Care Home: Burnriggs

What the care home does well This service provides good outcomes for a small group of adults with highly complex needs, learning disabilities, mental health issues and behaviours that can be challenging to them selves or others.Health professionals’, `Have Your Say` surveys, told us, "I am very impressed with the staff and service at Burnriggs, staff have a good caring approach, and treat clients with respect and care". They also said, "the service does well supporting people who have severe learning difficulties and challenging behaviour and the staff are well informed of their needs".Staff working in the home have received training to ensure they have the skills and knowledge to meet the needs of the people living there.People living in the home are supported to lead ordinary and meaningful lives, both in the home and within the community.A lot of effort is put into making sure that staff can communicate with the people living in the home. Each person has a communication plan to help them tell staff what they need and want to do. These plans include pictures, symbols and PECS, which reflect everyday items, activities and objects, to help them make choices about their lives. What has improved since the last inspection? This is the homes first inspection since registration as an adult service. During the past four and half months the service has made good progress changing from a children`s service to an adult`s one. The home was given a Safeguarding Award in August 2009 for providing a quality service in respect of safeguarding the people they support. To get this award the companies’ policies, procedures, staff training and practices were looked at by external assessors. What the care home could do better: Records in the home, including care plans, the Statement of Purpose and the safeguarding adult’s policy need to be changed to reflect this is now an adult service. The manager told us they are improving the ways in which they get feedback about how well the service is meeting people’s needs.They plan to do this by developing the ways in which they get feedback from people using the service, their families and other professionals involved in their care and support.New person centered care plans are in the process of being written, which the individual can understand and will tell staff what is important to that person. Key inspection report Care homes for adults (18-65 years) Name: Address: Burnriggs Burnriggs 2-6 The Green Hadleigh Ipswich Suffolk IP7 6AE 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: Deborah Kerr Date: 1 8 0 1 2 0 1 0 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. The first part of the review gives the overall quality rating for the care home:  3 stars – excellent  2 stars – good  1 star – adequate  0 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. They reflect the things that people have said are important to them: 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 40 Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by:  Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice  Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983  Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services.  Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2010) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 40 Information about the care home Name of care home: Address: Burnriggs Burnriggs 2-6 The Green Hadleigh Ipswich Suffolk IP7 6AE 01473827227 01473829298 annaboulton@inroadessex.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Inroads (Essex) Ltd Name of registered manager (if applicable) Ms Anna Boulton Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 7 0 care home 7 learning disability Additional conditions: The maximum number of service users who can be accommodated is 7 The registered person may provide the following categories of service 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 Learning Disability Code LD Date of last inspection Care Homes for Adults (18-65 years) Page 4 of 40 A bit about the care home Burnriggs provides accommodation for up to seven people with severe learning disabilities and challenging behaviour. There are currently five people residing in the home. Each person has their own room. The house and gardens allow the people who use this service to have maximum space and freedom. The service is close to centre of Hadleigh, which means people have access to the local community and public transport. This means people who use the service can get around easily. Page 5 of 40 Care Homes for Adults (18-65 years) The cost of using this service varies depending on the assessed needs of the individual. The weekly fees range from £2,400 to £3,000 per week. People considering moving to this home may wish to obtain more up to date information from the care home. Care Homes for Adults (18-65 years) Page 6 of 40 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 Care Homes for Adults (18-65 years) Page 7 of 40 How we did our inspection: This is what the inspector did when they were at the care home Time was spent talking with people living in the home and three members of staff, two directors of the company and the manager of the service. We looked at some staff files, peoples care plans and records about health and safety in the home. What the care home does well This service provides good outcomes for a small group of adults with highly complex needs, learning disabilities, mental health issues and behaviours that can be challenging to them selves or others. Care Homes for Adults (18-65 years) Page 8 of 40 Health professionals’, Have Your Say surveys, told us, I am very impressed with the staff and service at Burnriggs, staff have a good caring approach, and treat clients with respect and care. They also said, the service does well supporting people who have severe learning difficulties and challenging behaviour and the staff are well informed of their needs. Staff working in the home have received training to ensure they have the skills and knowledge to meet the needs of the people living there. Care Homes for Adults (18-65 years) Page 9 of 40 People living in the home are supported to lead ordinary and meaningful lives, both in the home and within the community. A lot of effort is put into making sure that staff can communicate with the people living in the home. Each person has a communication plan to help them tell staff what they need and want to do. These plans include pictures, symbols and PECS, which reflect everyday items, activities and objects, to help them make choices about their lives. Care Homes for Adults (18-65 years) Page 10 of 40 What has got better from the last inspection This is the homes first inspection since registration as an adult service. During the past four and half months the service has made good progress changing from a childrens service to an adults one. The home was given a Safeguarding Award in August 2009 for providing a quality service in respect of safeguarding the people they support. To get this award the companies’ policies, procedures, staff training and practices were looked at by external assessors. Care Homes for Adults (18-65 years) Page 11 of 40 What the care home could do better Records in the home, including care plans, the Statement of Purpose and the safeguarding adult’s policy need to be changed to reflect this is now an adult service. The manager told us they are improving the ways in which they get feedback about how well the service is meeting people’s needs. Care Homes for Adults (18-65 years) Page 12 of 40 They plan to do this by developing the ways in which they get feedback from people using the service, their families and other professionals involved in their care and support. New person centered care plans are in the process of being written, which the individual can understand and will tell staff what is important to that person. If you want to read the full report of our inspection please ask the person in charge of the care home Care Homes for Adults (18-65 years) Page 13 of 40 If you want to speak to the inspector please contact Deborah Kerr CQC East Citygate Gallowgate Newcastle Upon Tyne NE1 4PA Telephone: 03000 616161 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 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 14 of 40 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 15 of 40 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. Prospective people to use this service will have their needs assessed and they and their representatives will be provided with information, which tells them about the service. Evidence: A copy of the Statement of Purpose was provided at the inspection, whilst this information tells people about the aims, objectives and philosophy of the service and facilities available, the document needs to be amended to reflect this is now an adult service. The paperwork still makes reference to children and younger adults. The manager advsied they are in the process of updating this and reviewing the format of the service users guide. For people thinking about moving into the home and for those already living there, the Service Users Guide provides information they need to know about what the service provides. This is written in plain English and symbol format to make it easier for people with communication difficulties to understand. Together, with the people who use the service, work is in progress to further develop the guide, by making a DVD, and using Care Homes for Adults (18-65 years) Page 16 of 40 Evidence: pictures and/or photographs of activities they have taken part in. One of the directors of the organisation confirmed they already have video footage of an event held during the summer. Information provided in the AQAA and verified at the inspection confirmed the service has a clear admissions procedure, which includes undertaking assessments and investigation into the prospective individuals background, to assess their compatibility with the current client group. To help facilitate this, staged introduction visits are arranged for the prospective individual to the home, so that they and their representative and staff can be sure the home is the right place for them. The service is currently providing support to five adults with severe learning disabilities and challenging behaviour. The service user group has remained relatively unchanged for a number of years, with one recent admission from another Inroads respite service. Therefore it was not possible to fully assess standard 2, with regards to pre admission assessments. However, information provided in the files of the person who has recently transferred to the service, confirmed that a social worker had been involved in the transfer and a copy of the local authority care management assessment had been obtained by the home. The individuals files and care plan contained all the appropriate information about them, including detailed behavioural support plans, strategies and risk assessments, so that staff are provided with guidance on how to support the individual, however the paperwork needs to be updated to reflect the transfer from Ambleside to Burnriggs. The manager confirmed they are in the process of doing this, as part of a review of all care plans of the people using the service. The AQAA states a key worker system is in operation and that people using the service and key workers are matched, based on their particular skills and knowledge and experiences. Observation and discussion with staff confirmed that they are fully aware of the individual needs of people using the service and were able to provide a verbal account of the level of support each person requires. Staff told us, the service is very good at assessing peoples needs, which helps them to settle within the home and with the other people living there. One person commented, we have successfully supported one individual who was previously declined placements in other services, we have done this through appropriate training in autism and mental health, we also have an experienced staff team, who have worked together to help the individual settle. They also commented, we have developed good communication strategies with the people using the service and their families and we are good at creating a homely atmosphere, which does not feel institutional, this is the clients home and we respect that. Training records and discussion with staff confirmed that they are provided with training to meet the specific needs of people using the service. Training has included, understanding autism and mental health, epilepsy awareness, administration of a medication bucall madazolam for epilepsy, understanding autistic spectrum disorder, de escalation of violence and two staff have completed a BTEC level 3 for physical Care Homes for Adults (18-65 years) Page 17 of 40 Evidence: intervention and restraint. Service user contracts are held centrally in office, and were not seen on this occasion. Care Homes for Adults (18-65 years) Page 18 of 40 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using this service know they will receive care and support, which meets their individual needs and preferences and will be supported to take risks and make choices about their every day lives. Evidence: Information provided in the AQAA and verified at the inspection confirmed that Burnriggs have a staff team who are committed to supporting the rights of the people living in the home. The AQAA and Statement of Purpose both reflect that central to the focus of the support provided, is the promotion of independence, choice and supporting people to take responsible risks. Of the five people living at Burnriggs, four cannot communicate their needs and desires verbally. Therefore the key to supporting the people using the service is communication. This is an area, which the service has developed well. Communication systems have been tailored to each client, which enables them to identify their wants, needs, and dissatisfactions, which in turn develops their sense of choice and independence. Each person has a communication plan and folder, which reflects their individual Care Homes for Adults (18-65 years) Page 19 of 40 Evidence: communication needs, such as pictures, gestures and a Picture Exchange Communication System (PECS), which supports everyday items, activities and objects. Each individual has a pen picture explaining how they use the PECS to make choices and decisions about everyday activities, including choices of food and drink and leisure activities. The PECS system has been further developed to include voices. These PECS say the word when the individual PEC is pressed. Each person now has a general vocal PECS board and individualised ones for activities and food items. The vocal PECS are used to promote communication, ensuring peoples views and opinions are heard and acted upon. The records and care pathways of three people living in the home were tracked to ascertain how well the home is meeting their needs. These provide a good overview of the individuals likes, dislikes and interests as well as behaviours that may occur, the triggers and the actions staff should take to help calm the individual and situation. The AQAA states that care plans are written incorporating the views and opinions from many people, including parents, friends, professionals and school staff (some of the adults are still attending school, finishing in September 2010). The care plans showed that the combined views and opinions are used to arrive at the most effective way in which the person and the people assisting them can communicate. The care plans are divided into four sections, staying safe, enjoying and achieving, making a positive contribution and achieving economic well being. Each section has a detailed plan of care and behavioural plan, which collectively set out the actions required by staff to ensure that peoples health, personal and social care needs are met. Time was spent discussing the format of the care plans with the manager and the directors. Some of the information still refers to childrens services, the manager confirmed they are in the process of updating these. Although the care plans are very informative and could easily be used by people unfamiliar with the individual, to deliver a personalised and consistent service. These could be further developed to provide the individual with a person centered plan, which describes and / or illustrates a range of information that is important to them, such as plans to support feelings and who and what is important to them. The manager advised us they are in the process of reviewing all of the care plans to make them more person centered, however due to the complexities of the needs and behaviours, of the people currently using the service, development of such a care plan is difficult, as the majority of the people have no interest in having their own care plan. The care plans provide detailed information, for supporting people with behaviours that are challenging to them selves and / or others. These include guidance and strategies for staff regarding planned or unplanned physical intervention techniques, assessed and agreed with and for the individual. These reflect the types of behaviour the individual may exhibit, things that may trigger behaviour to occur and staffs approach to deal with the situation. The content of the behavioural support plans provides good detail, with good guidelines of how to support that person. Care Homes for Adults (18-65 years) Page 20 of 40 Evidence: Risk assessments and safety guidelines have been developed to enable people using the service, to take part in community based activities, these reflect staff must be aware of the environment and describe the action they must take in circumstances where individuals can become aggressive or violent. Staff confirmed they have received appropriate training for dealing with behaviours that are challenging and are confident in supporting individuals in their care. The risk assessments also reflect that relatives are involved in discussions about restrictive physical interventions and types of holds assessed, as being appropriate, are demonstrated to them, and their consent obtained for these to be used. We received information in two health professionals Have Your Say surveys which told us, I am very impressed with the staff and service at Burnriggs, staff have a good caring approach, and treat clients with respect and care. They also commented, what the service does well is the management of young people with severe learning difficulty and challenging behaviour, for example aggressive, unpredictable and no sense of danger and staff are well informed of the needs of the young people and relate well with health professionals and managing challenging behaviour using pre empting strategies, visual communication and physical intervention techniques to de-escalate arousal levels in the young people. People using the service are supported to manage their own money, which they use for activities and personal items. Support plans are in place to promote individuals understanding of the value of money. The acting manager told us they are currently looking to secure an advocacy service for the clients that live at Burnriggs to assist with financial matters. Money expenditure record sheets are in place, providing a running balance of income and expenditure, all receipts are kept. Personal monies are kept locked securely in the seniors office. Relatives currently have control of clients monies, however the acting manager is in the process of writing to all relatives with regards to benefits with a view to supporting each individual to have their own individual bank account. Care Homes for Adults (18-65 years) Page 21 of 40 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using this service are supported to make choices about their lifestyle and take part in social and recreational activities, which meet their expectations. Evidence: The Statement of Purpose reflects one of the objectives of the home is to offer people using the service opportunities to explore activities and experiences, previously unavailable to them due to challenges that they may present. Information seen in peoples care plans and observation during the inspection confirmed that people using the service are supported to lead active, positive and meaningful lives. During the day, two people were at home, two were at school and a fifth individual was at their parental home. The two people remaining at Burnriggs, were observed moving freely around their home spending their time as they chose. This included using the trampoline in the garden area, watching television in one of the sitting rooms and spending time in their room reading. The interaction between people using the service and staff was good, and reflected that people using the service are treated as individuals and with dignity. Care Homes for Adults (18-65 years) Page 22 of 40 Evidence: Each individual has their own activity planner, which is updated each week. One specific member of the staff team has been allocated with the responsibility for activities and has been appointed a small team to assist them in planning and executing these. This has included sourcing more age appropriate activities and events, such as visiting the theatre and concerts and a boat trip on the Orwell with a band on board providing entertainment. The activity planners reflect people using the service have access to community based activities on regular basis, giving them the opportunity to mix with other adults. These have included swimming, ten pin bowling and horse riding. Additionally, clients are supported to use the local facilities such as shops, restaurants, library, parks and businesses and are a familiar part of their local community. Staff have also supported individuals to have a holiday away from the home, these have included an outdoor bound centre in Wales and a stay at a well known holiday resort in Skegness. Risk assessments are completed prior to any undertaking of activities detailing any aspects that are cause for concern. Additionally, the home has an excellent staffing ratio, of one to one staff support for each of the people living in the home. This ratio is increased to two staff to one client, when identified as required, when accessing the community. These measures ensure each individual is supported to live their life to the full, taking advantage of new experiences and opportunities. Although Burnriggs is now registered with us as an adult service, two of the service users continue to attend school on a full time basis. The manager informed us they are currently trying to find suitable day time activities and facilities for these clients, such as social clubs and meeting places, so that a tailored programme of activities can be created for when they finish full time education in July 2010. However, the manager told us they are experiencing problems, with the changes in the commissioning process from childrens to adult services, which is causing difficulties accessing funding and appropriate services for adults with learning disabilities. One of the people using the service, no longer attends school, as the environment was found not to be conducive with anxiety issues. They however do receive input from a tutor at home. As part of their home tuition, they had completed a project, designing a dress and putting on a fashion show, local schools, relatives and friends had been invited to attend. Their care plan reflects that their next project is to include photography. Information provided in the AQAA and verified at the inspection confirmed that socialising and contact with friends and family is an important part of the clients lifestyle. Discussion with the manager, staff and information in care plans reflects the service works well with families, ensuring that people living in the home maintain links and visits to and from family members. The people living at Burnriggs are supported and encouraged to participate in day to day running of the home, including mealtimes. Diets are sourced through the support of Care Homes for Adults (18-65 years) Page 23 of 40 Evidence: dieticians and food preferences are considered when designing the menus. Activities such as buying, cooking and preparing peoples own choice of foods have happened on a planned basis. People were observed accessing the kitchen helping themselves to snacks and drinks, as and when they required. Care Homes for Adults (18-65 years) Page 24 of 40 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using this service receive effective personal health care and support based on their individual needs. The principles of respect, dignity and privacy are put into practice. Evidence: Care plans contain relevant health and personal care information setting out the actions required by care staff to ensure that peoples health and personal care needs are met. These include the individuals personal details, General Practitioner (GP), medical history, medical and professional interventions. All personal care details are fully explained, including the individuals preferences of how they wish to be supported and provide guidance to staff on the actions they should take to promote the individuals independence, whilst respecting their wishes, privacy and dignity. Records in care plans confirmed that peoples health is being monitored and that they are supported to have access to health care professionals, and have good links with GP surgery and dentist. Additionally, information provided in the AQAA and verified at the inspection confirmed people using the service are supported and encouraged to express themselves, their sexuality and voice their opinions. Clients are supported to shop for their own clothes, go to the hair dressers or have their nails done. Discussion with staff confirmed that whilst it is recognised that routines are an important part of the work carried out at Burnriggs, clients can make changes or take the lead when deciding when to wake, sleep or eat. Care Homes for Adults (18-65 years) Page 25 of 40 Evidence: This is supported unless or until the choices made have a negative impact upon their mental health and / or safety. The home has developed efficient and comprehensive medication policy and procedures for ordering, storing, administering and disposal of medicines. Medication is received into the home in its original packaging as dispensed by the pharmacist. The manager explained they had considered using a Monitored Dosage System (MDS), where peoples medication is provided by the pharmacist in a convenient form of packaging, such as blister packs, however frequent changes to peoples medication make this difficult to manage. Two weeks worth of medication is delivered to the home at a time with pharmacist instructions fixed to the packaging so that staff can check the instructions and dosage against the Medication Administration Records (MAR). All medication is kept locked securely in a metal cupboard located within the seniors office, which is also kept locked at all times. Night staff do a nightly stock take to monitor medication is being administered correctly. The manager has developed their own MAR charts for recording and monitoring peoples medication A current list of medication for each service user is held at the front of the MAR chart and reflects the current stock held. The MAR charts were viewed and were found to be correctly completed with no gaps. The MAR files also contained detailed protocols for the administration of PRN (as required) medication, for reducing anxiety, these have been agreed with consultant psychiatrists and staff had made good use of the reverse of the MAR charts, to reflect when and why PRN medication had been administered. Training records and discussion with staff confirmed that staff responsible for administering medication had received the appropriate training The manager confirmed they do not currently have any service users prescribed Controlled Drugs (CD). They were advised by us that should controlled drugs be prescribed to one or more persons in the future the CD cupboard must meet the specifications as stated in the Misuse of Drugs (Safe Custody) Regulations 1973. Care Homes for Adults (18-65 years) Page 26 of 40 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use this service have access to a complaints procedure which is in a format they understand and which enables them to make their views known and are protected from abuse or being placed at risk of harm or abuse. Evidence: The policies and procedures for dealing with complaints, whistle blowing and safeguarding people living in the home were examined. These reflect procedures are in place to protect people using the service and identify the actions staff should take if they receive a complaint, or if an incident of abuse is discovered or reported to them. To ensure all staff have access to this information, the policies and procedures for safeguarding vulnerable adults and the complaints process have been translated into staffs first language, where this is not English. Information provided in the AQAA reflects the difficulties staff have to finding ways to hear the complaints and concerns of people using the service who are unable to communicate vocally. All clients have at least three key workers who are encouraged to develop a close and trusting relationship, so that subtle changes in peoples behaviour may be observed and recorded as a communication of dissatisfaction. The service has tried different ways to enable the people using the service to make their concerns or displeasure known. This has included developing user friendly posters and a user friendly Complaints book. These books are written using the PECS format and pictures and provide people using the service with a tool to communicate how they are feeling, using a range of emotions and locations where problems may have occurred for them to choose Care Homes for Adults (18-65 years) Page 27 of 40 Evidence: from. Three staff spoken with all described using this book to communicate with service users, if they were concerned about an individual, if there behaviour had changed, or if they appeared unhappy. Information provided in the AQAA and verified at the inspection confirmed that Burnriggs has not received any complaints about the service since becoming registered with us as a new service. One safeguarding referral was made to Social Care Services by the manager where an individual expressed concerns about contact with family members. This has been fully investigated and systems have been put in place to protect the individual in the future. The companies Safeguarding Vulnerable Adults (SOVA) policy and procedure was reviewed in April 2009, this still has the Safe Child heading, however the information does relate to adults and provides staff with a flow chart of the steps to take if they suspect or are informed of an allegation of abuse. Staff confirmed they were aware of the SOVA and whistle blowing polices and procedures and were able to give a good account of what they would do to report poor practice. Information provided in the AQAA and verified at the inspection confirmed that the service achieved a Safeguarding Award in August 2009 for quality service in respect of safeguarding the client group they support. To achieve this award the companies policies, procedures, training and practices were scrutinised by external assessors. As previously mentioned in the individual needs section of this report, good records are kept to reflect where restrictive physical intervention is used. Booklets have been designed for this purpose and have good instructions, about recording inside for staff guidance. The booklet reflects any incident involving restrictive physical intervention or where a persons liberty has been deprived. This includes a full detailed account of the incident, action taken, with a list of de-escalation techniques used to re-direct or divert the individual, including verbal directions, prn medication and any restrictive physical intervention used. Behavioural plans supported by risk assessments are in place, reflecting any planned physical restrictive restraint, which have been agreed by families and professionals involved with the persons care and support. The guidelines also reflect where unplanned, instant release techniques can be used in an in emergency situation, when all other options have been exhausted or are ineffectual and situation is dangerous, but states these must be reviewed and discussed following the event, and become part of a planned response in the care plan and management of behaviour strategy and future protocols agreed. Staff confirmed they have received training to manage challenging behaviour and felt confident in using the interventions they have been taught. One of the directors, informed us they are currently negotiating with the National Federation of Personal Safety (NFPS) and Unisafe to provide further training for staff to manage challenging behaviour. They have also obtained a training pack, accredited by the British Institute of learning Disabilities (BILD). It is intended that directors will share the delivery of this training to Care Homes for Adults (18-65 years) Page 28 of 40 Evidence: staff, which will follow on from induction the process. The training schedule also reflects three days have been allocated to provide staff with training to understand the legal and ethical implications of physical and restrictive intervention. Care Homes for Adults (18-65 years) Page 29 of 40 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 physical layout and design of the home enables people to live in a safe and comfortable environment. Evidence: Burnriggs is situated in a residential area in the town of Hadleigh. Furnishings in the home are domestic in style, as is the lighting, carpets and curtains, providing the people who live there with a safe, homely and comfortable environment. There is off road parking to the front of the building and an enclosed garden to the rear. In the garden is a large stand alone activities room and separate staff office. On the ground floor of the premises there are two bedrooms, one bathroom, a toilet, staff office, staff toilets and shower facilities. The communal space consists of a large lounge and a small lounge, dining room and kitchen. The first floor consists of five further bedrooms, one of which is accessed by a separate stairway, and has its own bathroom consisting of a bath and toilet. There is an additional bathroom with a shower cubicle and toilet and a separate toilet. Discussion with an individual living in the home confirmed information provided in the AQAA that people living at Burnriggs are included in how the premises is set out and Care Homes for Adults (18-65 years) Page 30 of 40 Evidence: maintained. This includes asking them to choose colours for rooms to be decorated or what they would like certain areas of the house to be used for. This has resulted in the creation of two separate communal living areas, of a large and smaller lounge to provide more personal space. Additionally, the dining room has been moved, which has allowed people living there to enjoy uninterrupted mealtimes if another individual is feeling unhappy or exhibiting challenging behaviours. One of the residents showed us around the home and showed us their room, this was nicely decorated, reflecting their personality, they told us they had chosen the colour scheme of their bedroom them self. The AQAA states that Burnriggs has undergone a thorough process of updating and redecoration over the past 12 months. Maintenance of the home is continually kept up to date by an in house maintenance person. Observation of the premises confirmed that all areas of the home have been redecorated. Both bathrooms have been refitted with new fittings and the downstairs bathroom has been converted into a wet room enabling greater access for wheelchair users. There are further plans to create a computer and learning room, which will house two computers, with internet access and work stations. To ensure the welfare and safety of people living in the home all radiators are covered, all first floor windows are restricted, and all hot water is regulated at its outlet and monitored to ensure this is being maintained close to the recommended temperature of 43 degrees centigrade. There is no nurse call system in the home, however the one to one staff ratio means that people living there have access to staff when they need them. The home has a utility room equipped to launder soiled linen, clothing and bedding. Appropriate protective equipment, such as gloves and hand washing facilities of liquid soap and paper towels are provided in all toilets and bathrooms, where staff may be required to provide assistance with personal care. Care Homes for Adults (18-65 years) Page 31 of 40 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using this service are protected by the homes recruitment procedures and are supported by a staff team that are trained, skilled and in sufficient numbers to meet their assessed needs. Evidence: Staff told us, staffing levels in the home are good, they commented, 1 to 1 staffing ratio is the basic line, sometimes sickness at short notice can cause problems, however we can use agency to cover if necessary, but we have not used agency in a long time, we are well staffed at a safe and comfortable level and we cant complain, we normally have enough staff to keep people safe and to take part in activities and we have a brilliant team who pull together really well and help each other out. Another member of staff commented, staffing levels are good, the team are brilliant they pull together, really well, we have good team work, we need to help each other. The manager confirmed that 21.6 is the normal staffing compliment, however they currently have 19 staff employed on a full and part time basis. The duty roster confirmed that 5 to 6 staff are allocated each shift, to ensure there is a 1 to 1 ratio for all of the people living in the home, increasing to 2 to 1 in the community. There are currently 5 people using the service, one uses the service Wednesdays to Saturday, remaining at the family home for the other days. On the days they are not in residence this is reflected on the rota, with 4 staff Care Homes for Adults (18-65 years) Page 32 of 40 Evidence: rosterd. The rota also confirmed that additional staff are rosterd evenings and weekends to support activities. The service has 3 awake staff at night. The rotas for proceeding weeks reflect these staffing levels are being maintained. Information provided in the AQAA and verified at the inspection confirmed that Inroads have an effective recruitment procedure, which ensures that all new staff receive guidance and support. Three staff files examined confirmed all appropriate checks had been taken up prior to them commencing employment, including a Criminal Records Bureau (CRB) check and two, sometimes three satisfactory references. Although files contained documents to authenticate that people are who they say they are, there was no photograph of the individual for identification purposes. This was discussed with the manager who agreed to attach the required photographs to the files. CRBs are requested through the companies umbrella body. The umbrella body provides information of CRB disclosure via computerised system, however this information is not held on staff files at the service, but is held centrally at Inroads head office. This information was provided at the inspection by one of the directors. The director confirmed any details about convictions raised are noted and risk assessed to ensure the person employed does not pose a risk to the vulnerable people using the service. Additionally, all staff are required to sign a recruitment of ex offenders document to confirm they have no convictions. Information on the files and discussion with staff confirmed that recruitment had originally commenced through an agency recruiting from overseas, but reflected that a further face to face interview had been held by the company to ensure the individual was the right candidate for the job. Staff files contained a localised induction checklist reflecting staff are provided with an in house induction to familiarise themselves with the working environment, organisation, health and safety and specific safety training. Additionally, all staff are required to attend a three day induction, which complies with the Skills for Care, Common Induction Standards (CIS). Staff confirmed they had completed the CIS induction at a local college when starting their employment with Inroads. The induction process ensures that new staff are made aware of all policies and procedures and regular staff meetings and supervisions provide support and highlight training requirements. Inroads have a training policy to ensure that all staff attend training, and updates, so that they have the skills to undertake the role they have been appointed. Staff commented training is absolutely brilliant, it is sometimes not physically possible to attend all training provided. Records reflect training has included, administration of a medication bucall madazolam for epilepsy, fire safety safeguarding children and younger adults and adult safeguarding, understanding autistic spectrum disorder, moving and handling theory, epilepsy awareness, Unisafe, theory for the de-escalation of violence, and basic care including privacy and dignity, food hygiene and first aid. Two staff have trained at BTEC, level 3 Care Homes for Adults (18-65 years) Page 33 of 40 Evidence: physical intervention restraint level. The training schedule for 2010 reflects a rolling rota of training, including all basic training and induction, medication, report writing, physical intervention and as a part of the induction process challenges, choice and change. The AQAA states the home employs a total of 19 permanent care staff, 6 staff have completed a National Vocational Qualification (NVQ) level 2 or above. These figures reflect the home has not yet achieved the required 50 per cent of staff to hold a recognised qualification, which meets the National Minimum Standard (NMS). However, the AQAA does reflect all staff are offered the opportunity to work towards a NVQ. The 3 Staff spoken with confirmed they were in the process of commencing NVQ level 3 in health and social care. Staff files and discussion with staff confirmed that regular supervision is taking place, a supervision folder was seen with a list of dates supervision had taken place for each member of staff. Staff confirmed they felt well supported in their roles. They commented, the manager is very approachable, a good manager, very understanding and the training is brilliant and we have regular staff meetings to discuss issues about the service and the people living there. Care Homes for Adults (18-65 years) Page 34 of 40 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 management and administration of the home is based on openness and respect and is run in the best interests of the people living there by a competent and qualified manager. Evidence: Ms Anna Boulton is the Managing Director of Inroads (Essex) Ltd and is the Responsible Individual for Burnriggs. For the purposes of registering Burnriggs as a new adult service, Ms Boulton also registered as the manager of the service. Ms Boulton is well qualified, competent and has the experience to manage the service. They are a Registered Nurse in Learning Disabilities, and has studied to Diploma level in Behavioural Approaches for People with Learning Disabilities and has experience of working as a Behavioural Specialist for an Assessment and Treatment Team. They have also completed the Registered Managers Award (RMA) in 2006. Mr James Stapley is currently overseeing the day to day operation and is in the process of making an application to us, CQC to become the registered manager for the service in place of Ms Boulton. They have worked at Burnriggs for about six and half years and before that worked in residential care, schools and a maximum secure unit in mental Care Homes for Adults (18-65 years) Page 35 of 40 Evidence: health. They are currently undertaking a NVQ level 4 in the care of children and young adults and the RMA. Staff told us, the person acting as manager creates a positive atmosphere in the home, and that they are a good manager, who is approachable, as well as a great carer and a very caring person and the person acting as manager sets a clear sense of direction and they keep us up to date with clients needs and informed about changes in the service through regular staff meetings, team building days and morale days. The AQAA states great strides have been taken in all areas of management of the service to guide a staff team through a time of change and uncertainty. The quality and consistency of the care during this time has been testament to the management skills and dedication of the staff team, as the service to clients has been seamless. This was confirmed in discussion with staff who felt the transition between changing from a childrens service to adults has been managed well. They commented. Burnriggs is a unique home, which provides clients with a very homely place to live, the ethos is to support the clients to provide them with as much independence and choice as possible. Information provided in one health professionals Have Your Say survey told us, what the service does well, they commented Inroads Essex Ltd serve a highly complex group of young people with additional needs, learning disabilities, mental health issues and presenting challenging behaviours. It is worthy to note that to cover these extreme needs across a vastly rural area of Suffolk there is considerable liaison with a range of services required and to this effect the company strive to achieve their communication network in a positive way. Information provided in the AQAA and verified at the inspection confirmed that since Burnriggs registered as an adult facility they have been working towards developing policies and procedures that are reflective of an adult service rather than childrens. A review of clients records, the Statement of Purpose and the safeguarding adults policy reflects there is still work to be completed to ensure all information about the service and relating to people living there is clear and non-misleading, reflecting this is now an adult service. Inroads has a Quality Assurance system in place that includes an internal audit of services. The AQAA reflects policies and procedures are reviewed regularly and current guidance is sourced to inform new policies. Staff use questionnaires monthly to try to obtain the views and opinions of the people living in the home. These are set out in a similar format as the complaints book using the Picture Exchange Communication System (PECS), as a tool for people to communicate how they are feeling, using questions about what the individual thinks about Burniggs, if they like their room, feel safe, like going out with carers. If answers to any questions are no, staff then switch to using the complaints book to ascertain any problems. Completed questionnaires reflected that people living in the home are happy with the service they are receiving. Care Homes for Adults (18-65 years) Page 36 of 40 Evidence: The AQAA states that the service knows where it needs to continue making improvements, these include improving involvement of clients in evaluation of day to day service provision as well as making more public the goals of the service for the forthcoming year and to seeking feedback from clients family and professionals on how well the service is achieving their goals. They have also identified they need to continue development of the service with an emphasis on adults and to ensure staff are familiar with the change in philosophy and delivery of care that this entails. The home continues to take steps to safeguard the health, safety and welfare of people living and working in the home. The maintenance person and files confirmed weekly and monthly checks are completed to ensure facilities and equipment in the home are maintained and kept in good working order and compliant with safe working practices. The most recent Gas and Electrical Safety certificates were seen and Portable Appliance Testing (PAT) was taking place on the day of the inspection by a qualified electrician. The fire log book confirmed that the fire alarm, emergency lighting and fire fighting equipment is regularly serviced and tested. Additionally fire training for staff is updated annually and regular fire drills taking place. The fire risk assessment was seen and was found to be compliant with current fire safety guidelines. Care Homes for Adults (18-65 years) Page 37 of 40 Are there any outstanding requirements from the last inspection? Yes  No  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 38 of 40 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 Description 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 Description 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 41 Clients records, the statement of purpose and the safeguarding adults policy should to be reviewed to ensure all information about the service and relating to people living there are reflective of an adult service. Care Homes for Adults (18-65 years) Page 39 of 40 Helpline: Telephone: 03000 616161 or 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 © (2010) 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. Care Homes for Adults (18-65 years) Page 40 of 40 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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