Care Home: Chapel Hill Hostel

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What the care home does well All those residents seen at the home responded positively to our enquiries about life at the home and the services that are provided for them. It was good to hear residents speaking positively about the care and support they receive at Chapel Hill. They said they appreciate the friendly, relaxed atmosphere as well as the caring support of the staff group. Evidently they feel safe, well cared for and safe. What has improved since the last inspection? The Project has been completely redecorated and refurbished since the last inspection. Some of the rooms have been altered and improved both in their sizes and by having en suite accommodation provided. The Project looks clean and well cared for and the residents and staff seem positive about the work that has been carried out. What the care home could do better: Specific areas referred to in this report: The Manager must ensure there is an individualised needs assessment carried out for each resident after their admission to the unit. The Manager must ensure that for each resident there is a clear care plan format that draws together all the needs information set out in the CPA, the units own needs and the risk assessments. Risks identified in risk assessments must be included in the care plan formats to be developed. The Manager must ensure that appropriate provision is provided for controlled drugs. The self learning training for medication administration is supplemented by formal professional training for all staff. The Manager should issue a copy of the new handbook to all the residents. Staff be enrolled for the next protection of vulnerable adults training course with L. B. Greenwich. The Manager should ensure that evidence for all staff training and other qualifications is routinely held on staff files. The Manager must ensure that all staff files be reviewed and action taken to ensure that they contain all the necessary information as described in Standard 34. The supervision record should be sufficiently detailed so as to specify the key areas of discussion and all the decisions and agreements made in the meeting. Key inspection report Care homes for adults (18-65 years) Name: Address: Chapel Hill Hostel 44 - 55 Chapel Hill Crayford Kent DA1 4BY     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: David Halliwell     Date: 1 7 0 9 2 0 0 9 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 35 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 35 Information about the care home Name of care home: Address: Chapel Hill Hostel 44 - 55 Chapel Hill Crayford Kent DA1 4BY 01322553201 01322527786 chapelhill@together-uk.org www.together-uk.org Together Working for Wellbeing care home 23 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) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: Up to 4 places for people aged 65 years and over. Date of last inspection Brief description of the care home The Chapel Hill Project is owned by Bexley Council which leases the property to Together Working for Wellbeing. The service is registered to provide rehabilitation and support for 21 people with a mental disorder. The home consists of the following: a 5 bedroom flat; a 1 bedroom bed sit; a 5 bedroom house (B); a 6 bedroom house (C); and a 4 bedroom unit called Hill Top View for people requiring respite or who are in crisis. All the bedrooms are single occupancy and 19 rooms have en suite facilities. The property is in walking distance of shops and public transport services and there is limited off road parking. The Primary Care Trust funds some of the people living in the home. At this inspection the Manager confirmed that the fees range from £502 to £750 per week although depending on the needs of the person concerned they may be higher than this. The Care Homes for Adults (18-65 years) Page 4 of 35 Over 65 4 23 Brief description of the care home Manager told us that this does not include additional charges such as newspapers, magazines, toiletries, activities, hairdressing and personal clothing. Care Homes for Adults (18-65 years) Page 5 of 35 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 stars quality rating for this service is good. This means that people who use these services experience good quality outcomes. Service users said that they like to be called residents. This was an unannounced inspection visit of the service at the Chapel Hill Project in Crayford. The Inspection covered all the key standards and involved a tour of the home, a review of all the homes records and formal interviews with 3 members of staff and the Manager and 4 of the residents. We also received 7 feedback survey forms from residents at Chapel Hill and all this information was used as a part of this inspection. No enforcement activity has occurred since the last inspection. There have not been any changes in the ownership or management of the Chapel Hill Care Homes for Adults (18-65 years) Page 6 of 35 Project, Together Working for Wellbeing remain the provider agency. The Manager is registered with the Care Quality Commission as the Manager. 4 new requirements have been made as a result of this inspection and 1 repeat requirement has been made. 5 good practice recommendations have also been made. Feedback on the recommendations was fully explained to the Manager at the end of the inspection visit. We found the residents and staff most helpful and they are to be thanked for the assistance that they gave us over the course of this inspection visit. The Manager confirmed that the fees range from £502 to £750 per week although depending on the needs of the person concerned they may be higher than this. Care Homes for Adults (18-65 years) Page 7 of 35 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 on page 4. Care Homes for Adults (18-65 years) Page 8 of 35 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 35 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 35 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standard 2 was inspected at this inspection. People using this service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Prospective service users need to be fully assured that their needs are assessed and that their individual aspirations and wishes will be taken into account in the assessment process. Evidence: 3 of the residents files were inspected at this inspection and we also spoke with 4 residents. File order was tidy with the information set out in a helpful, logical and chronological sequence and on each file there was a detailed needs assessment and care plan (usually in the form of a Care Programme Approach) that had been supplied by the referring agencies. It is important however that the Unit carries out its own individualised needs Care Homes for Adults (18-65 years) Page 11 of 35 Evidence: assessment for each resident after their admission to the home. These needs assessments should cover all areas of the residents needs. This and the risk assessment information and that supplied by the referring authorities should inform the care plan. It is required therefore that the Manager ensures there is an individualised needs assessment carried out for each resident after their admission to the unit, usually after about 6 weeks. This should be regularly reviewed either as the persons needs change or at least once every 6 months. These needs assessments should be carried out in conjunction with the resident and should include the wishes and preferences of the resident. They should be signed off by both the resident or their representative and the home and should be dated. This is so as to ensure that all a residents needs have been identified, assessed and reviewed as they change or progress. Star plans for the residents have been drawn up by the unit. Care plans need to be based not only on the needs assessment information supplied by the referring agencies but also on the Units own needs assessment and risk assessment of the residents needs. Some information on the needs assessments should also include any cultural or religious needs that the resident might have and evidence of this should be able to be seen by us on the files to be inspected. This will help to ensure that all the residents needs are being met. Care Homes for Adults (18-65 years) Page 12 of 35 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standards 6, 7, & 9 were inspected at this inspection. People using this service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. At present residents cannot be assured that their assessed and changing needs and personal goals will be reflected in their care plans. They may be assured that they will be able to make decisions about their daily lives. When risks identified are included in their care plans they may be assured that they will be enabled to take risks as part of developing a more independent lifestyle with support and as they need it. Evidence: 3 residents files were inspected and we spoke to 4 residents over the course of this inspection. Care Homes for Adults (18-65 years) Page 13 of 35 Evidence: The Manager said that the care team base the residents care plans on the information provided to them by the referring teams. A new care plan format is in use called a Star Plan and this is completed together with the resident. It does not however include care plan objectives and it was difficult to see at this inspection how some of the care plan objectives set out in the CPA documentation had been addressed. As an example and on a residents file, the care programme approach needs assessment and care plan identified a number of needs in 9 key areas of the residents life. Some specific care objectives had also been identified. We were told by the Manager that the Star Plan is the care plan, however in the Star Plan there were no clear objectives that would assist the resident and the staff in meeting the needs identified and that would assist the resident to make positive progress in each of these areas. It is required therefore that the Manager ensures that for each resident there is a clear care plan format that draws together all the needs information set out in the CPA, the units own needs and the risk assessments. The care plan should include specific and measurable care plan objectives that have timescales defined for their achievement or otherwise and that can be reviewed at each formal care plan review. These care plans should be agreed by the resident or their representative and by the clinical teams that also support them. As the circumstances and the needs of the residents change the care staff should review the needs assessments and accordingly amend the care plans. All care plans should be reviewed at least once every 6 months. The 3 residents files that were inspected included most of the information required under schedule 3 of the National Minimum Standards. All residents are allocated a key worker and they sign their care plans when in agreement with the content. Residents who we interviewed confirmed that the staff do respect their rights to make their own decisions where appropriate. Care staff made it clear that they involve the residents wherever possible in making their own decisions in order to assist in supporting a positive move towards independence. The Manager told us about the self assessment forms residents are asked to complete at admission to the unit and the residents meetings that are held in the unit that Care Homes for Adults (18-65 years) Page 14 of 35 Evidence: involve the residents as much as is possible to make decisions about different aspects of their lives. This includes menu planning and daily activities as well as planning the routine maintenance tasks that have to be undertaken every day and which involves the residents. Residents confirmed with us that they attend these meetings together with staff. Minutes of the residents meetings were seen that supported what has been said. This all means that residents are able to make decisions about their lives with support as they need it. The Manager said that risk assessments are undertaken for each resident to assist in their taking responsible risks. Inspection of the files confirmed that these risk assessments had been undertaken. Care support staff also confirmed that they are involved with their residents in completing these risk assessments in order to support residents to lead as independent a lifestyle as possible. The clinical care teams are involved in these assessments appropriately. This means that risks to the residents are being assessed. It is important that risks identified in these assessments are includes in the care plan formats to be developed, this is a requirement. Care Homes for Adults (18-65 years) Page 15 of 35 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. Standards 12, 13, 15, 16 & 17 were inspected at this inspection. People using this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents may be assured that they will be able to take part in appropriate activities, some of which will be based in the local community. That they will be supported to maintain appropriate personal relationships with family and friends; and that their rights will be respected and their responsibilities recognised in helping them to construct an appropriate programme of activities in their daily lives. Residents were seen to be offered a healthy, nutritious and varied diet according to their needs. Care Homes for Adults (18-65 years) Page 16 of 35 Evidence: The Manager told us that in order to ensure that each resident is involved in daily activities appropriate to their needs and wishes, staff maintain daily activities sheets. These sheets were seen at this inspection. They record the activities of each resident and link the activities with what they say they want to do. Residents interviewed by us said that they participate in the activities they wish to do. Residents told us that if they wanted to do an activity, staff would support them to do so. The Manager told us that as a part of trying to maintain continuity for the residents in their daily lives and to support their rehabilitation, where ever possible previous interests, pastimes, hobbies and relationship are encouraged and are built into the daily activities plan for residents. The Manager said that some residents are attending colleges so that their skills and knowledge may be developed further in areas of interest to them. 1 resident who we spoke to said, I am doing some college courses that are helping me so that I can do more things when I leave here. Another resident said, I enjoy doing voluntary work as I think it will help me to get a job later on. The Manager and the residents who we spoke to told us that the significance of relationship links for the residents are important and that the importance for the residents of these links is not underestimated. Visitors are made welcome when they come to the home. Information about local activities was seen on the notice boards within the home and staff who were interviewed by us said how they will support residents, in their capacity as care support workers, to take as much of an active role in the community as is appropriate for residents. One member of staff at the time of the inspection talked to us about the importance for the residents to get out and about and socialise with other people. Residents told us that they are supported and enabled to take part in appropriate activities and that they are able to express their wishes and be listened to and responded to with active and appropriate support. The Manager told us that staff actively encourage residents to develop and maintain social, emotional and independent living skills where ever possible as a part of their rehabilitation package. Staff were seen to be actively supporting residents to make informed choices about the things they want to do and the activities they need to do. The location of the home in Crayford makes access relatively easy for those residents Care Homes for Adults (18-65 years) Page 17 of 35 Evidence: who are able and want to use public transport. 2 residents told us that they make use of some of the local leisure facilities and the Manager told us that staff support the residents to do so. The Manager informed us that all residents are registered to vote and are encouraged to use their votes. Residents confirmed that they are supported and enabled to vote. The Manager said that relations with the local neighbours are good with no problems arising up to this point in time for the home or for the neighbours. From discussions held with staff and residents, they do seem to be engaged as much as is possible with their local community and this will be likely to expand as their skills and abilities increase. The Manager said that because of the rehabilitative purpose of this home many of the residents are engaged during the day outside of the home. The purpose of this is to assist residents to become as much of the local community as is possible, some residents attend day centres outside of the home for a variety of reasons that all help to contribute to their well being and to their successful rehabilitation. This was confirmed by the residents. Interviews with 4 of the residents confirmed that where possible they do maintain regular contact with members of their families and either go out to visit their relatives or receive them at Chapel Hill. Residents said that they are enjoying the opportunities that they experience at this unit. Staff interviewed by us said that they encourage these visits and are sometimes involved in helping their residents sort out difficulties that they experience their relationships with their relatives as this often has a direct bearing on the mental well being of the resident. Visitors to the home are encouraged and use the visitors book to sign in. We saw information made available within the home about local activities for residents to take up if they wish. Policies seen by us to be established within the unit ensure that service users rights to privacy, respect and dignity are respected. Those residents who were interviewed also confirmed that they felt staff respected these rights. Care Homes for Adults (18-65 years) Page 18 of 35 Evidence: The Manager told us that each resident has a key to the front door, to their bedrooms and that they have a lockable cabinet in each of their rooms. This was confirmed in the Service Users Handbook and by the residents who we spoke to. They said that they have a key to their own bedrooms, that staff use their preferred form of address and that staff do knock on their doors before entering. We observed staff to be interacting with residents in a friendly and respectful manner and staff confirmed in interview that they understand how to respect the privacy and dignity needs of the residents. The Manager told us that the Unit has a Cook who provides residents with cooked meals from Tuesdays to Fridays. The rationale for this is that on the other days of the week residents are encouraged to cater for themselves as a part of their rehabilitative programme. Staff told us that when residents prepare their own food they will assist them when necessary as part of their rehabilitation programme. This was confirmed by the residents who we spoke to as well. One resident said, There are lots of choices for dinner and eating times are flexible. Food menus shown to us indicate that menus are well balanced, nutritional and cater for the varying cultural and dietary needs of the residents. Residents are able to state their preferences when the menus are planned and there are discussions about this at the residents meetings that are held regularly. No complaints about the meals arose during the inspection in fact those residents interviewed said that they like the food provided. We asked the Manager if a dietician is used to advice on the menu planning in order to ensure that the food provided is always healthy and nutritious. The Manager said that a dietician is used in some cases where there is a specific need. This all means that residents receive a healthy diet and enjoy their meals and meal times. It also means that residents are being assisted to develop their own skills in food preparation and cooking. Care Homes for Adults (18-65 years) Page 19 of 35 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. Standards 18, 19 and 20. People using this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Service users may be assured that they will receive personal support in the way that they prefer and require and that their physical and emotional needs will be met. Service users can rely on the home providing a well managed service with regards to medication. Evidence: The Manager explained that most of the residents living in the home did not require support with personal care or mobility. In the last inspection report it was stated that where assistance is required a local domiciliary care agency is commissioned to provide personal care. The residents interviewed at this inspection said that they do choose when to go to Care Homes for Adults (18-65 years) Page 20 of 35 Evidence: bed, when to have a bath, what they wish to wear and what activities they do during the day. Where appropriate residents receive support from their clinical teams. With regards to the health care of the residents the Manager said that all residents receive a health check at the point of their admission to the home and then as needed. Evidence of this was seen on the residents files that we inspected. The Manager also said that residents are supported to keep well through accessing appropriate healthcare and associated mental health care support. They are signed up with one of the several local GP surgeries and some are registered with a local dentist. The Manager said that whether or not a resident uses the dentist is left up to the residents own decision but staff will encourage residents to use this service if required. Where residents do not use a local dentist the Manager told us that clinical team care coordinators can help to gain access to a dentist for the resident. Residents who we spoke to said that they go to see their GPs and dentists as and when necessary. This means that residents physical and emotional health needs are met at Chapel Hill. The homes policies and procedures manual contains appropriate policies for the control of medication. We reviewed the records for the administration of medication to residents (MAR sheets) and these had all been appropriately completed. There were no unexplained gaps seen on the MAR sheets that we saw that had been completed over the last month. Immediately after this inspection the Manager told us that they have ensured that photographs of the residents have been attached to the MAR sheets. This will help to ensure that staff administer medications to the right resident. The Manager told us that she ensures all staff are regularly assessed in terms of their competence and we were shown the assessment checklist that is currently being used by the Manager. This list is comprehensive and covers a review of equipment to be used; preparations necessary before providing medications to the residents; monitoring of actual staff practices in medicating residents and completion of the appropriate and necessary documentation. Completion of this process by staff should help to ensure that all staff who provide medication to the residents are competent to do so. We did a spot audit check on the stock control system for both controlled drugs and other medications and this proved satisfactory with the levels of medications being as Care Homes for Adults (18-65 years) Page 21 of 35 Evidence: stated on the control sheets. A check on the storage facilities for the medication was seen to be appropriate. There is also a refrigerated cupboard for those drugs requiring cool conditions. However there is not appropriate provision for controlled drugs as this should be a lockable metal unit within a locked metal cabinet. Although there is a secure metal cabinet bolted to the wall it is not within another lockable unit. It is a requirement that the Manager now ensures appropriate provision is provided. The Manager said that all staff administer medication to the residents and that staff have recently completed internet or on line training to do with the safe handling of medicines. There was no evidence of this seen in the staff training files, probably due to the nature of the training i.e self learning modules. It is recommended that this self learning training is supplemented by formal professional training so that staff remain appropriately skilled and residents needs continue to be met safely. The Manager said that a number of residents self administer their own medication and this was confirmed by the staff and the residents that we interviewed. Residents are being protected by the homes policies and procedures for dealing with medicines. Care Homes for Adults (18-65 years) Page 22 of 35 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. Standards 22 & 23 were inspected at this inspection. People using this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Service users may be assured that their views will be listened to and that they will be protected from abuse, neglect and self harm. Evidence: The residents who we spoke to confirmed that they feel their views are listened to and are acted upon. They said that if they had a complaint they know the procedure to be followed and would know how to do so if they needed to. Staff interviewed confirmed with us that the residents were all aware of the complaints process and that the whole staff group took any issues raised by residents seriously. The homes complaints policy was inspected and seen to meet the standards required of it. A copy of the procedure is supplied in the Service User Handbook that we were told by the Manager is supplied to all the residents. Some of the residents who we spoke to said that they had not received a copy of the handbook. We were provided with a copy at this inspection. Given that this has just been revised it is recommended that the Manager re issues a copy of the new handbook to all the residents. Care Homes for Adults (18-65 years) Page 23 of 35 Evidence: We asked the Manager to see the homes complaints record. 5 complaints had been registered in the record book this year. All but 1 had been resolved to the satisfaction of those people who had complained and the 1 was still in the process of investigation. The home is able to learn from complaints it receives in order to improve its service and all the residents know that their complaints and concerns will be listened to and dealt with appropriately. The home has an adult protection policy that links directly into the L.B.Greenwichs adult protection policy. The Manager informed us that although all staff have undergone appropriate POVA training in previous years they have not all had recent training experience. Inspection of the training information held in the staff files inspected demonstrated that 2 of the 4 staff in those files inspected had received this training in the last 3 years. It is therefore recommended that staff are enrolled for the next protection of vulnerable adults training course with L. B. Greenwich over this year. It is thought as good practice that all staff should undertake POVA refresher training at least once every 2 to 3 years on an authorised training course preferably offered by the local authority who provides the lead on protection matters. 3 members of staff interviewed confirmed that they know what to do if an allegation of abuse is made and they showed awareness of the procedures to be followed. This means that these staff are aware of what abuse is and the safeguards in place for the protection of the residents should they need them. We saw the allegation of abuse record; no allegations had been made since the last inspection. The Manager confirmed this. The policies and procedures manual for the home includes a whistle blowing policy and a policy on dealing with violence and aggression. Understanding the policies and procedures is a part of the staff induction process and evidence of this was seen on file, staff are asked to sign to say that they have read and understood the policies and procedures for the home. Residents are being protected from abuse, neglect and self harm. Care Homes for Adults (18-65 years) Page 24 of 35 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standards 24 & 30 were inspected at this inspection. People using this service experience excellent quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents live in a homely, comfortable and safe environment. The home is also clean and hygienic and well furnished. Evidence: At the last inspection the report raised concerns about the standard of the accommodation and the size of the rooms being used by the residents. Since that inspection a complete refurbishment of the home has been implemented. All the accommodation has been redecorated and those rooms that needed to be enlarged have been. New furniture has been provided throughout the home. The result at this inspection is that Chapel Hill is now fresh and clean, well furnished and appropriate in order to meet the needs of the residents. The Manager, the residents and the staff have all told us how pleased they are that this has been completed to a good standard and that the refurbishment works are now finished. Within the homes policies and procedures manual information is provided relevant to Care Homes for Adults (18-65 years) Page 25 of 35 Evidence: the control of infection. The home also has an infection control procedure which staff who were interviewed said they were aware of. At the time of this inspection the home was seen to be clean and tidy, hygienic and free from offensive odours. Systems are in place to ensure that the spread of infection is controlled and minimised. Laundry facilities are sited so that soiled articles are not being carried through the kitchen and hand washing facilities are appropriately provided to ensure staff can use them where appropriate. This helps to ensure the protection of the residents health and to ensure that the home is clean and hygienic. Care Homes for Adults (18-65 years) Page 26 of 35 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. Standards 32, 34, 35 & 36 were inspected at this inspection. People using this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Service users benefit from the clarity of staffing roles and responsibilities. They can be fully assured that they are supported by competent, appropriately trained, qualified and supervised staff. The homes recruitment policy and procedures helps protect the residents. Evidence: The Manager informed us that all new staff receive a 2 part induction, the first is that for the overall organisation and is Togethers general induction for new staff. This usually lasts for 2 days. The second induction is that which staff receive at the unit in their first 2 weeks of working at the unit. Those staff that we interviewed told us that they had received both induction courses and for those staff who had started worked at the home since the last inspection they told us that they found the homes induction very useful in helping them to get to know their new roles and functions in the home. The Manager told us that apart from looking at the policies and procedures for the Care Homes for Adults (18-65 years) Page 27 of 35 Evidence: home and familiarising themselves with them, staff also shadow more experienced staff over the 2 weeks. This helps new staff in several ways; with the running and organisation of the home and in getting to know the residents and spending time with them. The Manager told us that she ensures all staff receive a staff handbook and a copy of the General Social Care Council Codes of Conduct as a part of their induction. All staff are issued with job descriptions and are asked to read and discuss the homes policies and procedures. The Manager said that all of the support worker staff have achieved their NVQ level 2 awards and some have gained NVQ level 3 awards. Some evidence of these qualifications was seen on the 3 staffing files inspected however evidence for all staff training and other qualifications should routinely be held on staff files (this has been referred to under Standard 34). Residents interviewed said that staff are approachable and we saw staff taking time to deal with residents questions. There is in place an appropriate recruitment policy. 4 staff files were inspected. Generally the files were in good order; however some of the information required under Standard 34 was not in evidence and the Manager told us that evidence such as all the induction booklets and CRB information for 6 members of staff is being held at Head Office. It is important that this information is available for inspection in the home. Induction booklets provide a record of exactly what has been covered in the induction process and they should be signed and dated by both parties. At the last inspection a requirement was made regarding this Standard and this requirement is repeated following this inspection. It is required that all staff files be reviewed and action taken to ensure that they contain all the necessary information as described in Standard 34. Staff interviewed did confirm that have a contract of employment and that they understand their terms and conditions as well as their roles and responsibilities within the home, however a copy should be available for reference in the unit. The Manager said that there is a training programme for staff provided both in house and also by external agency training. This covers all the essential training required by the staff to do their jobs well and efficiently. The provision of funding for training is Care Homes for Adults (18-65 years) Page 28 of 35 Evidence: also said to be good and the Manager told us that if a training need is identified then a training course could be provided. However training certificates were not seen in most cases and it is recommended that certificates are gained for all staff training and held on file. This is valuable for the staff member in that it provides documentary evidence of the training input they have received and helps to document their CVs. The Manager told us that she is developing a new staff training matrix that would be helpful as a management tool in that it identifies future staff training needs and training already undertaken by staff. From discussions with the Manager and from interviews with 3 of the staff it is clear that staff do receive effective and individual 1:1 supervision and support in the work they undertake and a supervision record is maintained that is signed by both parties and dated. Staff told us that in their individual supervision sessions they discuss their work as key workers with residents; health and safety issues; their training needs; those staff that they supervise; personal issues and any other areas of their responsibilities in the home. Staff also told us that there are also many other opportunities for informal supervision and support. There are group meetings held weekly and staff reported that they are always able to discuss any issues both with their colleagues and with the Manager as and when required. Inspection of 4 staff files indicated that some staff supervision notes lacked sufficient detail. It is therefore recommended that the supervision record that is made about the key areas of discussion needs to be sufficiently detailed so as to specify all the decisions and agreements made in the meeting. Evidence was seen on all the staffing files inspected that staff receive annual appraisals. This was confirmed by both the Manager and those staff members who we interviewed. All of this means that residents benefit from well supported and supervised staff. Care Homes for Adults (18-65 years) Page 29 of 35 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. Standards 37 & 42 were inspected at this inspection. People using this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Service users benefit from a well run home. They may be confident that their rights and best interests are safeguarded by the homes record keeping policies and procedures. Evidence: The Manager was appointed in 2003 and was assessed and registered by the Commission in June 2004. The Manager holds an NVQ level 5 in operational management; the Registered Managers award; an NVQ 4 in management and an NVQ 3 in promoting independence and also in community mental health care. More recently in July 2009 the Manager has gained a PGCE Degree in education for over 16 year olds. Care Homes for Adults (18-65 years) Page 30 of 35 Evidence: There is in place a clear management structure in the home. Staff were satisfied with the support that they receive from the management team. We were shown information to do with relevant Health and Safety legislation. Policies and procedures were also seen for Health and Safety, risk assessment, moving and handling and fire. Up to date certificates were seen for: Boiler & Gas - 28.3.09 Fire alarms - 13.5.09 Emergency lights - 22.5.09 Fire extinguishers - April 09 Electrical system - 30.4.09 Portable electric appliances - March 09 Legionaires water tests - September 09 A fire risk assessment was undertaken by the Manager for the whole unit in June 2009. This is welcomed as it should assist in the prevention of accidents, raise awareness of the fire risks and what to do if a fire should arise. All food was seen to be stored appropriately and properly labelled with dates of opening and expiry. Records were seen that confirmed regular tests had been carried out for the: Fire drills. The Manager explained that since the last inspection fire drills are held bi monthly and at different times of the day so that residents and all the staff are involved in the procedure on a regular basis. At the last inspection a recommendation was made about this and given what has been stated above this has now been met. Fire alarm - weekly Fire extinguishers - weekly Emergency lighting - 6 monthly Fridge and freezer temperatures records were checked and records indicate that they came within the acceptable ranges. Hot water temperatures are tested bi monthly with the last test being held on 7th August 2009; records indicated that they came within the acceptable range. Accident records were checked. At the time of this inspection no fire doors were seen to be wedged open and the building appeared to be secure. Care Homes for Adults (18-65 years) Page 31 of 35 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 34 19 The Registered Person must 02/07/2007 ensure that all of the documents listed in paragraph 1 to 9 of Schedule 2 are obtained prior to allowing new staff to commence work in the home. Care Homes for Adults (18-65 years) Page 32 of 35 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 2 14 The Manager must ensure there is an individualised needs assessment carried out for each resident after their admission to the unit. In order to meet the NMS. 09/11/2009 2 6 14 The Manager must ensure that for each resident there is a clear care plan format that draws together all the needs information set out in the CPA, the units own needs and the risk assessments. Inorder to meet the NMS. 09/11/2009 3 9 14 Risks identified in risk assessments must be included in the care plan formats to be developed. In order to meet the NMS. 09/11/2009 Care Homes for Adults (18-65 years) Page 33 of 35 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 4 20 13 The Manager must ensure that appropriate provision is provided for controlled drugs. In order to meet the NMS. 09/11/2009 5 34 17 The Manager must ensure 09/11/2009 that all staff files be reviewed and action taken to ensure that they contain all the necessary information as described in Standard 34. In order to meet the NMS. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 3 4 20 22 23 32 the self learning training for medication administration is supplemented by formal professional training for all staff. The Manager should issue a copy of the new handbook to all the residents. Staff be enrolled for the next protection of vulnerable adults training course with L. B. Greenwich. The Manager should ensure that evidence for all staff training and other qualifications is routinely held on staff files. The supervision record should be sufficiently detailed so as to specify the key areas of discussion and all the decisions and agreements made in the meeting. 5 36 Care Homes for Adults (18-65 years) Page 34 of 35 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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