Care Home: Carrick

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What the care home does well Carrick provides a good facility for the care of people with autism. People living in the home seem to be supported to a good standard and support is tailored to individual needs. There is a good range of activities available for individuals, and transport is provided so people can go out. Staff work in a manner to enable people living in the home to receive appropriate care, and make choices about their lives where this is possible. What has improved since the last inspection? The registered persons continue to provide a good service for the people living at Carrick. What the care home could do better: This inspection has resulted in two statutory requirements. These are: (1) Staff training needs to improve in some areas (2) Improvement is required regarding the prevention of legionnaire`s disease. Otherwise the service is managed to a good standard. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Carrick 11 Carlyon Road Playing Place Truro Cornwall TR3 6EU     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: Ian Wright     Date: 0 3 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 27 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 27 Information about the care home Name of care home: Address: Carrick 11 Carlyon Road Playing Place Truro Cornwall TR3 6EU 01872864657 01326371099 mail@dcact.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) : Spectrum care home 5 Number of places (if applicable): Under 65 Over 65 0 learning disability Additional conditions: Date of last inspection Brief description of the care home 5 Carrick provides accommodation and personal care for up to 5 adults with autism. The registered provider is Spectrum, an organisation that provides specialist care for people with autistic spectrum disorders. Spectrum employs a manager, who is registered with the Commission, and a team of staff to provide care to the people living at the home. The home is located in the village of Playing Place, which is within easy reach of the city of Truro. The home is a single storey building, set in its own grounds, slightly off the main road. All people living in the home have their own bedrooms. The home has ample communal space, including a lounge/dining room, a second lounge and a conservatory. There is a spacious kitchen, a separate laundry room and a satisfactory number of bathrooms. Staff have a small office and separate sleeping in accommodation. The home has a large garden. There is satisfactory car parking space. The home has level access and could be adapted to provide for people with physical disabilities if necessary. Current people using the service do not require specialist Care Homes for Adults (18-65 years) Page 4 of 27 Brief description of the care home equipment or adaptations and are able to readily access all parts of the premises.The registered provider provides transport for the people to get out and about. The home is also near to local bus routes. Fees at the time of the inspection ranged from £932 to £3302. Fees are assessed according to individual needs and individually agreed with the persons sponsoring authority. There are additional charges made for personal items such as toiletries, newspapers and magazines. Care Homes for Adults (18-65 years) Page 5 of 27 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 inspection took place in five and a half hours in one day. All the key standards were inspected. The methodology used for this inspection was: (1) To case track two people using the service. This included inspecting their records. (2) Discussing care practices with staff and management. (3) Inspecting records and the care environment. Other evidence gathered since the previous inspection, such as notifications received from the home (e.g. regarding any incidents which occurred), was used to help form the judgments made in the report. Care Homes for Adults (18-65 years) Page 6 of 27 Care Homes for Adults (18-65 years) Page 7 of 27 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 27 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 27 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. Information provided to people who use the service (e.g. regarding services offered) is good. For example all people who use the service (and /or their representatives ) receive a statement of terms and conditions of residency or contract when they move in. This ensures people are aware of their rights and responsibilities. Pre admission assessment procedures are satisfactory and ensure the registered persons check they can meet the persons needs before admission is arranged. Evidence: We inspected a copy of the homes statement of purpose and service user guide. These contain satisfactory information about the service. The registered provider has a satisfactory assessment procedure. For example prospective clients and their families visit the home before admission is arranged. Senior staff visit the person to meet them as part of the assessment process. The person concerned also visits the home. There has been one admission to the service since the last inspection. A suitable process was followed, for example the registered provider visited the persons previous Care Homes for Adults (18-65 years) Page 10 of 27 Evidence: home, and the person visited Carrick several times to check it was suitable for them. The process was clearly documented. We were able to inspect contracts / statements of terms and conditions of residency for people using the service. Information inspected was satisfactory. Care Homes for Adults (18-65 years) Page 11 of 27 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. Satisfactory care planning procedures are in place. There is satisfactory opportunity for people to participate in making choices and be involved in decision making. Staff enable people using the service to take an appropriate level of risk so they can pursue as independent a lifestyle as possible. These measures ensure the needs of people who use the service are met and they are given the opportunity to make choices how they lead their lives. Evidence: A care plan was contained in the file for each person we case tracked. Care plans are accessible to staff. There is a review process in operation, and people who use the service (and / or their representatives) are invited to meetings which occur. From discussion and observation, people who use the service are as much as possible involved in making decisions about their lives, and how the home is run. However people have varying communication and cognitive skills so this involvement is limited. Care Homes for Adults (18-65 years) Page 12 of 27 Evidence: Where restrictions are in place, these are recorded. Restrictions in place appear appropriate considering peoples needs. Suitable risk taking seems to take place to enable people using the service to live as independently as possible. The home has its own transport, which enable people to participate in community activities. Suitable risk assessments are kept on file, and reviewed as necessary. Personal monies are managed by staff on behalf of people using the service. Money is held securely. Suitable records are kept recording any expenditure. Management have appropriate systems to ensure records are checked. Care Homes for Adults (18-65 years) Page 13 of 27 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 registered persons ensure people living in the home can live a lifestyle which meets their needs and wishes. Evidence: People using the service have the opportunity to pursue a range of activities such as going to college, social clubs, swimming, horse riding etc. Social and shopping trips are organised according to the wishes and needs of individuals. There is evidence from daily records that people participate in a suitable range of activities. People have opportunity to visit friends and relatives and these people also visit the home. Routines in the home seem appropriate according to individual needs. There was a relaxed and friendly atmosphere in the home throughout the time of the inspection. The home has a menu with a suitable range of meals available.Records also show Care Homes for Adults (18-65 years) Page 14 of 27 Evidence: people appear to have a varied and nutritious diet. Care Homes for Adults (18-65 years) Page 15 of 27 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. Personal and healthcare needs of people living in the home are generally satisfactorily promoted and met. The management of medication is satisfactory so people using the service and their representatives can be assured there medication is managed appropriately. Evidence: We observed people using the service receiving suitable care and support from staff. Support was carried out in a professional, but relaxed and friendly manner. Documentation regarding how care tasks are completed is satisfactorily documented in care plans. People living in the home appear to have their personal hygiene needs met. All people using the service looked well cared for on the day of the inspection. The manager said people living in the service have suitable access to health care professionals such as GPs, dentists, district nurses, chiropodists, opticians etc. Records of this support is well documented. We inspected the medication system. The medication policy seems satisfactory. Care Homes for Adults (18-65 years) Page 16 of 27 Evidence: Medication is stored appropriately in a medication cupboard. Medication is administered via a monitored dosage system supplied by a local pharmacist. Staff have received appropriate training regarding handling medication. Administration and recording of medication seems satisfactory. The inspector discussed with the registered manager what training staff had received regarding assisting people in the home with communication (some people have limited verbal skills). The registered manager said some of these people use the Makaton signing system or the PECS system. However, their knowledge is limited. Staff generally teach each other relevant signs that people use. A language therapist has been involved assisting people using the service to develop their skills. The registered persons need to keep staff training needs in this area under review, and provide appropriate support and training to assist staff to develop their skills as necessary. Care Homes for Adults (18-65 years) Page 17 of 27 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 registered persons have satisfactory complaints and adult safeguarding procedures. This should help to ensure any concerns, complaints and safeguarding allegations are investigated appropriately. Evidence: Copies of the complaints and adult safeguarding procedures were inspected and are satisfactory. We would advise the registered provider to include information regarding access to the social services complaints procedure within their procedure and /or within individual service user guides. People who are funded by local authorities have a right to use this procedure if they are funded by social services, and subsequently they should be made aware of this. The registered providers adult safeguarding procedure is satisfactory. Care staff said they would inform the manager if they suspected any abuse had occurred. Training regarding safeguarding is delivered to care staff as part of their induction. Staff who we spoke to, said they had no concerns regarding the attitudes of other staff or care practices in the home. Care Homes for Adults (18-65 years) Page 18 of 27 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. Carrick provides a suitable facility for the people living there. Evidence: The building was inspected. Five people are accommodated at the home. The home is a spacious bungalow. There is a large lounge / dining room. There is a spacious garden which people living in the home can use without staff accompanying them. There are suitable toilet and bathing facilities. The registered manager said thermostatic valves are fitted to all bath and shower facilities. The home was clean, warm and light enough on the day of the inspection. The kitchen was clean. Laundry facilities are satisfactory. The outside of the building and the gardens were maintained to a satisfactory standard, although the front of the building and garden would benefit from some cosmetic improvement. The door bell also did not appear to work and if this is the case needs to be fixed. Care Homes for Adults (18-65 years) Page 19 of 27 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. Staffing levels appear satisfactory to meet the needs of people currently accommodated at the home. Recruitment checks are to a good standard. Improvement is required regarding staff training. These measures ensure people who use the service are supported by suitably knowledgeable and skilled staff. Evidence: On the day of the inspection there were satisfactory numbers of staff on duty. The team appears to work well together. There is four members of staff on duty between 08:00 and 22:00. There is a sleep in member of staff on duty at night. Personnel records were inspected for the staff on duty for the day of the inspection. These were satisfactory.Staff employed had two references, a Protection of Vulnerable Adults First check (POVA First) , a Criminal Records Bureau check (CRB) , a completed application form and evidence of identification. It would be helpful if a scanned copy of the POVA First check is stored with other personnel records on the Spectrum records system. This will help us validate this check has been completed before the member of staff has commenced employment. We inspected training records for the same sample group of staff. By law staff require Care Homes for Adults (18-65 years) Page 20 of 27 Evidence: the following training: * Regular fire training in accordance with the requirements of the fire authority. *There must always be at least one first aider on duty (at appointed person level) *All staff must have manual handling training and should have regular updates of this (e.g. annually) *All staff must have basic training in infection control. * Staff who handle food receive food hygiene training. * All staff must have an induction and there needs to be a record of this. * Awareness training regarding the needs of people accommodated. The delivery of training is generally satisfactory. The registered provider offers staff a comprehensive staff induction which covers the majority of the elements required by law. Staff subsequently attend follow up training which covers the areas more comprehensively. However, some of the staff files inspected show that some of the staff still need to attend training for example in food handling, medication and infection control training. Staff have received training regarding autism and how to deal with difficult behaviour. We have issued a recommendation to review staff training regarding communication skills with the resident group. Information regarding this is outlined earlier in the report. There is opportunities for staff to obtain a National Vocational Qualification in care. When staff have received an NVQ 2 there is the opportunity to obtain an NVQ 3 in care if this is deemed by management as appropriate. Care Homes for Adults (18-65 years) Page 21 of 27 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 registered manager and the staff team are effective in ensuring the service is managed to a good standard. Quality assurance procedures are to a good standard. Health and safety procedures and checks are to a satisfactory standard, although improvement is required regarding the prevention of legionella. Evidence: The registered provider is Spectrum, a registered charity supporting people with autism / aspergers syndrome. A registered manager has been in post for several years. The registered provider has a good approach to quality assurance. For example an annual development plan was inspected for the service. However, there is no policy regarding quality assurance on file. This needs to be obtained from the registered provider. The registered provider has supplied the commission with their Annual Quality Care Homes for Adults (18-65 years) Page 22 of 27 Evidence: Assurance Assessment (AQAA) (an annual dataset, and self assessment required by CSCI). This was completed to a good standard. Any notifications, required by the commission (e.g. regarding untoward incidents) appear to have been received by us. Policies and procedure files in the home are dated May 2003. It is important there is evidence these are being regularly reviewed and updated when required. The registered provider has a health and safety policy. There is a fire risk assessment. Testing of fire extinguishers and the fire system appear to have been completed appropriately by external contractors. Internal checks on the fire system appear to have been completed appropriately by staff (e.g.emergency call points and emergency lighting). Health and safety risk assessments have been completed. However, we did not view any risk assessment or routine testing records regarding the prevention of legionella. If this is not occurring this needs to be organised. The Health and Safety Executive publish a useful document regarding this matter via their website. Suitable records regarding accidents and incidents are kept. Portable electrical appliances have been tested and appear satisfactory. The electrical hardwire circuit was tested when building work at the home was completed. The test results were satisfactory.Gas appliances have been serviced. An up to date certificate of insurance is displayed. Care Homes for Adults (18-65 years) Page 23 of 27 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 24 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 35 18 Staff need to receive training as outlined in the body of the report. This will ensure all staff have appropriate knowledge and skills, in accordance with the law and to meet the needs of the people accommodated in the home. 01/12/2009 2 42 12 Ensure a risk assessment is completed, and any subsequent control measures are introduced regarding the prevention of legionella. This should help to ensure staff and people who use the service are protected from this disease 01/10/2009 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 Care Homes for Adults (18-65 years) Page 25 of 27 1 19 Review training and support in communication skills with the resident group to assist people using the service to improve their communication skills if this is possible. Ensure there is reference to the Social Services Complaints procedure, in the homes complaints procedure, and /or service user guide, as people funded by local authorities have a right to use this if they have a concern or a complaint. 2 22 Care Homes for Adults (18-65 years) Page 26 of 27 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. 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