Care Home: Burrow Down Cottages

What the care home does well Burrowdown Cottages is very well managed. It focuses on providing very person centred support to enable people with learning disabilities to access a wide and varied life. Health care professionals recognise that the service work well with those who have complex behaviours, and are flexible in meeting the needs of both the person and professional. The admission process is robust ensuring that people have as much time as possible and information to make the move to the home as smooth as possible. Staff at the home also ensure that this process is a time when information is obtained on the person to ensure that the home are prepared and equipped to care for the person to a very high standard. This process is adapted particularly well for people who require respite care. People are empowered and supported to have choice and control over their lives and access to a flexible, wide and varied programme of personal development, education and leisure activities. People receive personal and healthcare support in a sensitive and person centred way. Communication with healthcare professionals is proactive ensuring that people are supported to maintain a healthy lifestyle. People can be confident that any complaints or concerns will be dealt with sensitively and effectively. People can also be reassured that policies and practices are in place to protect a person from abuse. The popular staff group are supported, supervised and trained to a high standard ensuring that they can meet the needs of the people who live at Burrowdown. People live in a homely, clean, well maintained, comfortable and safe environments. The improvements and refurbishment programme is ongoing ensuring that standard of fabric and furnishing in the home is to an extremely high standard. The management structure at the home ensure a smooth running place that his person centred and focused on ensuring that people have a positive lifestyle. The manager is in the home are focused, and aware of what needs to happen to ensure that the high standards continue in this home. What has improved since the last inspection? Although this is the first inspection performed under a new registration to become a limited company, there has been no actual change in management structure or organisation of the service. The service was awarded an excellent rating at the previous inspection, and there have been no downward trends in this home. Since the last inspection the home have continued to improve the service provided to people. Each year the service provide a business objective. Evidence seen shows that the majority of the business objectives for 2009 had been achieved. The information provided to people has improved by separating the service user guide for both services (the Lodge and the Cottage) which operate under Burrowdown cottages. This includes the use of Total Communication `talking boards` in each of the bedrooms for people to use as a visual care and support plan. Pictorial or written display of choices, activities, and `how to support me` are used. The service also strive to allocate `planned stays` to coincide with people`s choice of preferred co-residents and the room in which they stay. The service offer more respite and flexibility for each individual as requested or required and are forging better relationships with housing associations, benefits agencies and advocacy agencies in order to offer people who aim to live independently within the community the opportunity to do so. The management of medication has improved by the introduction of people keeping medication in their own bedrooms, reducing the institutionalised approach. This also minimises the number of people handling medication. Advanced training in medication for senior carers has been introduced and off duty is arranged to ensure a member of staff with advanced handling medication training is on duty at all times. Medication system has also changed to blister packs and the use of medication administration records has been introduced for people who come to the home for respite. The feedback of relatives and carers is encouraged further by ensuring property / feedback sheets are sent home with people after every stay and that any comments suggestions or complaints are recorded and addressed as appropriate. Staff have access to training with regards to Mental Capacity Act 2005 and its relevance to their work role in supporting people . Senior staff have also received information regarding Deprivation of Liberty legislation. Despite being rated excellent at the last inspection the environment has also improved in the past year. The Lodge has had bedrooms redecorated with new bedding being provided. The porch way has also been painted. The Conservatory roof and guttering has been cleaned and a new fridge freezer and washing machine have been purchased. The Cottage now has privacy screening at the back door giving privacy from the day service area. In addition to this the completion of drive ways and parking areas including humps helps to enforce the speed limit. The service has reviewed and retained their Investor in People Award. In addition to this they have improved staff retention by introducing activities that have contributed to team members being more involved and valued. The organisation has employed the service of Peninsula Business Service in relation systems to meet Health and Safety Regulations and Human Resource employment records system, both systems also provide advice and support to the organisation. What the care home could do better: Minor amendments are needed to ensure that information provided to people is up to date at all times. This should include ensuring all complaints procedures, statement purposes, and service user guides contain the correct Care Quality Commission address and contact details. Information within policies should also be amended to ensure it reflects the actual practices that take place at the home. This should include ensuring the safeguarding policy within the policies and procedures folder mirrors that of the locally agreed safeguarding policies. Improvements must be made to ensure that full and satisfactory information is obtained on all staff, before they work in the home. This must include ensuring two written references are obtained on all staff and should include systems to ensure that none returned references are followed up. Key inspection report Care homes for adults (18-65 years) Name: Address: Burrow Down Cottages Burrow Down Preston Down Road Preston Paignton Devon TQ3 1RN     The quality rating for this care home is:   three star excellent 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: Clare Medlock     Date: 2 3 0 2 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 34 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) 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 Care Homes for Adults (18-65 years) Page 3 of 34 Information about the care home Name of care home: Address: Burrow Down Cottages Burrow Down Preston Down Road Preston Paignton Devon TQ3 1RN Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Ms Sandra Allery Type of registration: Number of places registered: care home 6 Burrow Down Support Services Ltd Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accomodated is 6 The registered person may provide the following category of service only: Care home only -Code PC to service users whose primary care needs on admission to the home are within the following category: Learning disability code LD Date of last inspection Brief description of the care home Burrowdown Cottages is a registered residential care home for six adults with learning disabilities. The care home comprises of two separate buildings: the Cottage (two people) and the Lodge (four people). Burrowdown cottages is owned by Burrowdown Support Services Ltd, which also has Care Homes for Adults (18-65 years) Page 4 of 34 Over 65 0 6 Brief description of the care home Burrowdown residential home and ACCORDs domiciliary care service which operate within the grounds. Also, within these grounds, operates a day care service which does not fall under the Care Quality Commissions legislation and is not reported on. This report relates to Burrowdown cottages only. This care home provides care for up to six younger adults who may have learning disabilities with complex needs, including autistic spectrum disorders, Williams syndrome, down syndrome, attention deficit disorder, and needs in association with other syndrome that an individual may have. The cottages are situated within their own extensive grounds in the residential area of Preston, which is on the outskirts of Paignton, Devon. The Lodge has four separate bedrooms with individual wet room, shared kitchen, dining area, lounge area and conservatory. In addition to this there is a separate bathroom and laundry room. The Cottage has two bedrooms, a shared bathroom, staff sleeping room/office, a lounge area, and kitchen dining area. Access to the Lodge is via ramp and access to The Cottage is via a small ridge into the kitchen area. Fees are negotiated on an individual needs basis and can vary from £1161-£2176 per week depending on need. A copy of the statement of purpose and service user guide can be obtained from the manager at the home. Care Homes for Adults (18-65 years) Page 5 of 34 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: three star excellent service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is three star. This means the people who use the service experience excellent quality outcomes. Prior to this inspection we sent surveys to people who use the service and to healthcare professionals -- the findings of these surveys are incorporated within the report. This key inspection included a visit to the home on Tuesday, 23rd February 2010. During this time we spoke to the Registered Manager and Deputy Manager. We had spoken with one person who lives in the home at a previous visit and two members of staff. We case tracked three people who use the service. This means we looked in detail at the care these people receive. We spoke to staff about their care, we looked records that related to them, and made observations if they were unable to speak to us Care Homes for Adults (18-65 years) Page 6 of 34 or provide feedback. We looked at care plans, maintenance records, four staff recruitment records, training records and policies and procedures. We did this because we wanted to understand how well the recruitment and safeguarding systems work and what this means the people who use the service. During inspection we also watched interactions between staff and people living at the home. Prior to writing the report, the Provider sent us the completed annual quality assurance assessment for inspection (within timescales). The AQAA is a self-assessment record that focuses on how well outcomes are being met people using the service. It also gives us some numerical information about the service. This document was detailed and submitted well within timescales. All this information helps us to develop a picture of how the home is managed and what it is like to live at Burrowdown Cottages. Care Homes for Adults (18-65 years) Page 7 of 34 What the care home does well: What has improved since the last inspection? Although this is the first inspection performed under a new registration to become a limited company, there has been no actual change in management structure or organisation of the service. The service was awarded an excellent rating at the previous inspection, and there have been no downward trends in this home. Since the last inspection the home have continued to improve the service provided to people. Each year the service provide a business objective. Evidence seen shows that the majority of the business objectives for 2009 had been achieved. Care Homes for Adults (18-65 years) Page 8 of 34 The information provided to people has improved by separating the service user guide for both services (the Lodge and the Cottage) which operate under Burrowdown cottages. This includes the use of Total Communication talking boards in each of the bedrooms for people to use as a visual care and support plan. Pictorial or written display of choices, activities, and how to support me are used. The service also strive to allocate planned stays to coincide with peoples choice of preferred co-residents and the room in which they stay. The service offer more respite and flexibility for each individual as requested or required and are forging better relationships with housing associations, benefits agencies and advocacy agencies in order to offer people who aim to live independently within the community the opportunity to do so. The management of medication has improved by the introduction of people keeping medication in their own bedrooms, reducing the institutionalised approach. This also minimises the number of people handling medication. Advanced training in medication for senior carers has been introduced and off duty is arranged to ensure a member of staff with advanced handling medication training is on duty at all times. Medication system has also changed to blister packs and the use of medication administration records has been introduced for people who come to the home for respite. The feedback of relatives and carers is encouraged further by ensuring property / feedback sheets are sent home with people after every stay and that any comments suggestions or complaints are recorded and addressed as appropriate. Staff have access to training with regards to Mental Capacity Act 2005 and its relevance to their work role in supporting people . Senior staff have also received information regarding Deprivation of Liberty legislation. Despite being rated excellent at the last inspection the environment has also improved in the past year. The Lodge has had bedrooms redecorated with new bedding being provided. The porch way has also been painted. The Conservatory roof and guttering has been cleaned and a new fridge freezer and washing machine have been purchased. The Cottage now has privacy screening at the back door giving privacy from the day service area. In addition to this the completion of drive ways and parking areas including humps helps to enforce the speed limit. The service has reviewed and retained their Investor in People Award. In addition to this they have improved staff retention by introducing activities that have contributed to team members being more involved and valued. The organisation has employed the service of Peninsula Business Service in relation systems to meet Health and Safety Regulations and Human Resource employment records system, both systems also provide advice and support to the organisation. What they could do better: Minor amendments are needed to ensure that information provided to people is up to date at all times. This should include ensuring all complaints procedures, statement Care Homes for Adults (18-65 years) Page 9 of 34 purposes, and service user guides contain the correct Care Quality Commission address and contact details. Information within policies should also be amended to ensure it reflects the actual practices that take place at the home. This should include ensuring the safeguarding policy within the policies and procedures folder mirrors that of the locally agreed safeguarding policies. Improvements must be made to ensure that full and satisfactory information is obtained on all staff, before they work in the home. This must include ensuring two written references are obtained on all staff and should include systems to ensure that none returned references are followed up. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 10 of 34 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 11 of 34 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The detailed information provided to people enables them to decide whether Burrowdown Cottages is suitable for them. The robust procedure followed ensures that the admission process meets the needs of people. Evidence: The Statement of Purpose and Service User Guide are both well written and contain the necessary information needed by people to decide whether Burrowdown residential home can meet their needs. Changes have been made to the Statement of Purpose to clarify the difference between The Cottage and The Lodge. Both the statement of purpose and service user guide contains contact details for one recent change of address of the care quality commission, but is not the most recent change. The deputy manager and manager confirmed that they were aware that this needed to be done. The Statement of Purpose and Service User Guide states that Prospective service users should first make contact with the registered manager to have an informal visit Care Homes for Adults (18-65 years) Page 12 of 34 Evidence: to review the services and facilities and to obtain a referral form and information pack. The form should be completed and returned accompanied by a full and comprehensive assessment of need, which states the reason for the referral and the specific services sought. The AQAA states The needs and aspirations of prospective service users and their families are carefully assessed, and any input and support for the service required by multidisciplinary team is agreed, before a decision is made to use Burrow Down Cottages. The deputy manager stated that information is gathered from social workers, previous carers, service users themselves, and friends and family. We were told that an assessment called Whealen and Speak was used to assess the needs of each person coming into the home. Service user plans showed that these detailed and comprehensive assessments were used for each person in the home. A survey completed by a parent read My son was involved as fully as possible with the decision making about his move to the home. Because of his communication difficulties caused by a mixture of autism and learning difficulties this took the form of monitoring his reactions to this major change in his life. He shows no sign of reluctance when he returns there after his stays with us on some weekends. People who use the services of the Lodge often stay for periods of respite which can last between a weekend or longer. A care plan of a person who had used respite for a very short period of time was seen. This contained extremely detailed information regarding the needs of this person. This level of detail should be commended. All assessments seen showed that the process is thorough and person centred, showing that the individual needs of each person is taken into consideration before an admission is agreed. Regarding emergency admissions, the AQAA states Lodge: Emergency admissions only if would not cause disruption to other people staying and if able to ensure appropriately skilled staff available and The Cottage: No emergency admissions with current service users Each person is issued with a contract which signed by representatives or care manager responsible for the funding. Care Homes for Adults (18-65 years) Page 13 of 34 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are empowered and supported to have choice and control over their lives. Evidence: People told us that they are able to participate and make decisions about their life at the home. Some of the surveys we sent to people who use the service were completed by parents. One parent wrote whilst they are well supervised they allow them to do what they are interested in. a person who had completed their own survey wrote They helped me look after myself whilst another person wrote They understand when I need space. Health care professionals who completed surveys were extremely complimentary about the service provided. One health care professional wrote the service makes sure choices are available with client at the heart of the service. whilst another health care professional wrote that the service were flexible in meeting the needs of each service user. Care Homes for Adults (18-65 years) Page 14 of 34 Evidence: One parent to completed a survey wrote staff judged by his reactions whether or not he is happy with his daily activities. He is also able to ask to do things he likes and make his needs known on a basic level. He relies on the people around him to monitor his situation. Staff told us that daily routines were quite flexible and depended on the preferences and abilities of each person. The deputy manager told us that each person has a schedule of activities. Inspection of the showed that schedules varied. We were provided with examples were people living or staying at the home were able to make decisions regarding their life. Examples included choice of activities within the evening and decisions about activities of daily living. We were informed that people in the home participate in some aspects of life at the home but this varied. People who were at the home for respite had more options to decline joining in with household chores if they preferred not to. People staying for longer periods were encouraged and supported to participate in all aspects of life in the home, including household chores, food preparation and activities. The Responsible Individual has employed a psychotherapist on a part time basis to offer support for people living in the home to ensure they are able to express their views and feel empowered. Each person has a folder which contains very detailed information about their needs and preferences. The format of these folders varied between each person. However, each file contained information to inform staff of the persons likes, dislikes, communication needs, details about their lives, indications of when they are happy, or annoyed, and details of the persons goals in daily activities. The detail within these folders was commendable, well constructed and person centred. The AQAA stated Service users are empowered to make their own decisions in as many areas as possible and are consulted on all aspects of life in the home including meals, which bedroom they use when staying, what leisure activities would like to do etc. Service user plans clearly demonstrated risk assessments for each person to enable them to take risks as part of an independent lifestyle. These risk assessments were very specific and person centred. Themes included vulnerability in the community, medication and holding a key to their room. General risk assessments included information regarding activities of daily living including relationships, temperament, vulnerability, and medication. The level of detail within the risk assessments should be Care Homes for Adults (18-65 years) Page 15 of 34 Evidence: commended. The AQAA states that the process of people making choices about their lives has improved by the Introduction of Total Communication talking boards in each of the bedrooms for service users to use as a visual care and support plan, pictorial or written display of choices, activities, and how to support me. The subject of confidentiality is discussed during the induction period and covered within the staff handbook. During the inspection all staff respected the privacy and information regarding people in the home in a professional manner. The individual records of people living in the home were stored within a locked cabinets and people have their personal records stored within their own bedrooms. Care Homes for Adults (18-65 years) Page 16 of 34 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have access to a flexible, wide and varied programme of personal development, education and leisure activities. Evidence: People who live at cottages are pleased with the service they receive. One person living at the cottages were spoken to had a previous visit. They told us that they were extremely happy at the home, liked what they did and liked the staff. Surveys received from people who live at the cottages were also complimentary about their lifestyle. When asked what the home does well one person wrote they organise things and take me to nice places that I enjoy. Staff explained that key workers tend to be chosen to ensure a good match takes place. Gender is taken into account regarding this process. Care Homes for Adults (18-65 years) Page 17 of 34 Evidence: Staff explained that at present the people living in the Cottages do not access full-time education or employment but stated that this was due to the individual needs and preferences of the people rather than the service not offering these opportunities. Further examples were given to show that access to education and employment to take place. The manager explained that some people have tried work placements and attended taster sessions. The majority of people access day care services where they have access to experiences such as animal husbandry, arts and crafts and other activities. The manager also explained that where a one to one care package is provided this continues whilst the person is at day care. We were told that leisure activities included going into town, shopping, trips to the pub, bowling, going for walks or drives, swimming, cooking or pursuing particular hobbies. Staff also told us that sometimes people needed to support to learn how to relax and chill. Discussion and service user plans showed that people in the home were able to maintain links with their friends and family in the local community. Service user plans showed that some people in the home have personal relationships and these are supported with risk assessments in place where necessary. We were told that the cottages have access to a minibus is and people carrier but that staff are also used their car provided they had suitable insurance. The AQAA stated that Service users are encouraged to try and enjoy healthy, balanced meals and are offered choice of meals and given access to refreshments at any time. Meal times are flexible and service users have facility and opportunity to eat with there peers or in a quieter area as they wish or as indicated by behaviour. Staff encourage, and assist as appropriate, service users to participate in the preparation and cooking of meals, snacks and refreshments and to share the household tasks, not only to develop and maintain skills for independence but to also to give ownership and responsibility for their home. Staff at the inspection said because there are only a small number of people in each house choice over menu is easy to facilitate. Care Homes for Adults (18-65 years) Page 18 of 34 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People receive personal and healthcare support in a sensitive and person centred way. Evidence: Each person had a formal service user plan which contained detailed information including service user information, factors to maximise contentment, information regarding personality, communication, cognitive skills, personal preferences, observation and behaviours, sexual orientation, insight, personal cleansing, mobility, access to using the toilet, personal dressing, sleep patterns, medical conditions, and information regarding basic health care needs. All care plans and documents were well completed. Surveys received from healthcare professionals commented on the standard of person centred care provided at Burrowdown. When asked what the service does well one comment read they offer activities and care along devised person centred care plans. Service user plans showed us that each person has their needs met and reviewed on a regular basis. The deputy manager informed us that this process is formally performed Care Homes for Adults (18-65 years) Page 19 of 34 Evidence: at least annually, but often is more frequent as changes identified. A parent who completed a survey wrote He has key workers who oversee his care on a day-to-day basis. They are very knowledgeable about his disability and his needs. Evidence was provided to show that people in the home have access to NHS services and healthcare professionals. Evidence included psychiatrists, GPs, dentists, speech and language therapists, physiotherapists, district nurses, opticians, podiatrists, and psychotherapists. On the day of inspection one person had recently attended a hospital for investigations. Staff had supported this person and their family through this process. Staff informed us that there were no specialist equipment at either the lodge or cottage, but this equipment has been accessed and sourced with other people. People spoken to at a previous visits to the home told us that they were very happy living there. A health care professional survey stated it has been an all-round positive experience working with this service. Feedback from carers is also very positive. The clients appear to be very satisfied and in areas of challenging behaviour often a reduction in behaviour has been observed. Parents who had completed surveys on behalf of their young adult were complimentary about the service. One comment read The clients are always well cared for. Staff also wrote that they thought that the care and support provided was very good. When asked what the service does well healthcare professionals wrote They know the client and respond to their individual needs. and They liaise and joint work with families, carers and other professionals. Another comment read Staff are strong advocates for the clients needs. Medication practices are well managed at the home. Staff at the home encourage people to retain their own medication within the privacy of their bedroom. Support is then offered by staff to each person to take their medication in a less institutionalised manner. staff use the medication administration record to record that the person has taken the medication. The management of medication has improved by the introduction of people keeping medication in their own bedrooms, reducing the institutionalised approach. This also minimises the number of people handling medication. Training in medication for senior carers has been introduced and off duty is arranged to ensure a member of staff with advanced handling medication training is on duty at all times. Medication system has Care Homes for Adults (18-65 years) Page 20 of 34 Evidence: also changed to blister packs and the use of medication administration records has been introduced for people who come to the home for respite. Staff at the home deal with ageing, illness and death with sensitivity and respect. The home employ a psychotherapist who can be used for counselling purposes should this rise. Communication with healthcare professionals and GPs is very good. Care Homes for Adults (18-65 years) Page 21 of 34 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 can be confident that any complaints or concerns will be dealt with sensitively and effectively. People can also be reassured that knowledge and practices are in place to protect a person from abuse, but amendments to policies would improve this process. Evidence: All surveys received from people, families and healthcare professionals indicated that people are aware of how to make a complaint. A complaints record shows that minor issues are recorded in the same way as complaints. Staff at the home see complaints as a way of ensuring the service they provide is too high standard. Discussions with the deputy manager confirmed that minor issues are addressed as they arise on an informal basis. There are complaints procedures are displayed within the home, and located within the Service User Guide and Statement of Purpose. Systems are in place to ensure that people are protected from abuse, neglect and self harm. Risk assessments are present to enable people to take risks whilst being supported and protected. Recruitment processes also protect people by ensuring staff who are unsuitable to Care Homes for Adults (18-65 years) Page 22 of 34 Evidence: work with vulnerable adults are screened before employment. All staff have a criminal records bureau check and protection of vulnerable adults checks performed. staff to prayer on application forms whether they have a previous conviction, and this information is followed up on the written interview records. Staff are provided with safeguarding adults training during the induction process and also on a regular basis. The manager, deputy manager and staff were aware of how to correctly report allegations. However, closer inspection of the safeguarding adult policy showed that the process stated did not mirror locally agreed protocols, and could provide confusing advice to staff in the abcence of Management presence. The home have policies and practices regarding peoples money and financial affairs to ensure people are protected from financial abuse. The evidence seen at the inspection showed that support is provided to enable a person to maintain as much independence but their finances as possible, whilst taking necessary steps to protect them from abuse. Records were well maintained, with production of receipts where necessary. There were no example seen of people having their liberties deprived. The AQAA stated Staff have training with regards to Mental Capacity Act 2005 and its relevance to their work role in supporting our service users. and Senior staff have received information regarding Deprivation of Liberty legislation and guidance. Care Homes for Adults (18-65 years) Page 23 of 34 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 excellent 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 homely, well maintained, comfortable and safe environment. Evidence: Both Burrowdown cottage buildings are furnished and decorated to extremely high standard, providing people with a domestic, homely environment in which to live. Attention has been made to ensure that the home is not institutionalised with furnishings and fabrics within the home being domestic in style. Surveys showed that people appreciate the environment in which they live and work. When asked what the service does well one comment read Provides a safe and clean environment to live in. Another comment read Its a nice home. One comment contained a suggestion to have a better CD player in the car and better disabled access on the vehicles. All areas of each building are accessible by people who live there. Each person has their own bedroom, and within the lodge people are able to choose which room they stay in if they are having respite care. Each bedroom within the lodge has a large wet room, at the home also has a separate bathroom should people Care Homes for Adults (18-65 years) Page 24 of 34 Evidence: prefer to bath. People also have their own bedroom in the cottage and share a shower/bathroom. All toilets, bathrooms and on sweets were clean, hygienic yet maintaining a homely atmosphere. Shared spaces were also accessible for people who live at the home and were well maintained. All areas of the home appeared safe, clean hygienic and well organised. Each building had a designated laundry room with equipment to prevent the spread of infection. Gloves, liquid soap and aprons were available for staff use where necessary. Business plans were available outlining the future planned refurbishment programme. This was seen to be continuing programme. Despite being rated excellent at the last inspection the AQAA states that the following improvemnets have taken place in the past year. The Lodge has had bedrooms redecorated and new bedding purchased and has had the porch way painted. The Conservatory roof and guttering has been cleaned and a new fridge freezer and washing machine have been purchased. The Cottage has privacy screening at the back door giving privacy from the day service area, for the same reason encourage to use the front door. In addition to this the completion of drive ways and parking areas including humps helps to enforce speed limit. Care Homes for Adults (18-65 years) Page 25 of 34 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The stable staff group are provided with support, induction and training to ensure they can care for vulnerable adults. improvements are needed to show that the recruitment process is robust. Evidence: Feedback regarding staff was extremely positive. When asked what the service does well, one person wrote staff are good here Comments from healthcare professionals included The staff show obvious concern and care for their clients. whilst another health care professional wrote Training their staff in understanding and responding positively and constructively to challenging behaviour expressed by the service users. Healthcare professionals also appreciated that communication between the staff team, families and other professionals was excellent. Off duty records showed that the complex act of allocating suitably trained staff to the individual needs of people within the service is done very effectively. Off duty records reflected one-to-one packages of care, outreach work, and the specialist needs of people who use the service. The lodge and the cottage have separate off duty records which both showed suitable staff cover. Care Homes for Adults (18-65 years) Page 26 of 34 Evidence: The AQAA stated Ensure that staffing levels are sufficient and training, skills and personal development is appropriate to meet the needs of the service users and the organisation. Regular use of SWOT analysis and skills matrix, along with service user review and referrals, staff meetings, direct supervision and appraisals to provide information to identify areas of weakness in staff in staff team and / or individuals which in turn initiates actions for improvement. Staff working at the home were appreciative of the training opportunities provided. Staff surveys asked what this home does well. Staff comments included Training provided is sufficient to the job role and support for NVQ training is of a high standard. All new staff attend a specialist induction programmecalled LDAF (Learning Disabilities Award Framework) The Learning Disability Qualifications are a set of qualifications appropriate to people who work in learning disability services. During the induction period staff also access mandatory and specialist training which is performed on a rolling programme. Staff files provided examples of this training to include: autism, medication training, total communication, epilepsy, mental capacity act and the protection of vulnerable adults. Staff spoken to said they were encouraged to attend as much training as possible and were supported in achieving NVQ training. One member of staff told us he had achieved his NVQ three and was being encouraged to do NVQ four. A survey which had been completed by a parent read Management put a lot of effort into making sure that staff are well-trained and made aware of his needs. New staff have an induction package and existing staff receive regular ongoing training. Recruitment files were well structured and showed that the process is consistent. All files contained an application form, staff photograph, proof of identity, interview records, terms and conditions, and criminal record bureaus check. However, three of the four files inspected only contained one written reference. One file contained one reference from a friend, and this member of staff had a conviction on their criminal records bureau check. Evidence was present that references had been requested, but systems were not in place to chase up when references had not been returned. The manager explained a reason for this shortfall and stated that staff did not work unsupervised during the induction period, but gave assurances that this would be addressed as a matter of urgency. The AQAA states that recruitment had been recognised as an area to be improved, and stated that in the last year Activated Peninsula Business Service Ltd HR system Care Homes for Adults (18-65 years) Page 27 of 34 Evidence: have been contracted to support and to give advice and legal support on general employment practice. All staff are issued with the General Social Care Councils Code of Conduct when they begin work. Supervision records were present in all staff files and showed that this process was held on a regular basis. Staff said they appreciated the regular supervision and felt well supported in the home. The home also employ a psychotherapist who is used by staff to discuss any matters that may be affecting their work. Staff spoken to considered this a positive facility. Care Homes for Adults (18-65 years) Page 28 of 34 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is very well managed. Evidence: The Responsible Individual is a registered nurse specialising in learning disabilities. She has had managed and owned businesses in the care industry since 1983. She visits the home usually on a daily basis and provides monthly visits to ensure the service is meeting the needs of the people who live there. The Registered Manager has worked with people with learning disabilities since 1980. She has NVQ two, three and four in care and has the registered managers award including other management courses. The Registered Manager is responsible for the new domiciliary care service, the residential home, and the cottages which operate from one site. She is supported in the cottages by an experienced and knowledgeable registered manager, who was professional and knowledgeable during the inspection. This deputy manager has gained NVQ level 4 RMA. Feedback from surveys and speaking to people at the home confirmed that the Care Homes for Adults (18-65 years) Page 29 of 34 Evidence: managemnet and staff group were very popular. A comment from a member of staff read The registered manager is very supportive and knows her job very well. Staff told us that all managers were good to work for. Comments on health care professional surveys mentioned that communication was very good at the service. One comment included Communication with families, carers and other professionals is excellent. Whilst another health care professional wrote There is good communication between all. Feedback regarding the management of the home was also positive. Staff referred to be excellent working environment, and support staff received. Staff described as organised and professional, whilst at further comment read This is managed excellently -- ensuring care is centred on peoples needs and delivered to provide tailored services. When asked what the service could do better one comment read I would be happy if services are available to support people in a supported living situation in the community could expand. Many carers have a positive relationship and build trust with this provider which would enable them to care for their relative or relation. Another comment read Excellent service, rarely fails to deliver. One parent wrote management and staff are open about sharing information. Any matters raised are always addressed promptly and appropriately. The AQAA read Because of the growth of service it was considered necessary to ensure that the ethos and management style was not sacrificed for the sake of expansion. Therefore the restructuring of the staff teams with the effect of influencing leadership responsibilities has been implemented to assist this process. Regular manager meetings and staff meetings are held to ensure that the service runs smoothly. In addition to this the staff ensure that people living in the home are able to raise their concerns or their opinions on a regular formal basis. We were also informed that questionnaires, community reports, accident records, complaints and service user reviews also help provide feedback and raise areas that need improvement. The Registered Manager said she saw also the inspection process as clarification that the service was providing a good service. The AQAA states that the service continue to listen to the views of people in the home by regular reviews and/or core team meetings, service user questionnaire, Property list reverse invites comments and feedback, CSCI/CQC feedback. Then the AQAA continues to state Generally management and staff of the service is open and accessible to service users and their families, views of the people who use our services Care Homes for Adults (18-65 years) Page 30 of 34 Evidence: are welcomed informally as well as sought through the methods mentioned, therefore, any phone or face to face conversation may investigate changes in what we do and what we offer, as we endeavour to be creative and flexible. The Registered Manager and Deputy Manager are aware of what needs to be achieved in the home and has prepared quality assurance and audit documents to ensure the smooth running of the home. The service has been awarded Investors In People award. The home take the health and safety of people seriously and have many systems, risk assessments and practices in place to protect people. The AQAA told us that the service have Employed the consultation service of peninsula business services to oversee all our Health and Safety regulations. Maintenance records and service records showed that the home is well maintained ensuring that the safety of people is a priority. Evidence of Electrical checks, gas tests, water checks and risk assessments were seen doing this inspection. Staff have access to mandatory training as part of a rolling programme. Training matrix records showed which staff had achieved this, and which staff had been booked onto forthcoming events. Insurance certificates were seen during inspection within the general office. Accident records are well maintained and first aid boxes are available within the home. Care Homes for Adults (18-65 years) Page 31 of 34 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 32 of 34 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 34 19 Systems must be in place to 23/07/2010 ensure that references are chased if they have not been returned. This will mean that full unsatisfactory information is obtained on people who are due to work with vulnerable adults. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 1 The Service User Guide and Statement of Purpose should contain the recently changed contact details for The Care Quality Commission. The policies regarding action to be taken following an allegation of abuse should be clear to follow and mirror locally agreed procedures. 2 23 Care Homes for Adults (18-65 years) Page 33 of 34 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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. 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