also be held with daily diary records so that staff have access to the most up to date information about the people living at the home. What the care home does well: What they could do better: We recommend that a record be kept of any concerns or niggles and how these have been dealt with by the home; this evidences that any concerns have been dealt with positively. We suggest that a copy of accident/incident forms should be kept with daily care records so that staff have access to the most up to date information about each person living at the home. Care Homes for Adults (18-65 years) Page 7 of 11 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 set out on page 2. Care Homes for Adults (18-65 years) Page 8 of 11 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 9 of 11 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, 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 22 It would be good practice to record comments and niggles from people living at the home. These are currently dealt with effectively but recording them would evidence that positive action has been taken. We advised the manager that accident and incident reports should be stored with daily diary sheets so that staff always have access to the most recent information about people living at the home. 2 42 Care Homes for Adults (18-65 years) Page 10 of 11 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or got 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 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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