Care Home: Buxton House

What the care home does well It is a pleasant place to live; it has a homely welcoming environment where people feel at ease. The service continues to make improvements and is performing well. It continues to deliver and enables residents achieve positive outcomes. People entering the home receive good quality of support that is individualised. They receive appropriate support to manage appropriately conditions and avoid relapse. We received comments from mental health professionals involved in the arrangements for people using the service. The following is a selection of the remarks received. "The service communicates well with mental health services; information flow is good with all relevant practitioners", "People using this service are supported positively to achieve personal goals and comply with medication. The service works creatively and actively with other services and organisations to ensure that the person`s whole life needs are met, and goals addressed. What has improved since the last inspection? The home has sustained improvements found at the last key inspection and continues to identify any shortfalls and improve in other areas. Buxton House DS0000041799.V374916.R01.S.doc Version 5.2 The home has made improvements to record keeping; records are kept up to date and reflect more accurately the support given and staff delivering it. Staff are now more skilled and knowledgeable. The home has improved the training programme with training needs addressed; also new staff complete an induction programme in the first three months. Attention is now given to promoting a safe environment, with the temperatures of hot water temperatures monitored to ensure that it is within safe limits. The manager has registered with the Commission. Additional resources have made improvements and include new bed linen What the care home could do better: The home has responded positively to the last inspection report of 2008. Where major shortfalls were identified action was taken to address these. Some outstanding repairs are needing attention. The vacant bedroom needs to have an efficient window restrictor fitted; the fluorescent light on the first floor needs to have a cover fitted. A number of recommendations are made and relate to best practice. Key inspection report CARE HOME ADULTS 18-65 Buxton House 50 Barrow Road Streatham London SW16 5PG Lead Inspector Mary Magee Unannounced Inspection 9th April 2009 09:45 Buxton House DS0000041799.V374916.R01.S.doc Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care home adults 18-65 can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Buxton House DS0000041799.V374916.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Buxton House DS0000041799.V374916.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Buxton House Address 50 Barrow Road Streatham London SW16 5PG 020 8769 9667 0208 769 9667 janet-yeboah@uku.co.uk Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Buxton Healthcare Ltd Ofori Kusi Care Home 6 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (6) of places Buxton House DS0000041799.V374916.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home Only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Mental Disorder, excluding learning disability or dementia - Code MD (of the following age range: 18 Years - 65 Years) The maximum number of service users who can be accommodated is: 6 2. Date of last inspection Brief Description of the Service: Buxton House is a small registered care home located on a residential road in Streatham, Southwest London. It was first registered in July 2004. It provides care and support for six people that experience mental health related conditions. There are six single bedrooms, a lounge, dining room/kitchen and a conservatory. It is a short distance away from public transport facilities and the local shopping area. The charges for the home range from £650 to £1050 per week. Buxton House DS0000041799.V374916.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience Good quality outcomes. This unannounced key inspection took place in early April 2009; the site visit was completed in one day. We used a variety of methods to gain evidence and to inform our judgements for the inspection report. At the home visit we met with the owner, the registered manager, a senior support worker and four residents. Case tracking was used to evaluate the quality of support. We examined a number of records in relation to the service, also observed were personnel records for support staff and residents Other information was gathered too. Prior to the inspection we received a copy of the AQAA, and a copy of the business and development plan. We also spoke with Care Coordinators directly involved with people using the service. We toured the home and viewed all communal areas and three bedrooms. Residents and staff were helpful and cooperative and facilitated this inspection. What the service does well: What has improved since the last inspection? The home has sustained improvements found at the last key inspection and continues to identify any shortfalls and improve in other areas. Buxton House DS0000041799.V374916.R01.S.doc Version 5.2 Page 6 The home has made improvements to record keeping; records are kept up to date and reflect more accurately the support given and staff delivering it. Staff are now more skilled and knowledgeable. The home has improved the training programme with training needs addressed; also new staff complete an induction programme in the first three months. Attention is now given to promoting a safe environment, with the temperatures of hot water temperatures monitored to ensure that it is within safe limits. The manager has registered with the Commission. Additional resources have made improvements and include new bed linen 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. Buxton House DS0000041799.V374916.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Buxton House DS0000041799.V374916.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 2, 3, 5. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People that use the service find that individual needs and aspirations are considered and that the home is providing appropriate services to meet these. Following an appropriate period of living at the home individuals find that they are enabled to develop the desired skills and live more independently EVIDENCE: Very little change has taken place within the client group. No new resident has moved to the home since the last inspection. It was found in the last inspection visit that pre admission assessments were completed for all residents before moving to the home. All needs assessments we found to be up to date with relevant support plans to respond to these. Evidence was provided of a service that is performing well and enabling individuals overcome major obstacles. The service has a good working relationship with mental health professionals and maintains contact with key health professionals. We spoke to four residents over the first day to evaluate the service provision and share their experiences. All residents communicate well and are confident at expressing their views. Buxton House DS0000041799.V374916.R01.S.doc Version 5.2 Page 9 Two residents we selected to case track their support and the outcomes of this. Completed surveys were received from all five residents. People using the service feel they have choice on the things that matter to them. They feel secure, they are where they want to be and their needs are being met appropriately. A supportive staff team gives the encouragement and commitment needed by individuals. The service continues to perform well, with residents achieving goals and positive outcomes. We found that a resident following a period at the home moved on recently to supported living. He maintains contact with the home and comes back to meet with residents and staff. We found that contracts are in place for residents specifying the terms and conditions of the service. Buxton House DS0000041799.V374916.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 6 7 8 9 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individual goals and aspirations are considered, The lifestyle at the home is influenced by residents’ preferences and involvement in how the home runs. The service develops support plans with individuals that reflect the assessed and changing needs of residents. Key workers are assigned to work with individuals. They respond to the plans appropriately and enable and support residents to take risks as part of an independent lifestyle. EVIDENCE: We used case tracking to gain evidence of the support arrangements and to examine how the support given impacts on individuals’ path to progress. The support plans in place for two residents were selected for evaluation. Prior to admission both residents records were held of the needs assessments completed, these recorded all areas where support is required. Also held were details of any risks associated with conditions including access to community. Since moving to the home risks for both residents have been constantly reviewed and revised. Alongside records of assessments are medication profile plus details of how these are administered. A recommendation is made that risk assessments are amended to reflect when level of risk has reduced. Buxton House DS0000041799.V374916.R01.S.doc Version 5.2 Page 11 The service involves individual residents in the planning of care which reflects the support and assistance required, the lifestyle and quality of life aspired to. The plans are person centred and are reviewed and adapted on a regular basis to reflect any changes that occur. Key workers are selected by residents to ensure that personal support plans are responded to appropriately. Reviews focus on asking what has worked for the individual, where there is progress, achievements, concerns and identifies action points. Each support plan includes a comprehensive risk assessment, which is reviewed regularly. The management of risk is positive in addressing safety issues while aiming for improved outcomes for people. We found that this is an area that staff focus on. Also the evidence is that residents gradually overcome many barriers associated with the mental health conditions that include anxieties, and fears and phobias. Residents consult with the care coordinator, records of CPA meetings and outcomes are maintained on files. Staff when spoken to have a good knowledge of the outcome of CPA meetings, they are included and attend the meetings. We observed the records held by staff of how support plans are delivered and the outcomes, the progress made by individuals in achieving goals and aspirations. The progress by some individuals is remarkable. All residents now access the community independently following lengthy periods of escorts and observations by support staff. Staff understand the importance of residents being supported to take control of their own lives. Individuals are encouraged to make their own decisions and choices. Residents attend and participate in social and community activities. They also hold regular weekly meetings on Wednesdays with the staff team to discuss issues relating to their needs. Minutes of the meetings record all the issues that residents wish to raise. Files relating to residents were observed to be stored securely. Residents spoken to have no concerns regarding confidentiality issues, they find that they have confidence in the staff team. Residents with the support of staff are enabled to develop lifeskills and manage their finances. Each resident collects their own personal allowances from the post office. Some individuals (3) have difficulty with managing the money. Support staff help these resident with budgeting. Residents choose to ask the support of staff to hold money in safekeeping in a locked cabinet in the office. We looked at the procedures in place. The system is robust. Records are held for each transaction with details of all incoming and outgoing transactions. Buxton House DS0000041799.V374916.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): This is what people staying in this care home experience: 11 12 13 15 16 17 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals have the opportunity for personal development; support is given that enables individual access to activities of choice. The service promotes and respects the rights and choices of individuals. Residents are enabled to build and develop relationships. People using the service are offered healthy meals of choice that they prepare and serve. EVIDENCE: The home gains the views of the residents and considers the varied interests in planning the routines of daily living and organising activities both in the home and the community. The service makes sure that structure is in place for residents. Many residents prior to admission have experienced quite chaotic lifestyles with frequent hospital admissions and relapse. Buxton House DS0000041799.V374916.R01.S.doc Version 5.2 Page 13 Residents find that structure in their lives at the home has enabled much progress in their state of well being and mental health. Routines are flexible and residents can make choices in major areas of their life. The routines, activities and plans are person centred, individualised and reflect diverse needs. The home has sought the views of the residents and considered their varied interests when planning the routines of daily living and arranging activities both in the home and the community. Each resident has an activity programme that reflect choice, need, and aspirations. Residents are supported to develop and maintain personal and family relationships. We observed how dignity and rights are promoted. Staff were observed to respectful of residents’ wishes and do not enter individual bedrooms without knocking and receiving an invitation to do so. Residents tell us that staff are respectful of individuals and address them appropriately. The home has rules on smoking and makes available facilities for smokers n th eback garden. Having overcome some barriers due to health conditions all residents now enjoy going out and use the facilities available in the community. They attend appointments and no longer require the support pf an escort. Some attend college and training projects, part time employment. They feel part of their community and are consulted in most issues of the home. Residents hold their own meetings. Individuals take responsibility for household chores, duties include maintaining bedrooms and laundry, cooking. They regard these as an opportunity to develop important and essential lifeskills. Meals at the home are chosen by residents. Residents are involved in purchasing the provisions for the home. Additional fridges and freezers are provided for residents to store additional perishable foods. At weekly meetings residents plan the menus for the home. Residents are involved in the domestic routines of the home. They take responsibility for their own room, menu planning and cooking meals, making sure that they are able to enjoy the food they prefer and like. The menu is varied with a number of choices including a healthy option. It includes a variety of dishes that encourage individuals to try various food. Residents spoke of the meals they enjoy; the meals are balanced and nutritious and cater for the varying cultural and dietary needs of individuals. Buxton House DS0000041799.V374916.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents access good quality physical and mental health care and receive support with promoting good health care. Staff support residents to manage their medication safely and to achieve compliance. EVIDENCE: We gathered evidence of the benefits of the service and of the progress made by individuals. One resident who initially lacked self confidence to socialise with his peers or even go out to the local shops or leisure centre on his own has been supported to regain some confidence. He is now able to socialise with peers and also able to go out independently and return home alone. Another resident has been successfully encouraged to continue with his college course and is now enjoying and attending college without prompting or missing a lesson. Another resident is due to move on to a lower support unit soon. Health plans are in place for residents. Staff make sure that residents are encouraged to be independent. They oversee and support them attend regular appointments with care coordinators and community psychiatric nurses, and they visit local health care services. All residents are self caring. However there are occasions when a little prompting and encouragement are required. Buxton House DS0000041799.V374916.R01.S.doc Version 5.2 Page 15 Staff are good at promoting self worth and self esteem and recognize the importance of encouraging residents to take an interest in their appearance. The physical and psychological needs of individuals are monitored carefully. recorded and changes are reported to relevant health professionals as the need arises. Nutritional needs are monitored. Prompt action is taken to respond to any changes that may indicate signs of deterioration in emotional or psychological state. Residents are registered with a local GP practice. Records are maintained of all consultations. There are also records held of CPA meetings, appointments with psychologists, psychiatrist and community psychiatric nurses. Daily records and key workers’ reports are maintained giving a good indication of progress and response to medication and consultations. Records we viewed for the last nine month period indicate that the emotional and physical states have remained stable with no records of incidents. We found that progress reports for a resident demonstrate sustained improvements and that he will ready to move on to more independent living. All residents are self caring. However there are occasions when prompting and encouragement are required according to individual need and varying circumstances. The home has an efficient medication policy supported by procedures and practice guidance, which staff understand and follow. Staff receive training in medication procedures and are deemed competent in this. We examined the medication procedures for two residents. Prescribed medication is supplied in blister packs. In addition medication is also dispensed by the mental health day centre in the original containers. The residents collect this medicine and hand it over to the home with written details of the medicines prescribed and dispensed. We viewed records confirming that for relevant individuals regular blood tests take place to monitor the impact of medication. Medication records were fully completed, contained required entries, and were signed by appropriate staff. Regular management checks are recorded to monitor compliance. The home respects and understands the rights of residents in the area of promoting health care and compliance with medication. The home has improved medication procedures. Regular audits take place of individual medication stock. Staff work together with individuals and relatives to ensure compliance with medication. Residents receive the support they need to manage their medication. Two residents following assessment now self medicate. We examined the procedures in place to monitor and support these; we found that appropriate measures are operating to ensure compliance. Buxton House DS0000041799.V374916.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has an inclusive feel with people using the service feeling confident at expressing their views any raising any concerns when necessary. The home has procedures in place that safeguard vulnerable adults. EVIDENCE: We talked to four residents, five completed written surveys that we sent out. Our findings are that residents feel that their views matter. They feel valued as people and included in how the home operates. Relationships between residents and staff were observed to be good. Staff interacted with residents and responded to their requests. Residents’ meetings are held independently, residents feel comfortable meeting as a group and putting forward their views and suggestions. A suggestion box in place enables residents to raise issues anonymously. The home has a complaints book. Details of the complaints procedure is displayed on the dining room notice board for residents to view. Surveys received from all five residents declared that the home operates an effective complaints procedure. All residents spoken to during the inspection are confident in the complaints procedure. In 2008 three of the staff team attended training in safeguarding procedures organised by the local authority coordinator. The remainder of the team should attend training on safeguarding procedures. We held discussions with the manager and a member of staff, both demonstrated a good knowledge of the safeguarding procedures. Buxton House DS0000041799.V374916.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 24 25 27 28 30 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a safe comfortable and homely environment that is well maintained. The small scale design and layout people find beneficial, it allows for a small group of people to live together in a noninstitutional environment. EVIDENCE: The home provides a small homely environment. It is safe comfortable, bright and cheerful. Single bedrooms are available for each resident. The premises are well maintained. We found it to be attractively decorated and clean. We viewed all the communal areas and three bedrooms. There is a selection of communal areas both inside and outside of the home, this means that people using the service have a choice of place to sit quietly, meet with family and friends or be actively engaged with other people who use the service. A lounge, a conservatory and dining room with suitable good quality furniture complement the resident’s individual space. In addition is an enclosed garden to the rear. It is pleasant and contains suitable premises to use for those that Buxton House DS0000041799.V374916.R01.S.doc Version 5.2 Page 18 smoke. There is an abundance of bed linen, home has purchased additional bed linen for residents. There are adequate numbers of conveniently located bathroom and toilet facilities. A window restrictor/safety catch found to be broken at the last inspection on a bathroom window is repaired. We observed that the vacant bedroom window has no window restrictors, this needs to be addressed. Residents say that there is plenty of hot water and the temperature in the home is comfortable. All bedrooms promote high levels of privacy and have locks for promoting privacy. All residents have a key to their own room unless a person centred risk assessment indicates otherwise. We viewed maintenance records for the premises. Hot water temperatures are monitored regularly to make sure that temperatures are within safe limits. Repairs are generally responded to swiftly, however some areas need attention. A fluorescent light fitting on the first floor bathroom needs to have cover. The home is kept clean but bathrooms could benefit from a heavy duty clean. Currently residents in line with the development of daily living skills take responsibility for household chores. They have a rota for the cleaning. It is recommended that residents receive more guidance and support from the staff team. Buxton House DS0000041799.V374916.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 32 33 34 35 36 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service experience consistency in the support received. They find that the regular support staff provide them with security and stability. Staff receive appropriate training and are trained and competent at supporting people achieve goals and aspirations. Recruitment procedures are improving and ensure that staff are vetted and suitable to work with people using the service. EVIDENCE: People have confidence in the staff who care for them. Rotas show that there are appropriate staffing levels in place for supporting current residents; also the service is experiencing a lower turnover of staff. This is giving stability to the home. In turn the outcome for residents is positive with much progress in developing life skills. Staffing levels reflect the numbers needed on duty to support residents. As a result of ongoing progress in achieving goals and outcomes all residents no longer require escorts and are now accessing the community independently. Two support staff are available during the day, the home has one waking night staff. The duty rota shows that support staff are on duty for twelve hours. The Buxton House DS0000041799.V374916.R01.S.doc Version 5.2 Page 20 duty rota should be reviewed to address staff fatigue as a result of working more long shifts. The home has addressed issues in relation to training and development. A workbook for the induction programme was viewed. It has also introduced staff to the foundation programme. It is recommended that all staff complete the foundation programme. We observed records of the training provided for the past twelve months. The training programme delivered for the team has addressed areas where development was needed. It included equality and diversity, mental health conditions, health and safety and risk assessment, also first aid, and food hygiene and safeguarding procedures. A number of staff are undertaking relevant NVQ programmes but maternity leave has delayed some completing this. Staff receive supervision and support. Records show that this can be inconsistent. It is recommended that it is more frequent and consistent. We examined recruitment procedures. Two new staff were recruited since the last key inspection. Completed application forms were seen, also CRB Enhanced Disclosures with POVA checks were completed before employment began. Immigration status was present on file with proof of identity. Two references were available for both employees. However the professional references for one worker was not from the main employment, the reference was from a manager where she worked part time. There was a lack of clarity on this when cross referencing it with the employment history. A recommendation is made. We have concerns that some night staff may have other full time employment. It is recommended that declarations of other employment are sought from all staff. Buxton House DS0000041799.V374916.R01.S.doc Version 5.2 Page 21 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 37 39 40 41 42 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home continues to deliver on quality and benefits from stronger management. Residents are protected by policies and procedures that are kept up to date. People using the service know that their health and welfare is promoted. In monitoring and operating a quality assurance system the home strives to operate in the best interest of those using the service. EVIDENCE: In the past twelve months the home has sustained the improvements found at the previous inspection and continued to develop the service. By reports received from mental health professionals and from the evidence of residents’ progress the home demonstrates that it is delivering well and achieving positive outcomes for people using the service. We found improvements in a number of areas; record keeping is now up to date and accurate. It is clearly identifying the staff team on duty. Residents Buxton House DS0000041799.V374916.R01.S.doc Version 5.2 Page 22 too benefit from the stability of the team who are good at supporting people using the service. The manager has registered with CSCI. He has enrolled with a local college and is undergoing training to achieve the Registered Managers Award. He demonstrates drive and enthusiasm and has strengthened the service. Residents are confidence in how the service is run. Care Coordinators spoke of a service that is well run, they find that staff follow up on issues with the mental health team and have good lines of communication. The home has purchased additional and sufficient quantities of bed linen for residents use. Regular health & safety audits/checks are conducted to highlight any repair work that is needed. It is recommended that the required frequency of health and safety checks is recorded in health and safety manuals. There are some oustanding repirs needed in the kitchen. A recommendation is made that appropriate action be taken to address these repairs. Records of service for fire fighting and emergency lighting were viewed, fire drills take place at intervals specified in fire risk assessment. The fire risk assessment should be reviewed and updated for 2009. A recommendation is made. Records are held confirming that portable appliances are tested and safe to operate. The home in consultation with an employment consultant has reviewed the policies and procedures and brought them up to date to refelct current legislation. We viewed the business and development plan for the home, it was submitted after the last key inspection. The home is now operating an effective quality assurance system, this demonstartes how the service is performing. The views of people using the service and stakeholders are involved. A a result the home recognises the areas for improvement and highlighted for attention Buxton House DS0000041799.V374916.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 3 4 X 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 2 26 X 27 2 28 3 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 x LIFESTYLES Standard No Score 11 3 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 X 3 3 3 3 x Version 5.2 Page 24 Buxton House DS0000041799.V374916.R01.S.doc No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA25 YA27 Regulation 23 (2) b Requirement Attention must be given to the following, Bedroom and bathroom windows must be fitted with window restrictors. A fluorescent light fitting in first floor bathroom needs a cover. Timescale for action 30/05/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA1 Good Practice Recommendations The registered person should ensure that the service users guide is kept updated to reflect changes to staffing. The registered person should continue to work with residents around recording information about their wishes with regard to illness and death. The staff team should receive refresher training on safeguarding procedures. It is recommended that residents receive more guidance and support from the staff team when undertaking household chores and that attention is given to DS0000041799.V374916.R01.S.doc Version 5.2 Page 25 2 YA21 3 4 YA23 YA35 YA30 Buxton House maintaining high standards of hygiene. 5 6 YA34 YA34 It is recommended that declarations and details of other employment are sought from all staff and held on file. Recruitment procedures should make sure that professional references sought correspond with employment records and relate to current or most recent full time employment. It is recommended that a review takes place of the hours worked by staff both at the home and at other settings. Fatigue should be avoided; staff should not be working excessive hours by combining work at the home and elsewhere. It is recommended that all support staff complete the foundation programme It is recommended that one to one supervision is provided more frequently and at least two monthly It is recommended that the required frequency of health and safety checks is recorded in health and safety manuals It is recommended that fire risk assessment is reviewed and updated. 7 YA33 8 9 10 11 YA35 YA36 YA42 YA42 Buxton House DS0000041799.V374916.R01.S.doc Version 5.2 Page 26 Care Quality Commission London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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. Buxton House DS0000041799.V374916.R01.S.doc Version 5.2 Page 27 - 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!