Care Home: Callum House

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What the care home does well All the written and verbal feedback we received from the people who use the service, their relatives, professional representatives, and staff that work at Callum House was extremely complimentary about the standard of the care and support provided there. The service continues to benefit from being consistently run by a suitably competent and qualified manager who has ten years experience being in day-to-day charge at Callum House. The manager dealt very professionally with all safeguarding issues that came to light last year, and continues to recognise what the service could do better. All the written and verbal feedback we received about the manager from the people using the service and their relatives was extremely positive. Typical comments included `the manager is nice - i like talking to her`, `the manager in particular is amazingalways cheerful, helpful, superb at her job, and able to bring out the best in my relative`, and `the manager is good at communicating with my relative - shes superb`. All the social, leisure, and recreational activities the people who use the service have the chance to participate in each day, both at home and in the wider community, remains extremely varied, `age` appropriate, and interesting. The service also has a very good track record of actively encouraging and supporting families to continue their involvement in the life`s of their loved ones and the running of Callum House. The manager is in regular contact with the families of the people who use the service, with whom she has built up good working relationships over many years. Families are also routinely invited to attend their loved ones care plan reviews and to express their views about how Callum House is run - either through informal chats with the manager or by completing the providers own satisfaction surveys. The people who use the service are actively encouraged to make their own choices about what they do each day. For example, staff are very good at supporting people to express their opinions and helping them make informed decisions about what activities they participate in, when and where they go out, what they wear, and what they eat and drink. We observed all the staff on duty at the time of this site visit, which included the manager, interacting with the people who using the service in a very caring, respectful and professional manner. Finally, the atmosphere remained extremely relaxed and congenial throughout the course of this site visit, which included lunchtime when everybody sat down together in the dinning room to eat. What has improved since the last inspection? The single most important improvement made by the service in the past year is the successful recruitment of sufficient numbers of suitably competent new staff to fill the majority of the homes staff vacancies. The process of rebuilding the staff team and morale at Callum House after the dismissal of almost a third of the workforce at the end of last year for abusing and/or neglecting the people who lived there has clearly started in earnest, for which the providers and manager are commended. All the outstanding requirements and good practise recommendations identified in the services last inspection report, which largely pertained to the poor decorative state of a various toilets and bathrooms, have been addressed within the agreed timescales for action. Other improvements made to the interior design of the home in the past year include the installing of new ceiling light fittings in the lounge, the fitting of a new shower facility on the top floor, and the redecoration of the dinning room and hallways on the ground floor. As recommended in the services last report the manager has now reviewed the fire safety risk assessment for the building and up dated it as required. What the care home could do better: All the positive comments made above notwithstanding, and despite no outstanding requirements being made in this report, we have identified three good practise recommendations for the manager to implement: Firstly, the outcome of `best interests` meetings held by the service to determine how willing and capable people were to take greater responsibility for looking after their own medication should be included in their care plans. This will ensure anyone authorised to inspect the plan can determine whether or not the people who use the service are being appropriately supported to make informed decisions in their life`s and to live it as independently as they can. Secondly, the service still has one senior staff vacancy which the providers need to fill as soon as practicable with a suitably experienced and competent individual who will be able to support the manager on a day-to-day basis. Finally, the way in which the service arranges for fire drills to be carried out should be reviewed as not all its permanent night workers are participating in them at regular enough intervals. This will ensure they know exactly what to do in the event of the fire alarm being sounded in order to keep the people using the service safe. In addition to these recommendations we will also be closely monitoring progress made by the service to achieve this years training targets for all its existing and new members of staff. Key inspection report Care homes for adults (18-65 years) Name: Address: Callum House 26 The Drive Coulsdon Surrey CR5 2BL     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Lee Willis     Date: 2 4 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 31 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 31 Information about the care home Name of care home: Address: Callum House 26 The Drive Coulsdon Surrey CR5 2BL 02086604379 F/P02086604379 oregoncareltd@btinternet.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Oregon Care Ltd care home 7 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The number of service users who can be accommodated is: 7 The registered person may provide the following category of service only Care Home Only (CRH - PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Learning disability - Code LD Date of last inspection Brief description of the care home Callum House is owned by Oregon Care Ltd and is registered with us to provide personal support and accommodation for up to seven younger adults who have learning disabilities. Some of the people who live there may also have behaviours that can challenge and/or a past or present experience of mental ill health. The services registered manager, Kim Yoeman, has worked at Callum House for the past ten years and has been in operational day-to-day charge since 2005. Located in a residential suburb of Coulsdon and within easy walking distance of the local town centre the people using the service are well placed for accessing a wide variety of community based facilities and services, which includes - shops, restaurants, Care Homes for Adults (18-65 years) Page 4 of 31 Over 65 0 7 0 7 0 1 2 0 0 9 Brief description of the care home cafes, and banks. The service is also well placed for accessing public transport in the form of a local train station and numerous bus stops with good links to Croydon and the surrounding areas. This two-storey detached property comprises of seven single occupancy bedrooms, a main lounge, dining room, kitchen, laundry and separate utility room, and a ground floor office. There are sufficient numbers of toilets, baths, and shower facililties located on the first and second floors near the bedrooms of the people using the service. The large garden and patio area at the rear of the property are well maintained and there is plenty of garden furniture and a purpose built barbeque for people using the service and their guests to enjoy this outdoor space. More detailed information about the facilities and services provided at Callum House can be found in its Statement of Purpose and Guide. Care Homes for Adults (18-65 years) Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service remains two stars. This means the people who use the service continue to experience good quality outcomes. From all the available evidence gathered during the inspection process it was clear the service has far more strengths than areas of weakness. We spent four hours at Callum House during this site visit and in that time spoke at length with three people who use the service, the long standing manager, and a support worker. We also looked at various records and documents, including - care plans; needs and risk assessments; activity schedules; weekly planned menus; the complaints book; health care action plans; medication administration sheets; personal files for all new staff employed in the past year; Regulation 26 inspection reports carried out by the provider; the services internal annual quality assurance report, and various health and safety checks, and fire safety records. The remainder of this visit was spent touring the premises. Care Homes for Adults (18-65 years) Page 6 of 31 The services Annual Quality Assurance Assessment (AQAA) form was returned to us by the manager when we asked for it. We use this self-assessment tool to help us determine what the service does well, what has improved since the last inspection, and what they could do better in future. We would like to thank all the people who contributed to the inspection process for their time and input. Care Homes for Adults (18-65 years) Page 7 of 31 What the care home does well: What has improved since the last inspection? The single most important improvement made by the service in the past year is the successful recruitment of sufficient numbers of suitably competent new staff to fill the majority of the homes staff vacancies. The process of rebuilding the staff team and morale at Callum House after the dismissal of almost a third of the workforce at the end of last year for abusing and/or neglecting the people who lived there has clearly started in earnest, for which the providers and manager are commended. All the outstanding requirements and good practise recommendations identified in the services Care Homes for Adults (18-65 years) Page 8 of 31 last inspection report, which largely pertained to the poor decorative state of a various toilets and bathrooms, have been addressed within the agreed timescales for action. Other improvements made to the interior design of the home in the past year include the installing of new ceiling light fittings in the lounge, the fitting of a new shower facility on the top floor, and the redecoration of the dinning room and hallways on the ground floor. As recommended in the services last report the manager has now reviewed the fire safety risk assessment for the building and up dated it as required. 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 31 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 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective users of the service and their representatives are fully involved in the admissions process and will be able to decide whether or not Callum House is the right place for them through planned visits and a thorough assessment of their needs, wishes, and aspirations. Evidence: The manager confirmed that as she had stated in the AQAA the service continues to be fully occupied and that no placements had broken down in the past year. The manager demonstrated a good understanding of what constituted best practise regarding assessing the suitability of new referrals and was very clear that any prospective users of the service and/or their representatives would always been given the opportunity to come and visit Callum before any decisions about moving in are taken. The manager was also adamant that she would always took into account the views of the people already residing at Callum House about any new admissions and that how compatible they would be with the existing peer group was up-most in her mind. Care Homes for Adults (18-65 years) Page 11 of 31 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service can expect to be provided with a care plan that addresses their specific needs and aspirations; this being developed as far as is practicable with the involvement of the pople using the service and/or their representatives in the decision-making process. Consultation with people using the service relies on both direct contact and also a broader approach of checking with their relatives, staff who work there, and their other professionals representatives. Risk assessments form a fundamental part of the care planning process, enabling independence and self-determination for service users within a framework of safety and protection considerations. Evidence: Care plans we looked at were all very person centred and set out in detail what the unique needs, strengths, and goals were of the individuals for whom these plans were Care Homes for Adults (18-65 years) Page 12 of 31 Evidence: intended. These plans also contained a lot of information about what support the people using the service needed to receive from staff in order to minimise the risk of them being harmed, as well as achieve their personal goals. Furthermore, these plans contained detailed guidance to help staff prevent and/or effectively manage behaviours that could challenge the service from time to time. We spoke to a new member of staff about how they would deal with behaviours that challenge the service. They told us the manager had discussed at length with them what type of incidents of aggression they might expect to experience while working at Callum House and what action had proven most successful in the past at deescalating such occurrences. The manager told us care plans are up dated on a regular basis and all the plans we looked at were being reviewed every month by the designated keyworkers of people using the service, and again more formally every six months when everyone involved in a particular individuals care is invited to attend. The manager told us it is customary for the families of all the pople who currently reside at Callum House to attend sixth monthly care plan reviews. The manager told us the service has developed a variety of ways to enable the people who use the service and their families to have a big say in how Callum House is run. The manager was able to produce the minutes taken at the last three house meetings, which indicated they are held at regular intervals and are well attended by the pople who using the service. Furthermore, the manager showed us an annual report that contained the results of all the satisfaction surveys completed by the people using the service and their families in the past, which were in the main very complimentary about the standard of care provided at Callum House. A number of the people who use the service told us staff are always asking them want they want to eat, and where they want to go out. These individuals also knew who their designated keyworker was, and what their role was. All the written and verbal feedback we received from the manager and staff indicated the service actively encourages and supports the people who use the service to do as much for themselves as they are wiling and capable of doing. A number of the people who use the service told us they are expected to bring their own laundry down from their bedrooms, go food shopping with staff, and clear up after themselves when they had finished their meals. During this visit we observed a number of people who use the service carry their own plates of food to the dinning room and bring down their laundry for washing. It was also evident from the managers comments and the risk assessments we Care Homes for Adults (18-65 years) Page 13 of 31 Evidence: examined in depth that the people who use the service are actively encouraged and supported to take responsible risks as part of the process of helping individuals to develop their independent living skills. This includes - travelling independently in the wider community without staff support, having a front door key, and doing your own ironing. All the risk assessments contained in the care plans we looked at had clearly been developed with the people for whom they were intended, and/or their representatives; and set out in detail what action staff needed to be take to order to prevent and/or effectively manage any identified risks and/or hazards. The manager also told us best interests meetings had recently been held for nearly half the people who currently reside at Callum House and their representatives to establish whether or not they were willingness and capable of taking at least some responsibility for looking after their own medication. The outcome of these best interest meetings are currently not included in anyones care plan, which we recommend the service addresses after the process of assessing everyones capacity has been completed. Care Homes for Adults (18-65 years) Page 14 of 31 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. The social, leisure, and recreational activities the people who use the service have the chance to participate in each day, both at home and in the wider community, remains extremely varied, age appropriate, and meaning. The service continues to be very good at encouraging the families of the people using the service to remain involved and take an active role in supporting their loved ones. Dietary needs and preferences are well catered for ensuring the people who use the service are provided with daily variety and choice of nutritionally well balanced meals. Evidence: It was evident from all the verbal feedback we received and staff practises observed that encouraging and supporting the people who use the service to have active and interesting social lifes is an important part of the ethos of Callum House. During this Care Homes for Adults (18-65 years) Page 15 of 31 Evidence: site visit we observed staff positively respond to requests from a number of people using the service to go out shopping in the nearby town and attend art classes at a local community college. These leisure pursuits could easily be identified in the respective individuals care plans as something they had expressed an interest in doing. Others we met told us they regularly went out with staff for tea and cake at a local cafe, bowling at a nearby alley, and the cinema. One person who uses the service told us they didnt like going to the pictures, but agreed it was good that staff always invited them just in case they changed their mind. The manager confirmed that most of the people who use the service had decided to go to the cinema that night. The individual who had chosen not to go the cinema also told us they liked going out for buns and on day trips to the seaside, which staff helped them to do. The manager told us the families of all the people who reside at Callum House are actively involved in supporting their loved ones and are always invited to attend care plan reviews and more informal events such as parties and barbeques. The manager also told us a lot of the people who use the service regularly spend the weekend with their families. During this visit we observed the manager speak on the telephone to family members of two people using the service and noted a list of all next of kins Birthdays pinned to the wall in the office. A number of the people who use the service told us their relatives can come and visit them whenever they liked. During a tour of the premises we noted all bedrooms doors have been fitted with locks that could be locked from the inside to ensure privacy, but also overridden by staff from the outside in the event of an emergency. The manager confirmed that all the people who use the service can have a key to the front door and their bedroom if they wished. All the staff we met were observed interacting with the people who use the service in a very friendly and respectful manner, and always knocked on bedroom doors before entering. The two people we spoke with at length about the meals serviced at Callum House were both very complimentary about them. They both confirmed that they go food shopping with staff sometimes and have a takeaway meal at least once a month, which they looked forward too. During this visit we asked a number of staff on duty at the time ask the people using the service what they wanted to eat for their lunch. It was evident from the minutes taken at the last house meeting that the people who use the service are actively encouraged to plan the weekly menus. A person who uses the service was able to locate a copy of that days lunchtime menu choices when we asked to see it and it was also clear from the record kept by staff of the meals actually eaten that people have a real choice about the meals they are provided. All the staff we spoke with were very clear what the people who used the service liked to eat and Care Homes for Adults (18-65 years) Page 16 of 31 Evidence: drink and the four weekly planned menus we looked at reflected these tastes. One person told us they liked curry and another said they liked puddings, which appeared a number of times on this months planned menus. The atmosphere in the dinning room, where everybody sits down together to have their meals, remained very relaxed and congenial during the course of lunch. Care Homes for Adults (18-65 years) Page 17 of 31 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. The service has developed some good arrangements to ensure the people who live at Callum House receive all the personal and health care support they require and in the way they prefer it to be provided. The people using the service are protected by the homes policies and procedures for dealing with medicines and are actively encouraged to take greater responsibility for looking after their own medication if they are willing and capable of doing so. Evidence: All the people we met who use the service were suitably dressed in well maintained clothes that were appropriate for their age and the season. The majority of the people using the service who returned our satisfaction surveys ticked the usually box in response to the question can you make decisions about what you do during the day, evening, and at weekends. All the people who use the service we met during this visit told us they could choose when and where they went out, what they wore, and what they ate and drank at mealtimes. All the staff who returned our surveys told us they believed the service was particularly good at respecting peoples rights to make informed choices about how they lived their life. As previously mentioned in this report Care Homes for Adults (18-65 years) Page 18 of 31 Evidence: we observed a number of staff listening to the requests from the people using the service to go out and choose something different from the planed menus, which we all granted without hesitation. The manager was able to produce health care action plans for each of the people who used the service, which set out in words and pictures the dates and outcomes of all the appointments people had attended with various health care professionals in the past year. It was evident from the information continued in these plans that the service users are actively encouraged and supported by staff to attend appointments with various health care professionals, including GPs, community based nurses, dentists, opticians ect... One person who uses the service told us they had a medical appointment booked that day and that staff made sure they did not miss it. The manager confirmed one person who uses the service had been admitted to hospital in an emergency in the past year, which all the relevant parties with an interest in this individuals welfare were notified about without delay. No recording errors were noted on any of the medication administration records (MAR sheets) we looked at. These records accurately reflected stocks of medication currently held by the home on behalf of the people who live there. The manager told us she regularly carried out spot checks to quality monitor her staff teams medication handling practises and these are inspected on an annual basis by an approved pharmacist. All the medication currently held by the home on behalf of the people who live there is securely stored away in locked cabinets. The manager told us the service does handle some as required behavioural modification medicines. Records indicated this type of medication is not used that often and only as a last resort when more conventional methods to deal with challenging behaviour has failed. Staff we spoke with about it were very clear when and how to administer this type of as required medication responsibly and the manager was able to produce detailed protocols regarding its safe and proportionate use. Care Homes for Adults (18-65 years) Page 19 of 31 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. The service has good arrangements in place for dealing with complaints, which ensures the people who use the service and other major stakeholders feel any concerns they may have will be listened to and acted upon. People who use the service are kept safe because staff understand what constitutes abuse and are now much clearer what they must do if they witness or suspect it. Evidence: The manager told us the service had not received any formal complaints about its operation since its last inspection. A copy of the providers complaints procedures are included in its Guide. There were two separate allegations made in the second half of 2009 that three members of staff who work at Callum House had abused and/or neglected the people who lived there. Both disclosures were taken seriously by the provider and all the relevant external agencies, including - the police, the local safeguarding adults team, and us, were all notified about the alleged abuse without delay in accordance with agreed safeguarding protocols. The manager confirmed that all the alleged perpetrators of the abuse were immediately suspended from their duties without prejudice while these matters were investigated in line with recommended best safeguarding practises. The manager told us all the allegations made were substantiated following a full enquiry, and that as a direct consequence all three Care Homes for Adults (18-65 years) Page 20 of 31 Evidence: members of staff who were involved have now been dismissed for gross misconduct and referred to the Independent Safeguarding Authority for possible inclusion on their barring list for people who are unfit to work with vulnerable adults. All the aforementioned safeguarding issues were dealt with by the providers and service manager in a very prompt, open, and professional manner at the time, for which they are commended. The manager told us that in light of recent safeguarding issues all new and existing members of staff have been reminded about their duty of care to report any incidents of abuse or neglect within the service, and/or the bullying or intimidation of other staff members. Staff we spoke with demonstrated a good understanding of what constituted abuse and were very clear who they would tell if they witnessed or suspected anyone one who lives or works at Callum House was being abused and/or harassed. The manager told us the majority of existing staff had received up to date training on safeguarding, managing challenging behaviour, and professionally recognised physical intervention techniques. A time specific training action plan we saw indicated that all new staff are to receive there training in the aforementioned areas of practise by June 2010. The manager is also aware that restraint training must be refreshed at least once a year. Progress made by the service to achieve this training target will be assessed at its next inspection. A new member of staff we met told us the manager had been very clear during their induction that redirection and verbal deescalation techniques were always the best way to deal with incidents of aggression and that approved physical intervention methods should only be used as a last resort when all else has failed. Care Homes for Adults (18-65 years) Page 21 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who use the service live in a very comfortable and homely environment, and are kept safe because there are some good infection control systems in place. Evidence: During a tour of the premises we noted all the outstanding requirements and good practise recommendations we made in the services last report that related to the physical environment of the home had been addressed in full. This included resealing a first floor bathroom and replacing all the damaged bath panels in this room; and redecorating a top floor toilet. The manager told that in addition to these changes the dinning room and ground floor hallways had recently been redecorated, new light fittings installed in the lounge, and the top floor shower facility repaired. All the communal areas looked very homely and comfortable places to relax. One person who uses the service told us they liked watching television in the lounge, but could also spend time alone in their bedroom if they wanted. All the bedrooms we viewed contained all manner of soft furnishings, furniture, and personal affects that clearly reflected the unique tastes of the individuals who currently occupied these rooms. People we met told us they had chosen the colour their bedroom had been painted. Care Homes for Adults (18-65 years) Page 22 of 31 Evidence: There is a large garden and patio area at the back of the property, which all the people who current reside at Callum house can access. The home looked spotlessly clean throughout and smelt fresh. The services washing machine is capable of washing clothes at appropriate temperatures to comply with infection control standards and is located at the rear of the property so no laundry has to be taken through areas where food is prepared, stored or eaten. Care Homes for Adults (18-65 years) Page 23 of 31 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 manager has now recruited enough permanent support workers to ensure the people who use the receive continuity of care from people who are becoming more familiar with their needs and wishes. The staff team still has quite a lot of experience, is well supported by the manager, and an on going training programme is in place to ensure new and existing staff have sufficient opportunities to continually develop their skills. Staff recruitment arrangements are also sufficiently robust to protect the people who use the service from being supported by people who are unfit to work with vulnerable adults. Evidence: All the feedback we received from the people who use the service and some of their relatives about staff who worked at Callum House was extremely positive, especially regarding their attitude. One relative wrote in a survey - staff are fantastic here, and a person who uses the service told us - staff are nice - i like most of them. The recent safeguarding issues that lead to almost a third of the staff team being dismissed for gross misconduct has inevitably had an adverse affect on the morale of Care Homes for Adults (18-65 years) Page 24 of 31 Evidence: the people who use the service and staff that continue to work there. Nonetheless, the manager told us she has successfully recruited four new members of staff in the past six months, which she believed had gone a long way to stabilising the service and improving morale. All the staff we spoke with told us they believed morale at Callum House was currently very good. The manager told us the service was definitely moving in the right direction now all the aforementioned safeguarding issues had been concluded, although acknowledged she needed more time to get all the new staff fully trained up. We also strongly recommend the remaining senior staff vacancy is filled with a suitably qualified and experienced individual as soon as reasonably practicable to provide the manager with all the day to day supports she needs to continue effectively running Callum House. As previously mentioned in this report all the staff we met were observed interacting with the people using the service in a very caring, respectful, and professional manner. The manager told us during the day she ensures there are always at least two staff on duty the early shifts and at least three during the late shifts. At night the service has one waking night staff on duty with a second person designated as on-call who does not sleep on site. The manager told us the on-call system had worked well on the few occasions it had been activated in the past year because the role is shared among sufficient numbers of staff who are all able to reach Callum House within 20 minutes of being called out. One new member of staff we spoke with told us their new employer had carried out satisfactory pre-employment checks on them before they were allowed to start working at the Callum House. We looked at the personal files for all four people the manager had recruited in the past six months. These files each contained up to date Criminal Records Bureau checks; two written references from their previous employers; proof of identities; full employment histories; and where applicable, Home Office approved work permits. The manager told us as part of the recruitment process she would always follow up the reasons for any gaps in prospective new employees previous employment histories and any reasons why they may have ceased to work with vulnerable adults in the past. The new member of staff we met told us their on going induction training they were receiving as part of their probationary period of employment had covered everything they needed to know about their care worker role, safe working practises and the needs of the people using the service. This individual also demonstrated a good good understanding of where the services fire exits and emergency assembly points were; knew who to speak too if they witnessed poor practise or abuse within the home; and said the manager had told them not to hesitate if they felt they were being harassed or bullied in the work place. Care Homes for Adults (18-65 years) Page 25 of 31 Evidence: As nearly half the services staff are relatively new there are quite large gaps in the teams overall knowledge and skills. However, the manager assured us the service does currently have enough suitably qualified staff on each shift to safely handle medication, administer first aid, appropriately use approved physically intervention techniques, and support people with epilepsy. In addition to this the manager was able to produce a time specific action plan that set out dates by which all persons working at Callum House should have received or refreshed their basic food hygiene, health and safety, managing challenging behaviour and physical intervention techniques, safeguarding vulnerable adults, and infection control training. Furthermore, the manager told us all those staff who had not achieved a National Vocational Qualification in care (level 2 or above), which represents just under half the current staff team, are expected to be at least enrolled on an approved NVQ course by the end of 2010. Progress made by the service to achieve these training targets will be closely monitored and assessed at its next inspection. All the staff we met told us they received one to one supervision sessions with their manager at least every six weeks or so and were expected to attend staff meetings with their peers at least once every two months. The minutes of the services last three staff meetings revealed they were all well attended and covered a wide variety of relevant topics. The manager acknowledged that although she had successfully ensured her staff team continued to be supervised at regular intervals, despite the lack of any senior staff to support her, the task would be much more manageable if she had a suitably qualified deputy or Team leader. Care Homes for Adults (18-65 years) Page 26 of 31 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who use the service continue to benefit from living in a home that is extremely well run by a very experienced and competent management who has been in day-to-day cage of Callum House for ten years. The providers have established some good quality assurance systems which enables all the people who use the service and their representatives to express their views and influence the running and future development of their home. The services fire and Health and safety arrangements are sufficiently robust to safeguard the welfare of the people who use the service, their guests, and staff. Evidence: All the feedback we received about the manager from the people who use the service, their relatives, professional representatives, and staff who work there - was very positive. Typical comments included - the manager is nice, the manager in particular is amazing- always cheerful, helpful, superb at her job, and able to bring out the best in my relative, the manager is good at communicating with my relative - shes superb, My client appears happy and said they particularly liked the manager who Care Homes for Adults (18-65 years) Page 27 of 31 Evidence: listens to them and the manager is firm , but always fair - it a good place to work. The manager told us the owners of Callum House are always on hand to offer her advice and support when she needs it. It was evident from the way the manager interacted with the people who use the service and staff that she has built up extremely good working relationship with them all over a number of years. The manager was able to provide us with copies of the services last three reports carried out by senior representatives of the provider who continue to inspect Callum House on a monthly basis as part of their quality assurance systems. In addition to this all the people who use the service, their relatives, and other professional representatives are invited to complete satisfaction surveys about Callum House at regular intervals, the results of which are always made available to any interested parties in an annual quality assurance report. As recommended in the services last report the manager was able to provide us with a copy of a new fire risk assessment of the building. The services other fire records revealed its fire alarm system continues to be tested on a weekly basis and fire drills are being carried out every quarter to comply with recommended good fire safety practises. The manager was aware that none of her permanent waking night staff had been involved in a fire drill for some time and had already made plans to rectify this by holding the next drill sometime in the late evening. During a tour of the premises we noted several fire extinguishers and portable electrical appliances we sampled at random had all been tested by a suitably qualified engineer in the past year. The temperature of hot water emanating from a first floor bath was found to be a safe 43 degrees Celsius when we tested it in just before lunch. The manager told us staff check the temperature of all the homes water outlets on a regular basis and keep a record of their findings. All items of food we found in the kitchen and pantries during our tour of the premises were correctly stored and labelled in line with basic food hygiene and environmental standards. Care Homes for Adults (18-65 years) Page 28 of 31 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 29 of 31 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 9 The outcome of best interests meetings held with the pople using the service and their representatives to determine whether or not they are willing and capable of taking responsibility for looking after their own medication should be included in their care plans. This will ensure anyone authorised to inspect the plan can determine whether or not the people who use the service are supported to make informed choices and to live their life as independently as they possibly can. The service needs to recruit a suitably experienced and competent senior member of staff who will be able to support the manager run Callum House on a day-to-day basis. The way in which the service arranges for fire drills to be carried out should be reviewed as not all its permanent night workers are participating in them at regular enough intervals. This will ensure they know exactly what to do in the event of the fire alarm being sounded in order to keep the people using the service safe. 2 32 3 42 Care Homes for Adults (18-65 years) Page 30 of 31 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. 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