Care Home: Blue Skies Care Home

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What the care home does well The service provides good information and it is written in a way people can understand.Blue Skies Care HomeDS0000073021.V375146.R01.S.docVersion 5.2People who use the service are listened to and are able to make their views known.People are helped to stay in contact with family and friends. What has improved since the last inspection? This is Blue Skies first inspection.Blue Skies Care HomeDS0000073021.V375146.R01.S.docVersion 5.2 What the care home could do better: The information on people`s care plans is not always arranged in the best way for staff to see how to support them.Some of the arrangements for storing and recording information about medication could be improved.If you want to read our full report of our inspection please speak to the person in charge.Blue Skies Care HomeDS0000073021.V375146.R01.S.docVersion 5.2 Key inspection report CARE HOME ADULTS 18-65 Blue Skies Care Home 35 Brickenell Road Calverton Nottingham NG14 6PL Lead Inspector Susan Lewis Key Unannounced Inspection 13th May 2009 09:00 Blue Skies Care Home DS0000073021.V375146.R01.S.doc Version 5.2 Page 1 This report is a review of the 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. 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 home adults 18-65 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. Blue Skies Care Home DS0000073021.V375146.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Blue Skies Care Home DS0000073021.V375146.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Blue Skies Care Home Address 35 Brickenell Road Calverton Nottingham NG14 6PL 0115 965 2378 0115 965 2378 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Nestle Care Homes Ltd Mr Qasim Mahmood Care Home 4 Category(ies) of Learning disability (4) registration, with number of places Blue Skies Care Home DS0000073021.V375146.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 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: 2. Learning disability - Code LD The maximum number of service users who can be accommodated is: 4 New service Date of last inspection Brief Description of the Service: Blue Skies is located in a quiet cul de sac in a residential area of Calverton. It is a short walk from the centre of the village with shops and other local amenities close by. The home itself is domestic in character. It has a kitchen and lounge downstairs and three bedrooms and bathroom upstairs. One bedroom is double, none of them have en suite facilities and the home is not suitable for people with mobility problems. There is a small garden to the front and rear of the property. Fees for the service range from £465 per week to £1165 per week depending on the person’s needs. Blue Skies Care Home DS0000073021.V375146.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use the service experience good quality outcomes. We visited the home in May 2009 and we met with the manager and people who use the service. We asked the manager about what they do for people. We asked how they learnt how to do this. We looked at people’s records; we wanted to see if people were happy with their service. We looked at staff files to see if they were safe to work with people. Blue Skies Care Home DS0000073021.V375146.R01.S.doc Version 5.2 Page 6 We looked at other paperwork such as complaints people may have made. We found it difficult to speak to some people who use the service so we spoke to family members instead. What the service does well: The service provides good information and it is written in a way people can understand. Blue Skies Care Home DS0000073021.V375146.R01.S.doc Version 5.2 Page 7 People who use the service are listened to and are able to make their views known. People are helped to stay in contact with family and friends. What has improved since the last inspection? This is Blue Skies first inspection. Blue Skies Care Home DS0000073021.V375146.R01.S.doc Version 5.2 Page 8 What they could do better: The information on people’s care plans is not always arranged in the best way for staff to see how to support them. Some of the arrangements for storing and recording information about medication could be improved. If you want to read our full report of our inspection please speak to the person in charge. Blue Skies Care Home DS0000073021.V375146.R01.S.doc Version 5.2 Page 9 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. Blue Skies Care Home DS0000073021.V375146.R01.S.doc Version 5.2 Page 10 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Blue Skies Care Home DS0000073021.V375146.R01.S.doc Version 5.2 Page 11 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standard 2 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are assessed before they move to the home EVIDENCE: Blue Skies was recently taken over by Nestle Care Homes Ltd in 2008 and is classed as a new service, however the service was previously operating and all the people who lived at the service prior to Nestle Care Homes Ltd taking over are still in residence. From the pre inspection information provided by the manager it is the manager’s intention to ensure any new person moving to the home is fully assessed prior to moving in by speaking to the person, their relatives and any professionals involved. Blue Skies Care Home DS0000073021.V375146.R01.S.doc Version 5.2 Page 12 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People’s care is planned and they are supported to make choices in their daily lives. EVIDENCE: People who use the service were not spoken with during this inspection as we were not able to understand them. However we gathered information from plans quality surveys and observation. Two care plans were looked at as part of this inspection to check that there was enough information so carers could meet the needs of people who lived at the home. We saw that each person who uses the service has a file showing the plans made about their care. Each plan has lots of information about the person and shows the individual differences each person has. Blue Skies Care Home DS0000073021.V375146.R01.S.doc Version 5.2 Page 13 This includes how to support them in areas such as their personal care and communication, as well health care needs, and the things they like. There are also plans about how staff can help people manage their behaviour, and how they should respond if the persons behaviour becomes challenging. Sometimes the detail in the new care plan is not always enough to make sure all staff would know what to do. However in talking to relatives they felt that their loved ones were receiving very good care and the information in the daily log showed that people received the care they needed. We observed people at the home being relaxed they were clean and well dressed. Staff were available to assist them when they needed support but did not prevent them doing what they wanted to do. The plans also have information about how the staff manages the risks people face in their daily lives. We saw that people’s plans show staff how to support them making choices. Care plans showed that people were encouraged to take part in the daily life of the home and be involved in domestic activities. The manager showed us information he collects as part of his quality assurance system. This showed that staff had a good understanding of how to ensure people who live at the home were able to make choices in all aspects of their lives such as about what they ate and what they did. Relatives spoken with said that they felt their loved one received the support they needed to live happy and full lives. Daily records showed that meetings took place with social workers to ensure ongoing support was appropriate to the needs of the person. Families told us that the manager regularly spoke to them to let them know how their loved one was and ask if they were happy with the care they were receiving. Blue Skies Care Home DS0000073021.V375146.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): This is what people staying in this care home experience: 12, 13, 15, 16 and 17 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People receive a service that gives them choice and opportunities, they are supported to maintain relationships with people who are important to them. EVIDENCE: We saw people’s plans describe the type of activity they like to do and we saw diary notes describing the type of activity that the person is involved in, such as attending day service, Gettaway Club going for a pub lunch, swimming and walks around the village. We saw in minutes of staff meetings that discussions had taken place about planning future excursions and holidays for people. Families told us that their loved ones were able to be involved in different activities and that they were happy with their lives at the home. Blue Skies Care Home DS0000073021.V375146.R01.S.doc Version 5.2 Page 15 People’s plans show us that they are supported to maintain relationships with their families. They are supported to return home on a regular basis and to telephone home. Families told us that the manager stays in regular contact with them even phoning them when they are unwell not just their loved one. Birthdays and special events are celebrated and we saw photographs of them taking part in these activities. We saw records showing that people were able to choose what they wanted to eat and saw the lunch being prepared and they were asked what they wanted. Although there was no menu plan the manager said that as only three people lived at the home it was easier just to ask them on a daily basis what they wanted, taking into consideration each person’s likes and dislikes. We saw a well stocked kitchen, although there was a high proportion of a processed food. The manager said that healthy eating was encouraged and we saw records that showed people who had wanted to lose weight had been supported to do this. Blue Skies Care Home DS0000073021.V375146.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care that people receive is based on their individual needs and they are treated with dignity and respect. EVIDENCE: Families we spoke with said that staff treated people well and were ‘very kind’. They also told us that they felt ‘they have seen a positive change in them since the new provider has taken over’ and ‘the new manager introduced himself to me and I am satisfied that my son is happy at Blue Skies’. Care plans show how staff are to support people around their personal hygiene. The manager has also arranged for the community nurse to visit and give training to people who use the service on hand hygiene and oral hygiene. Daily records show how staff provide support and follow up where a person feels unwell, families told us that they are kept informed if their loved one is unwell and needs to see a doctor. We saw records that showed that health Blue Skies Care Home DS0000073021.V375146.R01.S.doc Version 5.2 Page 17 professionals are contacted and action plans were created if staff were advised of anything. We looked at the medication systems, to ensure people receive the medication as prescribed by their doctor. We saw certificates showing that staff have received training for safe handling of medication, however currently none of the people who use the service are on any long term medication, as a result the manager has yet to create any suitable lockable medication cabinet according to the Medicines Act 1968. Some people have had medication on a short term basis such as antibiotics where this has happened the manager has recorded this on hand written medication administration records and these showed that the medication had been administered correctly. Where medication was stopped following advice from the doctor this was recorded on the medication sheet referring to the date of the conversation with the doctor ensuring it was clear to all staff that the medication was no longer needed. Blue Skies Care Home DS0000073021.V375146.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service have access to an effective complaints procedure and are protected from abuse. EVIDENCE: The manager showed us the complaints book and an up to date procedure is in place to show people how to complain. Families spoken with said that they felt able to speak to the manager if they had any concerns and that he would deal with it. The manager also told us he speaks to each person regularly to ensure they are happy and have no concerns. This was seen on the quality surveys that the manager carries out every two months. In the ‘Have your say’ surveys people told us that they felt staff were nice and they would speak to the manager if they were not happy. The manager told us that they have not received any complaints since Nestle Care took over apart from one which we passed to them. This was thoroughly investigated using their procedure and they replied to us within the 28 day time scale. The complaint was not upheld as there was no evidence to support it. Blue Skies Care Home DS0000073021.V375146.R01.S.doc Version 5.2 Page 19 We asked the manager what he does to keep people safe from abuse. We saw certificates to show that all staff have received safe guarding adults training recently. They have copies of the local authority policies to support staff reporting any concerns. We saw that care plans identified where people were vulnerable and may need support to protect them from potential abuse. Blue Skies Care Home DS0000073021.V375146.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 People using the 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 design and layout of the home supports people to live in a safe, well maintained environment. EVIDENCE: Since taking over ownership of the service the new provider has fitted new carpet to the living room and one person’s bedroom. A new sofa has also been bought for the living room. The manager and provider told us in their pre inspection information that they intend to redecorate the whole house during the course of the next few months this includes the bathroom and the kitchen. The home is domestic in nature and has a bathroom upstairs and is sufficient for the needs of the people who currently use the service. We looked at people’s bedroom and they were decorated according to that person’s likes and dislikes, we saw a new carpet in one person’s room. The laundry facilities were domestic but suitable for the needs of the people who Blue Skies Care Home DS0000073021.V375146.R01.S.doc Version 5.2 Page 21 used the service and we saw certificates showing that staff had received suitable training to minimise the risk of infection. Blue Skies Care Home DS0000073021.V375146.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are cared for by well trained staff. EVIDENCE: We looked at the recruitment records for three staff. We saw that all the checks that needed to be made such references and Criminal Record Bureau checks were obtained before the person started work at the home. However one staff’s reference was written by the provider of this service and so was not suitable, the provider said he would obtain a third reference for this person. From ‘Have your say’ surveys staff told us that they were supported and all checks were made prior to them starting work at the service. We saw records showing that all the staff had received an induction when they started work and all had received training in first aid and food hygiene as well as other relevant training when they first started at the service. Blue Skies Care Home DS0000073021.V375146.R01.S.doc Version 5.2 Page 23 In the ‘Have your say’ surveys staff told us they received training when they joined the service. We also saw records that showed all staff had their National Vocational Qualification Level 2 with the deputy manager having his level 3. This ensures that people who use the service are cared for by competent staff. Recruitment records also showed that all the staff had previous experience in working with adults with learning disabilities. We also saw records of staff supervision with topics such as privacy and dignity being discussed. Team meetings are also held every two months and minutes were seen of these meetings. The diary notes showed that staff discuss what has happened during each shift to make sure they know how each person has been and if they need to follow anything up. Blue Skies Care Home DS0000073021.V375146.R01.S.doc Version 5.2 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a service that is managed in their best interests. EVIDENCE: The manager was registered with us as a fit person to be in charge of a care service in November 2008. The manager and new provider told us how they worked with the previous provider to ensure a smooth transition to the new ownership. We saw records showing that the new provider visits the service regularly to carry out his responsibilities as a provider to ensure that the people who live there are being cared for properly. Blue Skies Care Home DS0000073021.V375146.R01.S.doc Version 5.2 Page 25 We were told by families that the manager was supportive and caring not just to their loved ones but to them also. The manager has developed quality assurance systems to find out the views of people who use the service and families, we saw these records. The system used for the people who used the service was in a format that supported their needs. The manager told us on his pre inspection information that there were systems in place to protect people’s health and safety such as fire testing and maintenance of equipment. Blue Skies Care Home DS0000073021.V375146.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 X 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 X Version 5.2 Page 27 Blue Skies Care Home DS0000073021.V375146.R01.S.doc Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 Refer to Standard YA6 YA10 Good Practice Recommendations All information regarding the care of a person could be collated into a more accessible plan to make it easier for carer to meet all the needs of people who use the service. Where daily records are made they should follow that Data Protection Act 1998 this ensures all records relating to people who use the service are stored correctly. Ensure the Medicines Act 1968 and the guidelines of the Royal Pharmaceutical Society of Great Britain are followed regarding the storage facilities for medication. This ensures that people’s medication is stored safely. Where medication administration records are handwritten they should be signed and countersigned this ensures errors are minimised. Staff references should be from independent sources to ensure they are suitable for the job. YA20 4 5 YA20 YA34 Blue Skies Care Home DS0000073021.V375146.R01.S.doc Version 5.2 Page 28 Care Quality Commission East Midlands Region Citygate Gallowgate Newcastle upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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