Care Home: Burrow Down Residential Home

What the care home does well Burrowdown residential home 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. The admission process is robust ensuring that people have enough time 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. 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 recruited, 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 environment. 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? This is the first inspection under a new registration of the service this that came into effect last year. The new registration related to the name of the organisation rather than the way the home is run. The organisation is now a limited company. There have been no changes in management structure and organisation at the home since the last inspection. There have been no downward trends in standards noted at this inspection. The Care Quality Commission do not provide excellent ratings to newly registered services because of lack of track record. The Care Quality Commission considers that any new registration may affect the day to day running of the business. What the care home could do better: Very minor amendments including updating the service user guide to show the correct contact details for the Care Quality Commission would improve the accuracy of information provided to people. The manager should also ensure staff were called correctly in receipt of medication is coming to the home as stated in the home`s policy. It is also suggested that the date of entry be labelled on creams and lotions used to ensure they are not open long enough to cause an increase in spread of infection. The recruitment process could be improved even further by ensuring that references are chased when they are not returned and looking at ways that staff health can be assessed before employment. Key inspection report Care homes for adults (18-65 years) Name: Address: Burrow Down Residential Home 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: 0 9 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 32 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 32 Information about the care home Name of care home: Address: Burrow Down Residential Home 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 14 Burrow Down Support Services Ltd Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability physical disability Additional conditions: The maximum number of service users who can be accomodated is 14 The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following categories:Learning disability - code LD Physical disability - code PD Date of last inspection Brief description of the care home Burrowdown residential home is a large care home within its own extensive grounds in the area of Preston, which is on the outskirts of Paignton, Devon. This care home provides care for up to 14 people with learning disabilities with mild to moderate Care Homes for Adults (18-65 years) Page 4 of 32 Over 65 0 0 14 14 Brief description of the care home needs, and physical disabilities which are not wheelchair dependent. The service caters for complexity of needs ranging from, autistic spectrum disorders including Aspergers. Downs syndrome, Attention Deficit Disorder, Visually Impaired and Fragile X . Also within the grounds of this residential home are two smaller care homes which are registered as separate businesses and are therefore not reported on in this report. Also, within the grounds, operates a day care service which does not fall under the Care Quality Commissions legislation and is not reported on. The home is located within a residential area on the outskirts of Paignton. The home is within walking distance of local shops and a post office. Entrance to the home is via a few steps into a large lobby/all area. The ground floor has five single ensuite bedrooms, and a further bathroom and toilet. There are two large lounge is on the ground floor, a dining area and games room. The games room is furnished with a pool table and computer. On the ground floor there is also a laundry area, well-equipped kitchen and separate pantry area. Access to the first floor is via the staircase, which leads to 7 further bedrooms. One of these bedrooms is for shared occupancy whilst the others are for single usage. Fees are negotiated on an individual needs basis and can vary from three hundred and forty pounds twenty pence to eight hundred and twenty pounds and fifteen pence, depending on need. Care Homes for Adults (18-65 years) Page 5 of 32 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 3 star. This means the people who use this 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 into the report. This key inspection included a visit to the home on Tuesday, 9 February 2010. During this time we spoke to the Registered Manager and Deputy Manager. We spoke with three people who live in the home, three 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 or provide feedback. Care Homes for Adults (18-65 years) Page 6 of 32 We looked at care plans, maintenence records, three 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 for people using the service. It also gives us some numerical information about the service. All this information helps us to develop a picture of how the home is managed and what it is like to live at Burrowdown residential home. Care Homes for Adults (18-65 years) Page 7 of 32 What the care home does well: What has improved since the last inspection? This is the first inspection under a new registration of the service this that came into effect last year. The new registration related to the name of the organisation rather than the way the home is run. The organisation is now a limited company. There have been no changes in management structure and organisation at the home since the last inspection. There have been no downward trends in standards noted at this inspection. The Care Quality Commission do not provide excellent ratings to newly registered services because of lack of track record. The Care Quality Commission considers that any new registration may affect the day to day running of the business. Care Homes for Adults (18-65 years) Page 8 of 32 What they could do better: 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 9 of 32 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 10 of 32 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 residential home is suitable for them. The robust and excellent 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. 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 states that people who are considering moving to the home have to have their needs thoroughly assessed before entering the home. The statement of purpose states that for those people who are already in contact with the social service department, the initial assessment will be undertaken as part of the care management process, but that staff at the home also needed to assure themselves Care Homes for Adults (18-65 years) Page 11 of 32 Evidence: and the person that Burrowdown the right home for them. The statement of purpose also states that for people who are approaching the home direct this admission process would require calling on specialist advice and reports as necessary. The AQAA stated that the service has Developed a website and that there has been staff development and training in all aspects of pre-admissions, including good knowledge and understanding of the impact of change and loss in the context of moving into residential care. Service user plans showed that the admission process is thorough and person centred, showing that the individual needs of each person is taken into consideration before admission is agreed. Policies within the home also informed us that people are offered a two night stay at no charge whilst a brief assessment is carried out within the home. The policy also states that people are offered three months to decide on an agreement to move into the home on a permanent basis. A survey sent to a person living in the home was completed with help from a parent. This parent added a note on the bottom of the survey that read the transition from respite care to residential was smooth and enabled him to cope with change calmly. We are totally confident that the transition to supported living eventually will be handled equally well. Discussion with the deputy manager confirmed that there is an awareness that mental health or physical health issues often accompanied the primary disability and gave examples including depression, obsessive-compulsive behaviour, paranoia, epilepsy and diabetes. It was obvious from the conversation that the staff group are trained and knowledgeable in caring for these needs as well as the learning disabilities. Service user plans showed that each person has their care needs identified early on in the admission process and that these needs varied greatly depending on the person. Each person is issued with a contract which signed by representatives or care manager responsible for the funding. The AQAA states that the fees charged can be broken down to identify all charges which include: Accommodation, Food, including special diets, Utilities, Staffing (shared care & support 1:4 ratio), Staffing (individual care & support 1:1 ratio), The purchasing of meaningful training and occupation, Staff recruitment, training and development, Administration and management and Profit. The AQAA states that the majority of profit is reinvested into the business. This Care Homes for Adults (18-65 years) Page 12 of 32 Evidence: investment was obvious through the inspection. Care Homes for Adults (18-65 years) Page 13 of 32 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. Staff informed us that because there are so many people in the home there needs to be a degree of routine to enable the home to run smoothly, but emphasised that these routines were very flexible and depended on preferences and abilities of each person. The deputy manager told us that each person has a schedule of activities and no schedule was the same. The deputy manager was able to provide examples where people living in the home made decisions regarding their life. One example was a recent house meeting to discuss what sort of holiday people wanted to choose. A picture board showed that different people had chosen different styles of holidays and these were being facilitated. One person was keen to show us the brochures that staff had provided on her choice of holiday. We also witnessed a conversation where people living in the home were empowered to make decisions about their everyday life. Care Homes for Adults (18-65 years) Page 14 of 32 Evidence: We were also informed that people in the home participate in all aspects of life in the home. Examples of this included household chores, food choices and activities. The deputy manager informed us that people living at the home were involved in the interview process of new staff. We were informed that when potential staff have an informal visits to the home people have an opportunity to talk to the staff and are able to give their feedback and opinions. 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 family, indications of when they are happy, or annoyed, details of key worker meetings and details of the persons goals in daily activities. The detail within these folders was commendable, well constructed and person centred. 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, however, and themes included independents in the community, mobility, aggression, falls and safely dealing with finances. The level of detail within the risk assessments should be commended. The AQAA supports these findings by stating Service user plans have been updated to include more calculated risk taking such as using local transport and managing own finances by opening personal bank accounts and organising direct debits etc. 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 15 of 32 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 spoken to at the inspection told us they were very happy at the home. One person said they had been at the home for a number of years and liked it. This person explained that they had attended college and had chosen their key worker. The deputy manager informed us that key workers can be chosen by people living in the home but in some instances, where there was a need this was allocated immediately after somebody had been admitted. The deputy manager told us that although there were not many male carers at the home, specific attention had been taken to ensure that key workers shared interests with each person, and gave an example of a female key worker who was particularly interested in sport became the Care Homes for Adults (18-65 years) Page 16 of 32 Evidence: key worker of a person in the home who was also interested in sport. People living at the home told us they had attended college to gain certificates in courses. During the inspection we saw evidence of courses held at Torquay community college which included: exercise classes, cooking and arts and crafts. One person informed us that they had achieved a BTEC IT course. The deputy manager also informed us that staff at the home also facilitate people to gain skills in independents living which include specific support in taking public transport and safely following a walking route. Other achievements noted at the inspection included people gaining certificates in: emergency life support, number skills, good work awards and exercise. We were also informed that some people at the home were in employment at local hotels, shops and within the Council. We were informed that these jobs were salaried and the money paid into the persons individual bank account. Records and discussion also informed us that some people attended the on-site day service, whilst others attended external day services and day centres. We were informed of the South West organisation but also provided a service providing people with a working style environment. People told us that is leisure activities included going into town with staff, playing on computer games, going to the pub, going shopping, attending football and rugby matches, attending dance classes, visiting nightclubs, and horseriding. The deputy manager informed us that the home have access to a minibus but that the home also have a people carrier for bigger trips. Staff told us that if they consented they were able to use their own car, provided they had suitable insurance and were paid 30 pence per mile for this service. The deputy manager informed us that bigger trips were discussed at house meetings where people could express their preferences. Surveys received from people living at the home confirmed that they were happy living at Burrowdown. One survey was completed with help from a parent. This person wrote I like Burrowdown, I like the food and I liked my birthday. This persons mother asked are you happy at Burrowdown, yes or no? To which the reply was a firm yes. This parent went on to write He has done very well at Burrowdown, everyone says how much improvement there has been in his communication and maturity. When asked what the home could do better this parent wrote Apart from an indoor heated pool!! We cannot think of anything. This parent went on to comment Visiting Care Homes for Adults (18-65 years) Page 17 of 32 Evidence: the home is always a pleasure. The staff showed great respect to the clients and ourselves. The house is always spotless, the food good and nutritious. We visit every weekend and it is consistent. When we collect here and he is always clean and happy. The AQAA informed us that Burrow Down is always focused on improving growth, personal development, social integration and inclusion of each and every service user. Individual service user plans demonstrate growth and development in independence, social inclusion, confidence, self esteem, occupation and education. Parents regularly report on the improvement of their son/daughters lifestyle since moving into Burrow Down. 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. The deputy manager explained that some people in the home have personal relationships and these are supported where necessary. A survey received from a community support worker read service users always appear happy and well looked after. The manager informed us that there were routines within the home and some house rules but these were in place to insure that people are able to promote independence and exercise their choice. We were informed that some people needed more prompting to get ready for work and for their various activities, whilst others for more independent when doing this. We were informed that breakfast is served any time between 7.15 and 9 am, and varied because of different routines, work and leisure activities. Lunch is available between the hours of 12 midday and 2 PM and the evening meal is served between five and 6 PM. Staff assured us that these times were flexible depending on the activities that people were attending. Care Homes for Adults (18-65 years) Page 18 of 32 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 receive personal and healthcare support in a sensitive and person centred way. Minor amendments to medication records would improve safety in the home. Evidence: Each person had a formal service user plan which contained detailed information including service user information, and involvement, Bath routines, key worker information, health care professional visits, medication information activity programme is, detailed care plans and detailed risk assessments. Some care plans where relevant contained a mental capacity assessment. All care plans and documents were well completed. 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 performed at least six monthly, but often is more frequent as changes identified. 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 Care Homes for Adults (18-65 years) Page 19 of 32 Evidence: psychotherapists. Records showed that each person has an annual health check review with the GP which looks at information such as a persons weight, skin, eyes and ears, feet, and BP. Records also showed that GPs use this opportunity to perform routine blood tests. Where identified as care needs people are supplied with walking aids and mobility equipment. One survey received from a community support worker read I have visited the service for all five times for social care review meetings. I have always found staff welcoming and are able to answer any questions. They are very supportive of the service users being fully involved in the review. I recently reviewed to some for the second time (first review was a year ago) and actions agreed had been completed. and also stated on my initial physics, I havent really seen anything that could improve as service user needs have been well met on review meetings. Medication practices are generally 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. A small number of people in the home have chosen to opt out of this support and continue to be administered their medication from the central cupboard. Storage facilities within the home for medication are suitable and secure. Medication records were generally well completed, however, the receipt of medication was not recorded on the medication administration record (MAR). The deputy manager said that she would deal with the shortfall as a matter of priority. There are no controlled drugs stored at the home at present, but the deputy manager was aware of suitable storage facilities should controlled drugs be kept at the home. Records for the returns and disposal of medications are well-managed and medication policies were present. A suggestion was made to record the date of opening and creams and lotions for infection control purposes. The deputy manager gave assurances that this would be commenced. 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 to rise. Communication with healthcare professionals and GPs is very good in a blink supports to be arranged as it arises. Care Homes for Adults (18-65 years) Page 20 of 32 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 policies and practices are in place to protect a person from abuse, however minor improvements in record keeping would improve some processes. 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, but that key worker meetings, and house meetings would be another way people could make a complaint or concerns known. 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. Care Homes for Adults (18-65 years) Page 21 of 32 Evidence: Recruitment processes also protect people by ensuring staff who are unsuitable to work with vulnerable adults are screened before employment. All staff have a criminal records bureau check and protection of vulnerable adults checks performed. Staff are provided with safeguarding adults training during the induction process and also on a regular basis. 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. A very small number of people need to staff in the home to look after some of their cash. Records and receipts are maintained for transactions and inspection showed that all but one record were complete. (Further inspection showed a secondary record that clarified this situation.) Discussions were held regarding the importance of ensuring two staff sign financial transaction records. Care Homes for Adults (18-65 years) Page 22 of 32 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: Burrowdown residential home is a large detached premises decorated to an extremely high standard, providing people with a domestic, homely environment in which to live. Great attention has been made to ensure that the home is not institutionalised. Furnishings and fabrics within the home are to an extremely high standard and make the home is a pleasant place to live and work in. All areas of the home are accessible by people who live there. During the inspection people were seen to access the kitchen to make themselves refreshments and snacks. All areas of the home appeared safe, comfortable, bright, cheerful, clean and free from offensive odours. Each person has their own bedroom, apart from two people who choose to share. Screening is provided within the shared room. Each bedroom where well equipped and decorated to a high standard. People had personalised their bedrooms with pictures, ornaments and personal items. All toilets bathrooms and ensuites were clean, hygienic and homely. Care Homes for Adults (18-65 years) Page 23 of 32 Evidence: There were many areas of comfortable, safe and accessible shared space for people living at the home. There were a choice of lounge areas, a dining area and a games room which could be used. People are able to spend time in their room as they choose or join their fellow residents. All areas of the home appeared to clean, hygienic and well organised. Laundry facilities contain suitable equipment to prevent the spread of infection. The AQAA had listed improvements to the home to include: New carpets in four bedrooms, redecoration of four bedrooms, including new blinds. The outside of Burrowdown has been painted as have the steps up to the front door. Wood floors and table in the lounge have also been re varnished. New bedroom furniture has been purchased for one room and new quilts, pillows and bedding for all rooms. New kitchen crockery and toaster.have been supplied to improve the kitchen. In the lounge the double glazed units have been replaced and new handmade curtains, coffee table, TV cabinet and light fittings have een installed. In the garden Leylandi trees have been reduced by 10ft and Inspection of all trees and dead wooded has taken place where necessary. Care Homes for Adults (18-65 years) Page 24 of 32 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. Evidence: People spoken with said they liked the staff and could choose their key worker. One person was deciding who she wanted to take on holiday. Surveys completed by families showed that the staff group are popular. Relatives stated that The staff show great respect to the clients and ourselves. A survey sent by a health care professional read Although I only visit every six weeks, I have found staff very supportive and pleasant. Records and discussion confirmed that from 7.15 a.m. there are three staff present, one who assists with breakfast and two who assists people living in the home with their work and leisure routines. During the afternoon and early evening there continue to be three members of staff. Care staff are responsible for household chores, driving people to their various activities and supporting people in the home. During the evening to members of staff are present at the home. In addition to these numbers The Registered Manager and deputy manager at present on a regular basis. Care Homes for Adults (18-65 years) Page 25 of 32 Evidence: All new staff attend a specific induction programme called 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. Two of the three staff files contained evidence that staff were doing NVQ two training. Recruitment files were welcomed 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. Two of the files contained two written references, however, one file contained evidence that to references had been requested, but is no evidence that a second reference had been chased up following nonreturn. None of the files contained evidence that staff had declared all have their health assessed before working. The deputy manager informed us that a new application form was being accused which did not ask for this information. The Registered Manager stated that this information is requested during the interview, but that she would look into the new style application form. All new 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. 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 26 of 32 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 well managed. Evidence: The Responsible Individual is a registered nurse specialising in learning disabilities. She has had managed and earned 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 two cottages which operate from one site. She is supported in the residential home by an experienced and knowledgeable deputy 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 staff Care Homes for Adults (18-65 years) Page 27 of 32 Evidence: group were very popular with people living there. The positive atmosphere at the inspection enabled people living at the home to feel relaxed. People were able to wander in and out of the office and speak to staff whenever they needed to. Staff at the inspection saw people in the home as a priority and naturally stopped what they were doing to attend to the needs of the person. This is seen as good practice. Regular manager meetings and staff meetings are held to ensure that the service runs smoothly. In addition to this key worker meetings and house meetings 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 staff listen to the views of people in the home by Customer satisfaction surveys, Relative and other professional surveys, Employee surveys, House meetings Individual key worker meetings, Pre admission assessments Care plans, Reviews, Independent advocates, CSCI / CQC feedback The AQAA states that following this process the following chnages have been made: Regular reviews Informing relatives of important changes (better modes of communication), Make public our business plan and ask for feedback, Suggestion box accessible to all and production of Statement of Intent and business plan for 2009 and beyond copy of which is added as supporting document this describes changes for modernising the service and changes that will take place to the home to achieve this. 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 Care Homes for Adults (18-65 years) Page 28 of 32 Evidence: 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 29 of 32 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 30 of 32 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 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 2 3 4 5 6 1 19 20 23 34 35 The service user guide should contain the recently changed contact details for The Care Quality Commission. Creams and lotions should be dated with the date of opening for infection control purposes. Systems should be in place to ensure that the receipt of medication into the home is recorded Two signatures on financial transaction records would protect staff and people in the home. Systems should be in place to ensure that the health of staff is assessed before they work. Systems should be in place to ensure that references are chased if they have not been returned. Care Homes for Adults (18-65 years) Page 31 of 32 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. Care Homes for Adults (18-65 years) Page 32 of 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!