Care Home: Caroline House

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What the care home does well Caroline House provides a homely and safe environment for the people who live there. People`s comments included `I like living here`, `I`m happy here`, `they cook good food and provide great care` and `they help me with everyday tasks`. Relatives and other visitors said `they always make you welcome`, `they involve the ladies in the day to day running of the home` and `they provide a happy and homely environment`. Staff feel they provide a safe, secure and homely environment, provide good care and support, are person centred, have good training opportunities and are proud to work for the organisation. What has improved since the last inspection? Care plans and health support plans have been developed in pictorial formats, making them more accessible to the people who use the service. Work has begun to make information about the services provided more accessible. The organisation has continued to look at the future of the service and how they can manage peoples changing needs. What the care home could do better: People who use the service told us they would like `more outings` and `to go to the seaside`. Staff told us the only thing they could do better is to ensure the environment is more appropriate to meet peoples needs. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Caroline House 114 Consfield Avenue New Malden Surrey KT3 6HE     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Emma Dove     Date: 0 8 0 7 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 28 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 28 Information about the care home Name of care home: Address: Caroline House 114 Consfield Avenue New Malden Surrey KT3 6HE 02083362600 F/P02083362600 manager.caroline@sonsofdivine.org Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Sons of Divine Providence Trading As Orione Care care home 5 Number of places (if applicable): Under 65 Over 65 0 learning disability Additional conditions: 5 The maximum number of service users who can be accommodated is: 5 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 Caroline House is a care home for five adults with learning disabilities. It is owned by a housing association and managed by the organisation Sons of Divine Providence, who have three other care homes in the local area. Four people are currently living there. Caroline House is situated in a residential area of New Malden close to local shops, leisure facilities with good public transport links. It is in keeping with neighbouring houses and is not easily identifiable as a care home. Accommodation is provided over two floors with one bedroom, staff office, lounge, kitchen/dining room and laundry area on the ground floor. The remaining four single Care Homes for Adults (18-65 years) Page 4 of 28 Brief description of the care home bedrooms, two bathrooms and a staff sleep-in room are available on the first floor. To the front of the home is parking for one car with more parking available in the road. To the rear is a large well-maintained garden with garden furniture. The home is staffed twenty-four hours a day. Inspection reports are available at the home and details of the CQC are included in the Statement of Purpose and Service Users Guide. Care Homes for Adults (18-65 years) Page 5 of 28 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: This key unannounced inspection was carried out over two hours on the 2nd July and one hour on the 8th July 2009 by one regulation inspector. We spoke with people who use the service, staff and the manager and looked at records. Surveys were sent to people who use the service, their relatives or representatives and staff. We received seven completed surveys, comments from which are included throughout this report. We received an annual quality assurance assessment (AQAA) from the manager. This gave us good information about the service, what it does well and areas that will be developed. We looked at information received from the service since the last inspection in July Care Homes for Adults (18-65 years) Page 6 of 28 2007. What the care home does well: What has improved since the last inspection? 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 set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 28 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 9 of 28 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. The service understands the importance of having sufficient information when choosing a care home, although information could be more accessible. Admissions are only made after an assessment of need has been completed, ensuring the service is appropriate for the individual. Evidence: We saw a Statement of Purpose and Service Users Guide have been developed which detail the services provided, information about the organisation, staff, how to make a complaint and financial information. The manager told us this information is being updated with accessible symbols and pictures. Two people who use the service told us they were asked if they wanted to move in and had enough information to help them make the decision. One relative said they always get enough information to make decisions. There have been no new admissions since the last inspection in July 2007. We saw Care Homes for Adults (18-65 years) Page 10 of 28 Evidence: detailed assessments, which are kept up to date to reflect any changes in individuals needs. Care Homes for Adults (18-65 years) Page 11 of 28 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 who use the service are involved in planning their care, developing care plans and making decisions which affect their future. Care plans are person centred. Risk assessments are in place. Evidence: We saw care plans, which are person centred. We saw one accessible care plan, using pictures and words, to be more meaningful for the people who use the service. One person told us they have been involved in developing this new pictorial care plan. The manager told us they get the views of people who use the service through residents meetings, six monthly and annual reviews and key work meetings. One person confirmed they meet their key worker regularly and have other opportunities to speak about the service. We saw detailed assessments of need in place, these show staff the care and support Care Homes for Adults (18-65 years) Page 12 of 28 Evidence: individuals need and their preferences. One relative said the service always meets the persons needs. They told us they are always kept up to date with important information and the service always gives the care and support needed and expected. Four members of staff said they always have up to date information about individuals needs and how to meet them. We saw risk assessments in place and updated as required. The manager and staff were clear about appropriate risks for individuals to take and the balance between safety and allowing people to live the life they choose. People told us they feel safe. Care Homes for Adults (18-65 years) Page 13 of 28 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service has a commitment to enabling the people who use the service to develop and maintain their social, emotional, communication and self help skills. People have access to community activities and are supported to keep in contact with family and friends. The service provides a varied menu to meet peoples needs. Evidence: The manager told us people see a music therapist, aromatherapist and go out to day centres, depending on their needs and wishes. We saw people be at home talking with staff and watching television, going out shopping, preparing for a party and returning from day centres during our visits. People attend churches of their choice. The manager told us they support people to keep in contact with family members or friends. One person said this is important to them. Relatives confirmed that the service Care Homes for Adults (18-65 years) Page 14 of 28 Evidence: helps them keep in touch. The manager told us people have planned holidays to places of their choice. One person told us they have booked a holiday and are looking forward to going away. The manager told us people are involved in meal preparation. We saw people helping staff with the evening meal and laying the table. People told us they like helping with the cooking. People made positive comments about the food including I like the food and I enjoy the meals. The manager told us they are looking at having a pictorial menu, which will be more accessible to the people who use the service. Care Homes for Adults (18-65 years) Page 15 of 28 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People receive the personal and healthcare support they require using a person centred approach. Peoples healthcare needs are well met. Medication is well managed. Evidence: The manager told us people who use the service are given choices around personal healthcare. We saw staff offer discreet support with personal care tasks. The manager told us they work with the community team and other health professionals to ensure peoples health needs are met. We saw health action plans in place. These are in pictorial format with photographs of the individual. They include an annual planner of health appointments, with clear records of any actions staff need to take. People are weighed monthly. Records are kept of chiropodist visits. People told us staff go to the doctor and other health appointments with them. Medication is appropriately stored, records are up to date and signed by staff and we saw medication had gone from the packs as required. Care Homes for Adults (18-65 years) Page 16 of 28 Evidence: The manager told us that two members of staff have completed training in end of life care, with other staff due to do this training. Care Homes for Adults (18-65 years) Page 17 of 28 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 developed a clear complaints procedure which is displayed in the home and accessible to some people who use the service and their representatives. Appropriate policies are in place for safeguarding and the manager is aware of her responsibilities. Evidence: People who use the service are happy with the care and support they receive, they told us they would speak with the manager, staff or their relatives if they were worried about something. Relatives are aware of how to make a complaint and feel the service responds appropriately. Four members of staff told us in surveys that they are aware of how to respond to concerns and complaints. There have been no complaints received at the home and we have not had any complaints. We received one phonecall about staff shortages, but were unable to follow this up. We saw staff levels to be sufficient to meet peoples needs during our visits. The manager told us they plan to develop the complaints procedure in pictorial format, which will be more accessible to the people who use the service. The manager told us that staff complete training in safeguarding and that this is an Care Homes for Adults (18-65 years) Page 18 of 28 Evidence: area they plan to improve with more regular updates. The service has a policy for the protection of vulnerable adults and would work with the placing authority if any issues are raised. Care Homes for Adults (18-65 years) Page 19 of 28 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 home is becoming less appropriate to meet the physical needs of the people who live there. People who use the service have their own bedrooms which they decorate and personalise to their taste. The home is generally well maintianed and kept to a good standard. Evidence: People have access to the kitchen with dining table and chairs, a lounge and staff office on the ground floor. One single bedroom with ensuite is on the ground floor, with remaining bedrooms, two bathrooms and a staff sleep in room on the first floor. People told us I like my room and said Ive got all I need and its comfy. We saw people to be relaxed in their bedrooms and communal areas. The manager told us there are no definate plans for the future but the organisation are aware that the home may not be appropriate for the people who live there as they age and their needs change. There is a detailed cleaning schedule and we saw all areas of the home to be kept to a high standard. People who use the service said the home is always clean and fresh. Care Homes for Adults (18-65 years) Page 20 of 28 Care Homes for Adults (18-65 years) Page 21 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have confidence in the staff who support them. Staff levels are sufficient to meet peoples needs. Staff recruitment is in line with regulations to keep people safe. Staff have access to appropriate training and have regular supervision from the manager. Evidence: We saw two members of staff on duty during the day and one asleep but on call at the home at night. The manager is available in addition to these hours some weekdays. People who use the service told us they go out and do the things they want. We did not see people prevented from doing things due to lack of staff. Four members of staff said there are always enough staff. People who use the service told us the manager and staff treat them well and listen and act on what they say. The manager told us they have a full permanent staff team, working well together. No new staff have been employed since the last inspection but the manager is fully aware of the process and the information needed. Four members of staff said they had all the appropriate checks before they started work. Four staff said their induction covered all Care Homes for Adults (18-65 years) Page 22 of 28 Evidence: they needed to know very well. The manager told us the organisation has a training programme available to all staff and they use some training provided by the local authority. Four members of staff said they have training to help them do the job. We saw staff have completed core training, covering medication administration, moving and handling, health and safety, fire safety, first aid, infection control and safeguarding vulnerable adults. Staff have also completed training on the Mental Capacity Act and the manager and one senior staff have completed training on the Deprivation of Liberties and Safeguarding and will be passing this information to all staff. We saw staff have a professional development file which details the training individuals have completed. This file also contains an evaluation sheet completed by the individual after every training session. We think this is used well, to show what they have learnt and any further training needs. Care Homes for Adults (18-65 years) Page 23 of 28 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 manager has the experience and qualifications to run the home. The service is well run in the best interests of the pople who live there. The annual quality assurance assessment included clear information about what the service does well, with evidence to confirm this. Quality assurance systems are in place to seek the opinion of the people who use the service and their representatives. Health and safety is well managed. Evidence: The manager has the required knowledge and experience. Staff meetings take place every month, all staff sign that they have seen the minutes and go through the minutes in supervision if they were not able to attend. The manager told us they have monthly residents meetings which are run by a facilitator who does not work at the home. People who use the service confirmed that they have regular meetings. Care Homes for Adults (18-65 years) Page 24 of 28 Evidence: A representative from the organisation visits every month and makes a report about the service. We saw evidence confirming that any issues raised have been addressed. The manager told us they do an annual survey, consideration could be given to publishing the results and showing people how they are listened to and any changes made as a result of their comments. The manager told us all health and safety checks are up to date and carried out at the appropriate intervals. We saw records confirming the gas safety was checked in August 2008, the electrical supply was checked in November 2004 and the portable electrical appliances were tested in February 2009. Care Homes for Adults (18-65 years) Page 25 of 28 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 26 of 28 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 1 Consideration should be given to providing information in accessible formats, to ensure any prospective or new people understand the service and can make an informed decision about moving in. Consideration should be given to publishing the views and opinions received in annual surveys, showing the changes made, this will show people that there views are listened to and acted upon. 2 39 Care Homes for Adults (18-65 years) Page 27 of 28 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. 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