Care Home: Chase Park Rehabilitation Centre

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What the care home does well The home has a skilled and competent management team who have a good knowledge of the people living in the home including their care and rehabilitation needs and as individuals . The staff working in the home also know the residents well and use the knowledge to good effect when providing care to them. The home has a very pleasant atmosphere and visitors are made welcome when visiting their friends or relatives. A number of relatives spoken to during the visit were complementary about the staff and the care they receive. The relatives were positive about the staff and an example being the "staff are always really nice to me and cant do enough to help". The residents living in the home receive good personal and health care and are supported to maximise their independence through effective rehabilitation programmes. The staff work hard to make sure that they are comfortable and feel safe. The staff are kind and friendly when assisting residents and were willing to spend time with them as part of their daily lives. There are very good social activities programmes being offered to the people living in the home, and this is offered in a way that takes into account their needs, choices and previous lifestyles. The facilities available to the people living in the home are exceptional in that there is a cafe, swimming pool and gymnasium available for both therapeutic sessions and social activity. The manager and staff have a good relationship with visiting professionals and they make sure that they seeks advice and support from them so that any actions taken on behalf of a resident are made in their best interest. The home provides a good standard of food which is well prepared and offers choice and variety. The food served during the visit was well received by the residents. Those of them who were asked all said that they enjoyed it and that the food was "the food is nice". They felt that they always had lots to eat and that they could have alternatives if the choices on the menu was not to their taste. The management are continuing to work at making the improvements identified as a result of the quality assurance process and is looking at "best practice" advice to improve the specialist nature of the service they provide. What has improved since the last inspection? This is the first inspection of the service since the home was registered separately from the older persons home which shares the same site. What the care home could do better: One requirement was made as a result of this inspection, this was that accurate records must be kept for all medicines including controlled drugs stored in the home and administered to service users.Four recommendation have been made. It is recommended that the home implements the supervision programme so that all staff have at least six formal supervision session per year. The dining room facilities should be reviewed to make sure that all residents have the opportunity to have their meals in the place of their choice. And the staff should be given additional training to prepare them for dealing with complex and sensitive relationship issues which may occur. Key inspection report Care homes for adults (18-65 years) Name: Address: Chase Park Rehabilitation Centre 8 Millfield Road Whickham Newcastle upon Tyne Tyne and Wear NE16 4QA     The quality rating for this care home is:   three star excellent 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: Suzanne McKean     Date: 0 1 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: Chase Park Rehabilitation Centre 8 Millfield Road Whickham Newcastle upon Tyne Tyne and Wear NE16 4QA 01914387351 01914387351 info@chaceparkrehab.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Whickham Villa LLP Name of registered manager (if applicable) Mrs Clare Elizabeth Pickthall Type of registration: Number of places registered: care home 30 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 physical disability Additional conditions: 1. The registered person may provide the following category of service only: Care Home with Nursing - Code N To service users of the following gender: Either Whose primary care needs on admisison to the home are within the following category: Physical Disability, not falling within any other category - Code PD, maximum number of places: 30 2. The maximum number of service users who can bve accommodated is: 30 Date of last inspection Brief description of the care home Chase Park Rehabilitation Centre is a partly converted and partly purpose built home set in a large site shared with a care home for older people. These homes are owned by the same business and until recently were registered as one service. The home is situated in a very pleasant and affluent residential area of Whickham and has very good access to the centre of the town with its shops and public amenities. It Care Homes for Adults (18-65 years) Page 4 of 35 Over 65 0 30 Brief description of the care home is close to the park and has very pleasant and well presented garden areas with a large pond and lawned areas. The home has a well equipped health club. This includes a cafe area a gym and a swimming pool. These facilities can be used by members who are either existing or previous residents who have retained membership by arrangement. Fees range from: £1000 a week to £1500 per week plus three Therapy bands from £210 to £750 depending upon the package agreed. One to one social opportunities packages are provided for between £200 to £600 and additional hours can supplement this part of the package at a rate of £20 per hour. Additional services can be contracted for example, Physiotherapy, occupational therapy, and speech and language therapy all at £41 per half hour, clinical psychology, aromatherapy, music therapy and case management are not included in the basic fee and are either funded privately or by the Social Services contract. Chiropody, hairdressing, transport, alcoholic drinks, clothing, toiletries, repairs to clothing, newspapers, magazines, cigarettes and dry cleaning are not included in the basic fee. 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: three star excellent 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: We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations, but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken Summary: This is an overview of what the inspector found during the inspection. How the inspection was carried out:- Before the visit we looked at, the information we have received since the service was registered. How the service dealt with any complaints and concerns since registration. Any changes to how the home is run. The providers view of how well they care for people. The views of people who use the service and their relatives, staff and other professionals. Care Homes for Adults (18-65 years) Page 6 of 35 The visit: An unannounced visit was made on 20th August 2009 a second visit was carried out on 1st September, the total time spent on the visits was nine and a half hours. The visit was undertaken by the link inspector for the home. During the visit we: Talked with people who use the service, relatives, staff, the manager and visitors. Looked at information about the people who use the service and how well their needs are met. Looked at the records which must be kept. Checked the staff had the knowledge, skills and training to meet the needs of the people they care for. Looked around the building and parts of the building to make sure it was clean, safe and comfortable. Checked what improvements had been made since the last visit. We told the General Manager what we found. 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: One requirement was made as a result of this inspection, this was that accurate records must be kept for all medicines including controlled drugs stored in the home and administered to service users. Care Homes for Adults (18-65 years) Page 8 of 35 Four recommendation have been made. It is recommended that the home implements the supervision programme so that all staff have at least six formal supervision session per year. The dining room facilities should be reviewed to make sure that all residents have the opportunity to have their meals in the place of their choice. And the staff should be given additional training to prepare them for dealing with complex and sensitive relationship issues which may occur. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are given detailed information about the service available. They receive comprehensive assessments of their needs to help them and the service make the right decision about the placement. Evidence: The home sets out the aims and objectives of the service in an information pack which is readily available to all of the potential and actual residents living in the home. The information pack sets out the focus of the service being offered. The contents of the pack are clearly set out and include the philosophy of care, and importance of outcome measures for the individual client, anonomised case examples with a description of the outcome experienced by them. The costs of the rehabilitation packages are clearly set out and it describes the resources available to help people achieve their outcomes. The information pack also includes some of the ways that the quality of the service is measured including the outcome of an ongoing customer feedback exercise. Although this is very comprehensive it is quite complicated and there is a more simple service user friendly satisfaction survey under development. Care Homes for Adults (18-65 years) Page 11 of 35 Evidence: Prior to any placement being offered there is a very detailed, full needs assessment carried out by the most appropriate people in the team, usually the specialist nurse and a therapist depending upon the initial information received at the time of the referral. The information from the Social Services Care Manager (if one is involved and where necessary the nurse assessor is also included in the assessment. There is also information in the preadmission information that relatives have helped to produce an initial care plan based their knowledge of the person. The assessments are detailed and encourage staff to explore issues relating to equality and diversity as it refers to gender, ethnic origin, religion, social history and preferred likes and dislikes. The service uses a number of assessment tools which are specific to rehabilitation and there is a clear focus on including the service users own priorities and choices when setting the goals which they are careful to ensure are achievable. The baseline assessments are also used to identify any progress made. Before choosing the service potential service users can visit and spend some time getting to know the home and meet some of the current people living there. The home confirms in writing to each individual that they can meet their needs and everyone has a contract that sets out the terms and conditions while living in the home. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care planning and access to health care is good and the way that the service provides rehabilitation and support for people to reach and maintain their potential is excellent. Evidence: The service develops and agrees with each service user an individual plan of care, which has a strong emphasis on rehabilitation or ongoing encouragement to maintain independence once the person has reached their potential. It clearly describes the services and facilities to be provided by the home, and how these services will support the individual to meet their current and changing needs, aspirations and achieve their goals. The care plans and records of the care being given were detailed, clear and up to date. They encourage staff to explore issues relating to equality and diversity as they refer to gender, ethnic origin, religion, social history and preferred likes and dislikes. Risk assessments include general assessments of continence, Waterlow, moving and Care Homes for Adults (18-65 years) Page 13 of 35 Evidence: handling, fall risk and nutritional risks using the (NRS) tool. There are also specialist assessments including The Assessment of Motor and Process Skills (AMPS), The Barthel ADL index and Canadian Occupational Performance Measure (COPM). They also contain up to date information about contact with specialists. This includes speech and language therapists, tissue viability nurses, falls specialist, dietitians, occupational and physiotherapists. Detailed information is available to make sure all staff know how to follow the requirements from the Speech and Language Therapists regarding enteral nutrition (PEG). This means that nourishment is monitored, weights remain stable and there is a reduced risk of aspiration. Assessment of the condition of wounds are good and the use of wound mapping and photographs are used as evidence of whether they are improving or deteriorating. There is clear evidence that the tissue viability nurse is contacted should staff have any concerns and her recommendations are then followed. The care plans also record the type of air mattress and chair cushion used the reason for any changes. Reviews are completed and a monthly analysis completed. The home has a range of pressure mattresses including Nimbus, Halo Tetra, Quattro Acute, and Cavalier Air Flow. The records show that if there is any deterioration in the condition of any person living in the home the staff contact the relevant General Practitioner. If the deterioration is around a wound the tissue viability nurse or the staff at the leg ulcer clinic are contacted and their recommendations are followed. There are a number of different pieces of equipment being used by the residents for mobility and to maximise their independence and specific equipment is provided according to assessments carried out by either physiotherapists, occupational therapists or specialist nurses. The home can access other high specification equipment at short notice if necessary. People living in the home were being nursed on appropriate profiling beds so that nursing care could be provided easily and residents could be safe and comfortable. Care plans are person centered and contain details about the residents likes, dislikes and current preferences. This includes information about the food they like to eat and the way they like to spend their time. They show what management arrangements are in place to show what staff need to do when someone presents with any behavior that would challenge the service. Information about peoples previous lifestyles and preferences are recorded and plans Care Homes for Adults (18-65 years) Page 14 of 35 Evidence: show that a person centered approach to care is being developed further. A resident said I know what is in my care plan because I have been involved all the way along the line. The records show if anyone has preferences about having help with personal care by male or female carers. Another gives details about how someone has been supported to use the pool and meet up with friends outside of the home. Everyone has access to all NHS facilities to ensure their healthcare needs can be met. There are regular visits from GPs and other health professionals including, Huntington and Parkinsons disease specialists, dentists, opticians and chiropody services. Many of the staff have worked in the home for some time and know the people they care for well. All of the staff worked very hard to make sure everyone was treated with respect and their rights to privacy and dignity maintained. The privacy and dignity of the residents is maintained and staff were aware of these issues as being important to the service users wellbeing. Two residents expressed some concern about the way that a shared issue was being dealt with. This was discussed with the manager to determine if it was one that needed to be dealt differently however it was resolved with negotiation between the parties. 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. The people living in the home are supported to live active and fulfilled lives in line with their abilities, choices and previous lifestyles. Evidence: The homes Statement of Purpose and Service Users Guide gives prospective residents an overall picture of the homes philosophy and style of living. This is evident in the policies and procedures and the way that the staff work with the people living in the home. The service users are supported to achieve their goals and the organisation of the daily routines and activities. Specialist provision is also planned with service users around the individuals needs and choices. Care plans show the variety of activities that people are taking part in and on speaking to them they are being consulted in deciding how they want to spend their time. One said I get to do the things I want, Care Homes for Adults (18-65 years) Page 16 of 35 Evidence: even if I need a lot of help another said the time I spend in the pool is great, and I go out with xxx when I want to go to the shops. The home has a system of providing support for people living in the home to have opportunities to experience positive social experiences. The service calls this part of the plan Opportunity hours. This is very well organised and the documentation to support this is very detailed. People are allocated one to one hours and if these are not used then they accrue and can be used later. This system is monitored by the senior staff to make sure that service users are getting the social support they are allocated. There is a very well equipped social / sports area which includes a gym and a swimming pool. The pool approximately 30 feet long and 15 feet across it can be used for either therapy sessions or for leisure and some residents use this as quality time with family members eg children. This is not part of the registered premises but is an on site facility which can be used by both of the services on the site. Staff help service users to find and keep appropriate jobs, continue their education or training, and/or take part in valued and fulfilling activities. One resident is being supported to re enter education. Service users can continue to take part in activities engaged in prior to entering the home, if they wish, or re-establish activities if they have moved to another area and had to seek alternative facilities to continue the activity. Staff support service users to become part of, and participate in, the local community in accordance with assessed needs and the individual Plans. This is by accessing local amenities such as shops and public houses and by giving them the opportunities to spend time in the local public park. People from both of the homes on the site can access the cafe which is sited in the part of the building with the swimming pool. This was being used by residents and visitors during the visits, some were sitting enjoying the atmosphere while others had coffee with their visitors. There is a monthly newsletter, which describes forthcoming and recent events that have happened in the home. This contains details of birthdays and forthcoming events. It also has information about additional services available. Visitors are welcome at any time and are able to use the lounges or their relatives bedrooms for visits. It was confirmed that there are no restrictions regarding visiting Care Homes for Adults (18-65 years) Page 17 of 35 Evidence: times although people are expected to be reasonable and allow the residents to keep realistic hours. Information about advocacy is available in the home. The bedrooms are particularly well personalised and many people have brought small items making them homely and reflective of their previous lifestyles, religious beliefs or cultural backgrounds. The home has one central kitchen, which supplies all of the meals to both units via a hot lock. The presentation of the dining areas are good although there was a problem on the first day of the visit as more residents chose to eat in the dining room than there were spaces to accommodate them. Residents and staff confirmed that this was unusual as people were usually out of the home at lunch time or chose to eat their meals in their bedrooms. People can also have their meals in the cafe. This serves continental breakfast and a range of light meals that are made to order. The staff were aware of the importance of helping the residents to develop and maintain personal and family relationships while resident in a care home. Only the concerns about the way that two residents felt they were being supported could have been managed more effectively. Care Homes for Adults (18-65 years) Page 18 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users receive very good individualised support so that their complex healthcare and rehabilitation needs can be recognised and a comprehensive plan put in place to help them to address them and maximise their independence. They are protected by the homes policies and procedures for dealing with medicines and the staff deal with the aging, illness and death of a service user with sensitivity and respect. Evidence: The care plans identify the way that the staff should provide the care and on discussion with them they were aware of the way that they should make sure that they maintain the service users privacy and dignity while promoting their independence. People living in the home are supported to state their preferences about how their rehabilitation is organised, although they are also guided to make sure that they make effective choices and this is explained and recorded as necessary. There is a policy to make sure that personal care is provided in private, and that there Care Homes for Adults (18-65 years) Page 19 of 35 Evidence: is a gender policy so that residents can be confident about who will be caring for them. The care plans contain information to identify the choices that residents make in their day to day lives including the times they prefer to get up and go to bed, baths, meals and other activities which can be reasonably flexible subject to restrictions agreed in the individual plan around their rehabilitation programme. Service users choose their own clothes, hairstyle and makeup and their appearance reflects their personality, an example being one female resident who had made a dramatic change to her hair colour during her stay. Service users have the technical aids and equipment they need for maximum independence, which staff are trained to operate as needed. This is determined by a professional assessment, reviewed and changed or replaced promptly as the service users needs change. There is a very good evidence that the people using the service receive additional, specialist support and advice as needed from physiotherapists, occupational therapists, speech therapists and others. The rehabilitation programme is very intensive and there are a number of examples of residents who have made significant improvements to maximise their independence and return to a community setting. There is a system of allocating staff according to the needs of the individual residents so that they are supported by the most appropriate member of the rehabilitation team. The care plan and rehabilitation programmes are reviewed regularly and are modified to take into account any changes to the persons condition or improvements they have achieved. Service users who cannot easily communicate their needs and preferences are supported by using advocates, family, friends and relevant professionals outside the home, subject to the service users consent to ensure that their views are valued. Service users health is monitored and potential complications and problems are identified and dealt with at an early stage, including prompt referral to an appropriate specialist. The treatment room used to store medicines is spacious and well equipped. Most Care Homes for Adults (18-65 years) Page 20 of 35 Evidence: medicines were stored appropriately in locked cupboards within the secure treatment room although the cupboard containing creams and ointments had no locks fitted. The treatment room was very warm on the day of the visit and there was no record of daily temperature readings since the end of June. Temperature recording of the medicines refrigerator was satisfactory. Prescriptions are sent to the home for checking before being sent to the pharmacy for dispensing and this helps identify and resolve any problems quickly. Full records are maintained for medicines sent for disposal. Medicine administration record (MAR) charts were looked at on each floor. With each service user MAR chart there was a sheet incorporating a photograph to assist in identification of the resident but an entry to describe any allergy or no known allergy had not always been recorded. No gaps were noticed in the administration records and handwritten entries on MAR charts were countersigned by a witness to confirm their accuracy although a few entries lacked dates of quantities of medicine received into the home. For one service user the wrong dates of administration of amoxicillin were recorded on the MAR chart although the course of treatment was being administered as prescribed. A small number of discrepancies between the quantities of medicine received, the number of doses recorded, and the quantities of medicine remaining were observed. In addition the quantity of medication carried over from the previous month was occasionally not recorded. This makes it difficult to have a complete record of medication within the home and to check if all medication is being administered correctly. We observed a medicine pot containing two tablets on top of the trolley when the nurse returned from the morning medication round. We were informed that the tablets had been found in a service users room and were assumed to have been part of night time medication administered the previous night. The MAR chart for this service user indicated that all night time medication had been administered and none had been refused. The date of opening of medicines with limited use once opened is not always recorded although there was no evidence to suggest that any medicines were being used beyond the expiry date recommended by the manufacturer. The controlled drug cupboard appeared to meet safe custody regulations. All entries in the controlled drug register were complete with a witness signature but the stock Care Homes for Adults (18-65 years) Page 21 of 35 Evidence: balance for two controlled drugs was incorrect and did not match the amount of medication in stock. In one case there had been a simple error when recording the balance after the last administration. For the other controlled drug an error had been made when transferring records to the new register and the entry had not been checked against the actual stock before being signed as correct by the two nurses. Care plans could be improved to include more detailed guidance for staff when medicines are prescribed to be taken as required. 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. Good complaints and protection procedures are now in place and being followed. People are now sure that their views are always listened to and that they are protected from harm. Evidence: There are good policies and procedures in place to show how complaints will be dealt with. These include timescales for acknowledgment of the complaint and action to be taken in the event of a complaint being made and standardised documentation to be used. In the reception area of both units is a comment book and suggestion box where people can write both concerns and compliments. There have been four complaints made in 2009. One record contained a very comprehensive investigation report and a detailed response to the complainant. There have been improvments in the way that the service deal with complaints and safeguarding issues. On discussing the way that the residents would raise their concerns one said that they felt, they could talk to the staff or the manager if they were worried about anything and another said I have plenty of times when I could talk about things that I am not happy with, but I think that there is nothing at the moment. Care Homes for Adults (18-65 years) Page 23 of 35 Evidence: Staff receive safeguarding training through their induction and probationary period. Formal training with the Local Authority is provided to the staff so that they will recognise signs of abuse and feel confident about identifying when to raise an alert and therefore, safeguard people most likely at risk. The home has worked with all external agencies including the Commission to ensure that any safeguarding issues are were investigated and any action taken to address any problems. At the time of the site visit there were no complaints or safeguarding alerts. 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. The home is well maintained and equipped, and a pleasant, clean and comfortable place for people to live. The facilities available to the people receiving rehabilitation and living in the home are excellent. Evidence: Chase Park is a combination of converted building and new built premises which includes bedroom and lounge areas, communal bathrooms and toilets and staff areas. The kitchen and laundry is located in the other (older persons) part of the site. The cafe, gymnasium, and health club are attached to the building and can be accessed either from inside of the home or directly from the outside of the building. There is a car park to the front of the building and a visitors car park to the rear of the site from the main entrance from the road. The home has a large and particularly decorative fishpond in the central area between the two buildings and it has a ramped area that enables wheelchair users to get close to it to see the fish, and the garden area is also accessible. An automatic door opening has been installed to the main part of the building which gives access to the lounges, dining rooms and the bedrooms. There is also an automatic door tho the at the front of the cafe and the changing areas. Care Homes for Adults (18-65 years) Page 25 of 35 Evidence: The pool area, gym and treatment rooms and cafe are not actually part of the registered premises however they are accessible from the main building or directly from the garden entrance area. All of this area was very clean and tidy with all equipment carefully stored away. The changing room were different sizes so were accessible to individuals needs. There is a choice of lounge day facility areas which can be used by the residents although it was noted that because the bedrooms are comparatively large a number of them use their own bedrooms to spend most of their time. These have large en suite facilities and were very nicely decorated. The upstairs bedrooms and en-suites all have overhead tracking fitted. The bedrooms also have Internet access and residents could share music between each other. People living in the home have some choices about the way that their room is decorated and furnished however as the placements are not always permanent the decoration tends to be kept neutral so that it can be kept flexible for others. They have also been encouraged to bring small items with them and most bedrooms are highly personalised and reflect previous and present lifestyles. The housekeeping and cleanliness is good and there are cleaning schedules and regular housekeeping audits undertaken to make sure the home is kept clean, tidy and free from offensive odours. Liquid soap and paper towels are available throughout the home to greatly help with the prevention and control of infection. The laundry is in the other unit and this was well organised and has a clean and dirty area. This reduces the risk of cross infection and provides more space and a safe place for staff to work. The sluices were locked and disinfectors have been provided on all units. Liquid soap and paper towels were available in these to enable staff wash their hands and prevent spread of infection. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service is staffed by sufficient numbers of well trained staff to provided the people living and receiving rehabilitation a very good, specialist service. Evidence: On the day of the first visit the following staff were on duty:- Two nurses, the nurses employed have a variety of different backgrounds and experiences and offer different skills - six rehabilitation assistants, these are care staff who provide personal and rehabilitation care for the people living in the home. They generally work twelve hour shift from 8am to 8pm to give uninterrupted support to the residents. - four opportunities workers, these staff provide support to the people living in the home to take part in social activities and to live active lives. They generally work 9am to 6pm but some work form 10am until 8pm so that they can offer evening support for particular social activities. There is a administrator who stays predominantly in the entrance and carries out varied tasks to support the staff. The manager from Whickham Villa was on duty and assisted with the inspection as she is to be the manager of the site once the registration process has been completed for the Whickham Villa older persons portion of the home. The Manager works forty hours usually 9am to 5pm and is in addition to the nurses. Care Homes for Adults (18-65 years) Page 27 of 35 Evidence: There is also provision on the off duty for the qualified nurse to have three and a half shifts supernumerary for staff training, reviews or clinical planning. There is a four week rolling programme of off duty with staff having fixed weekends working. This allows staff to predict when they will be working and can then request time off in enough time for it to be arranged. The programme shows that staff have completed all mandatory training. Qualified nurses have completed training in prevention of pressure ulcers, leg ulcer management, enteral nutrition, catheter, end of life care, care of an artificial airway and continence care. Other training includes safeguarding adults, dementia and dealing with behaviours which may challenge. New staff receive induction using Skills for Care Workbook, and have some supernumerary time working alongside experienced staff, when they are given the information they need to work in line with the job description of the role they are employed to undertake. The are offered the opportunity to enroll on NVQ training if they are suitable and once they have been made part of the permanent staff. There is a training plan for this year which offers a general overview of the training planned and carried out. The staff all have annual appraisals and as part of this they all have a sign a training contract. They each have an individual plan of training they have received and an outline of their training needs. Staff supervision has been planned for all staff but this is not being carried out as frequently as necessary (six per year) the domestic/laundry and administrative staff supervision is fully up to date. The home has policies and procedures in place to make sure that it operates a thorough recruitment procedure based on equal opportunities and ensuring the protection of service users. Plans are in place to have a Medical Consultant contracted to undertake four hours per week to offer additional neuro consultancy and attend the weekly multi disciplinary team meetings and offer expert guidence on planning care. Care Homes for Adults (18-65 years) Page 28 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. The home well managed by a competent management team who make sure that good quality assurance and safety systems are in place and that it is run in the best interest of the people living there. Evidence: The home has recently been registered as a separate service from the older persons home and so is viewed as a new registration. This included the registration of the manager who has a significant amount of experience in neuro disability care and rehabilitation. She was not in the home during the period of the inspection, both visits. However the general manager was able to assist in the inspection. There is a management team in place which includes a manager for each of the services, a general manager and the Chief Executive who remains involved in some of the issues and is based on the site. An outside consultant is available to give advice and direction to develop the service provision and gives supervision to the senior nurse in the team. Care Homes for Adults (18-65 years) Page 29 of 35 Evidence: here continues to be a significant amount of change as the service is developed to meet the changing needs of the residents and improve the way that the rehabilitation service is offered. The improvements in the number of senior staff has meant the manager has been able to work totally supernumerary and the qualified nurses have been able to work some time not working as the nurse on duty. This has improved the monitoring and record keeping systems throughout the service. Regular staff meetings are held with minutes kept. These show that all staff discuss current best practice, home issues and detail their requests for extra resources. Relatives, visitors and people living in the home are asked to complete questionnaires about the quality of the care and service so that the manager can have a clear understanding of how they view the home. The people living in the home have their own forum were they talk about issues that affect them. There is a three monthly newsletter published which has information about what is happening in the home, the last one included information about the Gardening group, the art group and dates of activities going on. People living in the home are confident to raise issues and are confident that their comments and requests about the running of the home are listened to and addressed. The AQQA was completed and the information gave a picture of what was happening in the home and information about how it plans to develop over the next year. The home has policies and procedural guidance had been revised and updated in September 2007 with good, appropriate information compiled by the Registered Nursing Homes Association. This has now been cross-referenced to give the local policies used within the service. A random check of personal financial records showed that clear and detailed records are kept. Accounts are held individually, receipts are kept for all expenditure and two signatures are recorded for all transactions. A very detailed quality assurance system is in place that monitors all areas of practice, health and safety and infection control. The home is working toward the Hospitality Assured Award which is a way of measuring the quality of the service being provided and the action plan is being addressed as part of this. Care Homes for Adults (18-65 years) Page 30 of 35 Evidence: There are a number of audits carried out which all contribute to the quality assurance programme these include care plans, training, fire safety, and medication. Accidents and incidents are recorded and the manager has now developed an audit tool where she can track the frequency of issues such as pressure ulcers, infections and accidents. This follows best practice and prevents as far as possible the same incidents and events from happening again. In house maintenance checks are carried out weekly. Water temperatures are recorded to ensure temperatures of 44 C is not exceeded. Safety certificates were available for gas systems, water chlorination and electrical appliances and, fire safety records are up to date. Care Homes for Adults (18-65 years) Page 31 of 35 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 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 20 13 Accurate records must be kept for all medicines including controlled drugs stored in the home and administered to service users. To safeguard the health and welfare of people living in the home. 08/11/2009 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 1 15 It is recommended that the manager looks at providing additional training for staff to prepare them to engage more sensitively with residents with regard to their relationships. The dining room facilities should be reviewed to make sure that all residents had the opportunity to have their meals in the place of their choice. The date of opening of medicines with a limited use once opened should be recorded to make sure that medicine is not used beyond the date recommended by the manufacturer. Page 33 of 35 2 17 3 20 Care Homes for Adults (18-65 years) 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 plans should be updated to reflect any changes made to medication and provide sufficient guidance for staff on the administration of as required medicines. The temperature of the treatment room should be regularly recorded to confirm that medicines are being stored within the appropriate range recommended by the manufacturer and so are safe to use. Allergy status to medicines should be recorded on the photo sheet and MAR chart of every service user. Locks should be fitted to the cupboards used to store ointments and creams. 4 33 The programme for staff to have formal supervision needs to be followed so that they receive their supervision in line with the national minimum standards of six sessions per year. 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. 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