Care Home: Chatsworth Care - Hollyfield House

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What the care home does well Prospective residents are being provided with the information they require,and in an accessible format,in order to make an informed choice as to where to live. Prospective residents have the opportunity to visit and stay overnight before deciding whether the home is suitable and likely to meet their needs. The home is able to demonstrate that it is fully assessing individuals` health, care and support needs, and that it has the skills and resources with which to meet these. Each individual is being provided with a service user agreement. This is being presented in a format that is appropriate to the communication needs of this user group. Residents are having their health, social and care needs set out in an individualised and person-centred plan of care. Residents, together with their advocates, are being fully consulted and involved in the process of care planning and review. Residents are being assisted to make choices and decisions on issues that affect their personal and social well-being, and to participate fully in the day-to-day life and activities of the home. Residents are being thoroughly assessed regarding potential risks to their health and safety, and are being assisted to take responsible risks wherever possible. Residents are being encouraged to develop their personal and independent living skills, and to access appropriate learning and developmental opportunities. Residents are being provided with a wide and varied range of opportunities for participating in recreational and leisure activities, and have extensive contact and links with the local community. The home actively encourages residents to maintain family links and friendships both inside and outside of the home. Residents` rights and responsibilities are being recognised in their daily lives. The home promotes the rights, responsibilities and independence of residents, and respects individuals` right to privacy. Residents` personal support and health care needs are being well met in this home, with support being planned and tailored according to the individual needs presented. Residents are being protected by the home`s medication training policy and procedures.Clear information for raising complaints is available, and residents, their relatives, friends or representatives are encouraged to raise any concerns that they may have. The home`s policies, procedures, training and practice indicate that residents are being fully protected from abuse, and that they are living in a safe environment. Residents live in an environment which is safe, well-maintained and adapted for people with disabilities. Residents` rooms are safe, comfortable and pleasantly decorated. They present as being well suited to meeting individuals` needs, and reflect their personal identities. All residents are provided with their own ensuite bathroom and toilet facilities, providing for individual needs and affording privacy. The home presents as being clean and hygienic, and as a pleasant and homely place in which to live. The best interests of residents are being protected through the maintenance of appropriate staffing levels, and by clearly defined staff roles and responsibilities. Residents are having their needs well met by an appropriately trained and qualified staff group. Residents are being protected by appropiate recruitment policies and procedures. Residents are benefitting from having staff who are well-supported and supervised. The home is being run competently, and in the best interests of the home`s residents. Following the departure of the previously appointed manager, the senior manager for Chatsworth Care is presently managing the home. A new manager has just been appointed, and will be applying to register with CSCI as the Home`s registered manager. Residents` rights and best interests are being protected by the home`s record-keeping and by its` policies and procedures. Generally, the health, safety and welfare of residents and staff are being appropriately promoted and protected. On the day of Inspection, portable electrical appliances had not as yet been certified, though an imminent inspection date had been arranged. What has improved since the last inspection? First inspection. What the care home could do better: The home is a new one and has not as yet had the opportunity to complete questionnaires with residents, relatives, professionals and other stakeholders. It will, however, need to do so during the coming months, and complete a quality assuranceaudit report by the end of its` first 12 months of operation. The home needs to evidence a safety certificate for portable electrical appliances. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Chatsworth Care - Hollyfield House 27 St James Road Sutton Surrey SM1 2TP     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Peter stanley     Date: 2 4 0 2 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 34 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 03000 616161 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 34 Information about the care home Name of care home: Address: Chatsworth Care - Hollyfield House 27 St James Road Sutton Surrey SM1 2TP 02086617252 02083353264 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Graham Peter Smith,Gabrielle Anne Smith Name of registered manager (if applicable) Kerrie Louise Roach Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The Registered person may provide the following category of service only: Care Home only ? Code PC To the service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning Disability ? Code LD The Maximum number of service users who can be accommodated is: 7 Date of last inspection Brief description of the care home Hollyfield House was registered in July 2008 as a care home for up to 7 young adults with learning disabilities and autism spectrum disorders.The home, which was inspected for the first time on 23 February 2009, aims to provide a supportive, enabling and homely environment for its residents. Hollyfield House is situated in a quiet residential road close to rail and bus links, and to local shops, services and leisure facilities in Sutton town centre. The property, which dates from the 1920s, has been converted from flats into a residential home. There are three lounges on the ground floor, one being a television room, a large dining room Care Homes for Adults (18-65 years) Page 4 of 34 7 Over 65 0 care home 7 Brief description of the care home and kitchen area, a laundry room and toilet facilities. There are five bedrooms on the first floor and two bedrooms on the top floor. All bedrooms have ensuite bathroom and toilet facilities. There are separate toilet facilities for staff and visitors on the ground floor. All windows in the home have been fitted with restrictors. There is off-street parking to the front of the property and a small lawned garden, for the use of residents, to the rear. Care Homes for Adults (18-65 years) Page 5 of 34 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 inspection was carried out over one day and involved discussion with the Senior Manager for Chatsworth Care and acting manager for the home, Kerrie Roach. Discussion also took place with the training manager for Chatsworth Care, Chris East and with other staff who were present. The inspector observed two of the homes residents. During the inspection, the inspector examined service user and staff files, together with other documentation relating to residents health and welfare, and their daily activities. Documentation relating to training, the homes policies and procedures, health and safety, and the day-to-day management of the home were also examined. Information was Care Homes for Adults (18-65 years) Page 6 of 34 also made available from the CSCI Annual Quality Assurance Assessment (AQAA), which the home is required to complete on an annual basis. What the care home does well: Prospective residents are being provided with the information they require,and in an accessible format,in order to make an informed choice as to where to live. Prospective residents have the opportunity to visit and stay overnight before deciding whether the home is suitable and likely to meet their needs. The home is able to demonstrate that it is fully assessing individuals health, care and support needs, and that it has the skills and resources with which to meet these. Each individual is being provided with a service user agreement. This is being presented in a format that is appropriate to the communication needs of this user group. Residents are having their health, social and care needs set out in an individualised and person-centred plan of care. Residents, together with their advocates, are being fully consulted and involved in the process of care planning and review. Residents are being assisted to make choices and decisions on issues that affect their personal and social well-being, and to participate fully in the day-to-day life and activities of the home. Residents are being thoroughly assessed regarding potential risks to their health and safety, and are being assisted to take responsible risks wherever possible. Residents are being encouraged to develop their personal and independent living skills, and to access appropriate learning and developmental opportunities. Residents are being provided with a wide and varied range of opportunities for participating in recreational and leisure activities, and have extensive contact and links with the local community. The home actively encourages residents to maintain family links and friendships both inside and outside of the home. Residents rights and responsibilities are being recognised in their daily lives. The home promotes the rights, responsibilities and independence of residents, and respects individuals right to privacy. Residents personal support and health care needs are being well met in this home, with support being planned and tailored according to the individual needs presented. Residents are being protected by the homes medication training policy and procedures. Care Homes for Adults (18-65 years) Page 8 of 34 Clear information for raising complaints is available, and residents, their relatives, friends or representatives are encouraged to raise any concerns that they may have. The homes policies, procedures, training and practice indicate that residents are being fully protected from abuse, and that they are living in a safe environment. Residents live in an environment which is safe, well-maintained and adapted for people with disabilities. Residents rooms are safe, comfortable and pleasantly decorated. They present as being well suited to meeting individuals needs, and reflect their personal identities. All residents are provided with their own ensuite bathroom and toilet facilities, providing for individual needs and affording privacy. The home presents as being clean and hygienic, and as a pleasant and homely place in which to live. The best interests of residents are being protected through the maintenance of appropriate staffing levels, and by clearly defined staff roles and responsibilities. Residents are having their needs well met by an appropriately trained and qualified staff group. Residents are being protected by appropiate recruitment policies and procedures. Residents are benefitting from having staff who are well-supported and supervised. The home is being run competently, and in the best interests of the homes residents. Following the departure of the previously appointed manager, the senior manager for Chatsworth Care is presently managing the home. A new manager has just been appointed, and will be applying to register with CSCI as the Homes registered manager. Residents rights and best interests are being protected by the homes record-keeping and by its policies and procedures. Generally, the health, safety and welfare of residents and staff are being appropriately promoted and protected. On the day of Inspection, portable electrical appliances had not as yet been certified, though an imminent inspection date had been arranged. What has improved since the last inspection? What they could do better: The home is a new one and has not as yet had the opportunity to complete questionnaires with residents, relatives, professionals and other stakeholders. It will, however, need to do so during the coming months, and complete a quality assurance Care Homes for Adults (18-65 years) Page 9 of 34 audit report by the end of its first 12 months of operation. The home needs to evidence a safety certificate for portable electrical appliances. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –03000 616161. Care Homes for Adults (18-65 years) Page 10 of 34 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 11 of 34 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents are being provided with the information they require,and in an accessible format,in order to make an informed choice as to where to live. Prospective residents have the opportunity to visit and stay overnight before deciding whether the home is suitable and likely to meet their needs. The home is able to demonstrate that it is fully assessing individuals health, care and support needs, and that it has the skills and resources with which to meet these. Each individual is being provided with a service user agreement. This is presented in a format that is appropriate to the communication needs of this user group. Evidence: The home has developed a Statement of Purpose and a Service User Guide. Both are very comprehensive and accessible documents, and meet all the required criteria that are detailed in the relevant regulations and care standards. The Service User handbook Care Homes for Adults (18-65 years) Page 12 of 34 Evidence: provides an appropriate format (using pictures and symbols) for assisting the understanding of individual service users. The acting manager, Kerrie Roach, advised the inspector that the home is focussing on meeting the needs of younger service users within the 18-30 age range. There are currently four service users in the home, aged between 19 and 22, with three vacancies. The home follows the same thorough admissions policy and processes that have long been in place within the other Chatsworth Care homes. The homes manager aims to ensure that any new prospective resident is compatible with the other residents living at the home. Following referral, care management and specialist assessments are obtained. The procedure involves visits from the care manager and from the parent or nearest relative. This is followed by a visit from the prospective resident to see the home and to meet staff and residents. The manager or deputy manager then arrange to visit the prospective service user in their present home, care and educational settings, and to complete their own assessment of support and health needs. Where necessary,psychiatric or psychologist reports are requested. Wherever possible, the home tries to involve the care manager or close relative as an advocate, or seek an independent advocate from within the local area. Once a prospective service user has been assessed and found to be compatible with other residents, he or she is encouraged to make a number of transitional visits. These are likely to include one or two overnight stays followed by a weekend stay. The process is designed to enable the individual to become fully familiarised with the home and the other residents prior to making a decision on whether to move in on a permanent basis. Service users vary from moderate to severe in their diagnoses. These include autistic spectrum disorder, epilepsy and episodes of challenging behaviour. Four service users have moved into the home since September 2008, two of whom were present during the inspection. Both service users presented as having settled in well into their new surroundings, with evidence of caring and purposeful interactions with staff. Service users files were examined.These evidenced that, following referral, Health and Social Services care management assessments and risk assessments are being obtained, together with specialist educational, health care, psychiatric and psychology reports. Files evidenced personal profiles, detailing individuals background and life history, and a thorough and structured process of assessment. This includes comprehensive Care Homes for Adults (18-65 years) Page 13 of 34 Evidence: assessments of health care and support needs, risk assessments and health action plans, together with a detailed record of the outcome of transition visits (Transition Plan) and reviews. A Communication Passport, which includes photos of the home, is compiled so as to assist the service user during the transition process. The individuals health, social, communication and personal care needs are being set out in a clear, well-structured and person-centred plan of care. Files also included outcomes of mental capacity assessments, together with recorded details of individuals goals, hopes and wishes. Review minutes and notes indicate that there has been some positive feedback from relatives and care managers regarding the settling in period for residents, and the capacity of the home to address and meet their individual needs. Each service user is provided with an agreement setting out the terms and conditions of their placement. This is agreed in consultation with the service user, his/her next of kin, care manager or advocate. The format uses pictures and symbols to help facilitate the service users understanding of itscontents. Care Homes for Adults (18-65 years) Page 14 of 34 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. Residents are having their health, social and care needs set out in an individualised and person-centred plan of care. Residents, together with their advocates, are being fully consulted and involved in the process of care planning and review. Residents are being assisted to make choices and decisions on issues that affect their personal and social well-being, and to participate fully in the day-to-day life and activities of the home. Residents are being thoroughly assessed regarding potential risks to their health and safety, and are being assisted to take responsible risks wherever possible. Evidence: The home is applying the well established principles and philosophy of care that has Care Homes for Adults (18-65 years) Page 15 of 34 Evidence: characterised Chatsworth Cares other care homes, and is developing good practice in this area. Prior to any move into the home, careful planning is undertaken (with a transition plan) to ensure that the prospective resident is fully familiarised with the home and that the individuals needs can be fully met. The home develops a comprehensive and person-centred care plan, which covers all aspects of the individuals care and support needs, and their communication needs. The care plan details the individuals social, leisure, educational and developmental needs, and their choices, goals and aspirations. Risk assessments are completed. The care plans are working documents, designed to ensure that staff are fully familiarised with the individuals behaviours, risk factors and support needs, and with the persons wishes and choices regarding their day-to-day activities and routines. The plans include a personal profile of the persons likes and dislikes, and information on how the service aims to assist the individual to meet his.her needs, targets, aspirations and goals. Inspection of residents personal files evidenced that detailed care plans have been put in place and that these have been kept under review and kept up-to-date. Monitoring forms are completed on a daily basis, with any changes in behaviour or general health being highlighted. Inspection of care plans also evidenced the involvement of the individual, and his/her relative or representative, in drawing these up. Files included evidence of initial review meetings to confirm placements. All residents will be required to have 6 monthly and annual reviews. Given the relatively short period of placement since admission, these have not, as yet, taken place. The care manager is invited for the initial statutory review and subsequent 12 monthly reviews. The individual resident attends reviews together with their key worker, close family members, friends and/or representatives. Any key professionals are also invited. Individuals are encouraged to make decisions regarding their day-to-day routines, activities and choices.As evidenced in care plans and activity charts, individuals are being consulted in respect of their day-to day routines, and choices of food and activities. There are a number of mechanisms in place for involving residents in the running of the home. Each resident has a key worker who consults on an individual basis and provides one-to-one support. There are monthly residents meetings, facilitated by the manager or deputy manager, which cover a range of issues including activities and outings, and the weekly menu. Residents also receive regular visits from the homes owners, Gabrielle and Graham Smith, who actively consult with both residents and Care Homes for Adults (18-65 years) Page 16 of 34 Evidence: staff. Residents are being assisted to make decisions about those things that impact on their day-to-day lives. This may involve a transitional situation such as a change in daily routine, change of activity or accessing a college-based course. Person-centred communication aids,including visual communication boards, are used in assisting individuals to exercise choice in their daily activities and routines, and in understanding their daily time-table.Visual boards offer varying degrees of information, with pictures and symbols depicting activities for the day or week ahead. Mini and micro TEACCH boards are carried around by residents when out in the community. Methods of communication are tailored according to individual needs, abilities and preferences. Inspection of residents files evidenced the completion of full and detailed risk assessments, together with risk management strategies that have been agreed with individuals. The home has a risk assessment procedure which details the risks and level of risk for each resident. The potential for developing the persons independence is encouraged and enabled wherever possible, subject to safe strategies for managing risk having been put in place. Care Homes for Adults (18-65 years) Page 17 of 34 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. Residents are being encouraged to develop their personal and independent living skills, and to access appropriate learning and developmental opportunities. Residents are being provided with a wide and varied range of opportunities for participating in recreational and leisure activities, and have extensive contact and links with the local community. The home actively encourages residents to maintain family links and friendships both inside and outside of the home. Residents rights and responsibilities are being recognised in their daily lives. The home promotes the rights, responsibilities and independence of residents, and respects individuals right to privacy. Care Homes for Adults (18-65 years) Page 18 of 34 Evidence: Residents are evidenced as being provided with extensive and varied opportunities for personal development, and for developing their social and life skills, abilities and learning. Residents at the home are evidenced as being provided with extensive and varied opportunities for personal development, and for developing their social and life skills, learning and capabilities. Inspection of residents files evidenced detailed individualised programmes for residents, with individuals participating in a wide and varied range of educational, social and leisure activities. The individuals preferred method of communication is used in any activity selection process. Daily programmes involve the individual and reflect their choices and interests. Activities are individualised so as to take into account differing needs, abilities, likes and dislikes.Each programme comprises of a number of varied activities which are based on their compatability with each residents interests and needs. Individuals are assisted to make choices from a range of educational, leisure and social activities. Two residents are attending a local college for half a day each week, building up his skills for independent living. Accessing opportunities for educational and developmental courses are identified wherever possible, but within the context of a changing local pattern of provision in which such opportunities have recently become more restricted. Two residents have, however, been accepted for full time courses, and two others, for part time courses, starting in September 2009, at Orchard Hill College. Given the relatively short period of time that the home has been open, the needs,capabilities and development potential of residents has not, as yet, been fully established. Daily programmes have been developed to reflect individual interests and choices, with individuals being assisted and enabled to participate. Courses and activities are accessed to develop skills and lifestyle, and to build confidence and independence. Community-based activities include sports and leisure activities, whilst activities such as involvement in a local Scouts group for people with Autism has proved to be popular with the residents. The home actively encourages residents to access community facilities such as the local shops and leisure centre. Individuals are assisted to go shopping for food or clothes, and to attend community events when these arise. Trips out are arranged on a regular basis, with residents making choices as to the various options at residents meetings. Care Homes for Adults (18-65 years) Page 19 of 34 Evidence: In-house activities are also offered, together with a computer and a games consule which is solely for the use of residents. There is also a wide-screen television, with DVDs, in the main lounges. The home recognises the importance of residents maintaining their contact with family and friends, and encourage pre-arranged visits to the home, and for residents to visit their family for occasional weekends. There are three lounges in the home, and visitors can be seen in relative privacy in a quiet area or in the individuals own room. The ethos of the home is orientated towards promoting independence and maximising choice and opportunities. Residents are encouraged to take responsibility for undertaking daily tasks such as cleaning and tidying their rooms, and preparing drinks, food and snacks. Care plans evidence that residents rights and responsibilities are being respected and recognised in their daily lives, and that individuals are being enabled to be as independent as possible within the constraints associated with their disabilities. Staff at the home work with individuals to increase their confidence, motivation and communication skills, and to develop their independent living skills. There were two residents present during the inspection.The inspector observed that staff engaged and interacted with them in a positive and respectful way. Mealtimes are flexible and take account of individuals work and activity schedules. Menus are designed to reflect residents preferences and choices, a varied and nutritional diet being offered. Professional advice is taken regarding any specific dietary needs, these being recorded in the individuals care plan. Individuals are consulted both individually, and at residents meetings, as to which foods they would like, and are encouraged to assist with food shopping if they so wish. Staff work alongside residents in preparing food, laying table and clearing up. Care Homes for Adults (18-65 years) Page 20 of 34 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. Residents personal support and health care needs are being well met in this home, with support being planned and tailored according to the individual needs presented. Residents are being protected by the homes medication training policy and procedures. Evidence: As detailed in residents assessments and care plans, there is a varied range of personal support needs that are presented. These include needs associated with health, personal care, communication, social skills and with complex or challenging behaviour. A relationship is gradually developed with each individual, with support being offered according to the the individuals needs, wishes and goals. This process begins prior to placement at Hollyfield and is developed throughout the transitional period and during the initial settling-in period following placement. Inspection of residents care plans indicates that there has been careful and thorough assessment of individuals needs and that flexible, focussed and person-centred Care Homes for Adults (18-65 years) Page 21 of 34 Evidence: support has been developed. These also evidence that the user, and his/her family, have been fully involved in this process. Feedback noted from reviews indicates that staff are seen to be enabling in promoting individuals choice and independence, and that individuals needs and wishes are being addressed in a positive and holistic way. Residents are encouraged, wherever possible, to maintain responsibility for their own personal care, hygiene and appearance. Where support is required, this is provided in the privacy of the persons own room. All residents have access to their own bathroom and shower. All residents are registered with a local GP, with referrals for more specialist psychology, speech therapy and other support being made through the GP and the local Community Learning Disabilities Team. Individuals are supported to attend any routine or emergency healthcare and hospital appointments that arise, and to access community dental and optician care. The home has a clear policy and procedures in place for the receipt, recording, storage, administration and disposal of medication. Medication is kept securely in a locked medication cabinet, and there is a a separate cabinet for controlled drugs should any be required at any time (none at present).The consent of residents is required at all times when administering medication, these being entered on MAR record sheets, a sample of which were seen. The home employs the Boots blister pack Monitored Dosage system, two staff members (one administering, one shadowing) being present for all medication that is administered. Each resident has their own medication profile. This includes a photograph of the person, and outlines any special requirements, or ways in which the resident likes to take his/her medication. Any changes in health care needs are referred to the relevant GP or healthcare professional, with profiles being updated where changes in medication occur. A Boots pharmacist visits the home to give advice on medication issues, and all staff have completed accredited medication training. Staff are also being provided with medication updates which are available in annual training sessions and via an etraining website. Care Homes for Adults (18-65 years) Page 22 of 34 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. Clear information for raising complaints is available, and residents, their relatives, friends or representatives are encouraged to raise any concerns that they may have. The homes policies, procedures, training and practice indicate that residents are being fully protected from abuse, and that they are living in a safe environment. Evidence: The home has clear policies and procedures in place for concerns, complaints and the protection of residents. The complaints procedure includes the required relevant information, including the stages and time-scales for dealing with a complaint. The procedure is produced in a format, using pictures and symbols, which is appropriate in meeting the communication difficulties experienced by this client group. Any written complaints are acknowledged within two working days, with investigations being completed within 28 days. All complaints are responded to in writing, either by the homes manager or by one of the two registered providers. Staff, residents, relatives or friends are made aware that they can raise concerns at any time, and that, if they wish to do so, they can contact CSCI. Care Homes for Adults (18-65 years) Page 23 of 34 Evidence: The home has been open to residents since September 2008. No complaints have been recorded since this time. The home aims to ensure that residents views are communicated and that, where concerns exist, these are addressed. Individuals are encouraged to approach the manager or any member of staff to express any anxieties or concerns that may arise. The home has policies and procedures in place for safeguarding vulnerable adults. These are consistent with the local statutory safeguarding policy and procedures in Sutton. All staff are familiarised with these policies on their induction, and are required to sign to indicate that they have read through these. Chatsworth Care also has a Whistle-blowing policy, for the reporting in confidence of any concerns that may arise regarding the eventuality of any abuse or poor practice within the home. Staff are made aware of this at their induction, and guidelines on the procedure are made available. Contact details for CSCI are included. The homes training programme includes induction and training in adult abuse. All staff are required to complete statutory safeguarding training at the earliest opportunity. As evidenced by the training programme, this is being provided on a regular 6 monthly basis by Chatsworth Cares accredited in-house trainer, with updates in this area being provided for all staff. Care Homes for Adults (18-65 years) Page 24 of 34 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. Residents live in an environment which is safe, well-maintained and adapted for people with disabilities. Residents rooms are safe, comfortable and pleasantly decorated. They present as being well suited to meeting individuals needs, and reflect their personal identities. All residents are provided with their own ensuite bathroom and toilet facilities, providing for individual needs and affording privacy. The home presents as being clean and hygienic, and as a pleasant and homely place in which to live. Evidence: Hollyfield House has been open to residents since September 2008, all building and conversion work having been completed to a high standard. The home is spread over three floors, and includes seven single ensuite rooms for residents on the first and second floors. Accomodation on the ground floor includes a laundry room, a spacious dining room and kitchen, a large TV lounge and a quiet lounge. There is a small lawned garden at the rear of the home. The home has a spacious and pleasant feel, Care Homes for Adults (18-65 years) Page 25 of 34 Evidence: and is decorated and furnished to a high standard. The dining area and lounges are well laid-out, with modern furniture, and provide pleasant areas in which to sit and relax. The larger lounge has a large wall-mounted widescreen TV. A smaller lounge includes a computer and games console for the sole use of residents. One resident was observed using the computer and clearly enjoying the activity in which he was involved. The kitchen is large and open plan and is very well equipped. This opens into the dining area which overlooks the garden. This has a homely feel, and provides a very pleasant area for having snacks and meals. Each resident is provided with their own bedroom which is personalised to reflect their own tastes, interests and choice of decoration. All rooms have sufficient useable floor space to meet individual needs and lifestyles, and are in excess of 12 square metres. These all an ensuite bathroom (with bath and shower) and toilet. Restrictors were observed to be in place on all windows that open out. Four of the seven bedrooms are currently occupied. All residents have a locked cupboard in their room and are well furnished. All furniture is provided and includes a comfortable bed and armchair, bedding, bedside cabinet, a TV or music centre. The home presents as safe and well-adapted to the needs of the current residents, all of whom are young adults and are able to mobilise freely around the home. The home has risk assessments in place for fire and health and safety (both evidenced on this inspection), together with risk assessments for all residents, These are completed on admission and were evidenced on the individuals personal files. The home presents as being clean and hygienic, with high standards of cleanliness being maintained throughout. Areas inspected included the kitchen, laundry room, communal areas, bedrooms and ensuite bathing and toilet facilities. Staff are required to attend food hygiene and infection control training, and there are policies and procedures in place that relate to the maintenance of hygiene in the home. The home has a small, lawned garden to the rear which is accessible for the use of residents. This is tended by a gardener. Care Homes for Adults (18-65 years) Page 26 of 34 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The best interests of residents are being protected through the maintenance of appropriate staffing levels, and by clearly defined staff roles and responsibilities. Residents are having their needs well met by an appropriately trained and qualified staff group. Residents are being protected by appropiate recruitment policies and procedures. Residents are benefitting from having staff who are well-supported and supervised. Evidence: An application pack is sent out to prospective staff members. This includes a comprehensive application form, a health questionnaire, a person specification and an equal opportunities monitoring form. The person specification specifies the essential and desirable qualities for a support worker, particularly in relation to autism and complex disabilities. Interviews are undertaken by two members of the management team. Care Homes for Adults (18-65 years) Page 27 of 34 Evidence: The home has a recruitment policy and procedure in place which meets the required regulations and care standards. This is based on equal opportunities principles and aims to ensure the protection of residents. The home has sufficient staff to meet the needs of the present resident group. A staff rota is maintained, with a minimum of 4 staff being on each shift during the day, providing one-to-one support for residents. Two waking staff are on-call at night. There are a number of new staff that have been recruited, and some that have been previously recruited, having transferred across from other Chatsworth Care homes. Inspection of staff files for those staff that have been recently recruited indicated that criminal records, identity and recruitment checks are being routinely completed. One recently recruited staff member is, however, currently working under supervision, pending the receipt of an enhanced CRB check. All other checks, including the POVA check, have been completed. It was confirmed that no one to one contact with any resident would be allowed until such time as the enhanced CRB check has been completed and the CRB certificate received. Staff benefit from clarity of staff roles and responsibilities, with detailed job descriptions being in place. Each staff member attends an initial induction and foundation programme of training which lasts for 6 months and is based on TOPPS standards. Induction workbooks accompany each section of the induction process to ensure that training and knowledge have been assimilated. The induction programme includes both core training and specialist training associated with the needs of the specific client group (autistic spectrum disorders) that support workers will be working with. Following the initial period of induction, there is a six-week period of observation and further training, with the new staff member working alongside an experienced staff member in a mentoring role. Overall, there is a six-month trial period which, if successfully completed, is then followed by further training and study for NVQ qualifications. Following the probationary period, the new staff member meets with the homes manager and training manager to discuss their proposed development and individual training plan. The plan details the relevant training needs, learning objectives, timescale and evaluation outcomes, and is monitored and updated by the training manager. At this stage, the new staff member is given an Autism Focus workbook, and is mentored and supported through to completion. This is followed by interactive training sessions on autism. These training sessions are held periodically throughout the year. Care Homes for Adults (18-65 years) Page 28 of 34 Evidence: Chatsworth Care has consistently demonstrated itscommitment to the training and development of its workforce, and has its own training manager, Chris East. Ms East works closely with all of the the Chatsworth homes managers in identifying and meeting their staff training needs. There is a comprehensive and on-going programme of training in place, which includes all the necessary mandatory training (including Health and Safety, Safeguarding and Medication), and the specialised training required for working with a client group that includes adults whose diagnoses include learning disabilities, autism, epilepsy and challenging behaviour. There is also mandatory training in areas such as equality and diversity, and anti-discriminatory practice. Specialised training in communication techniques and strategies, and in assisting users to develop the necessary communication skills, has been developed in conjunction with Chatsworth Cares participation in the NAS (National Autistic Society) Accreditation Award Scheme. Staff are encouraged to further their professional development, with ongoing training needs being monitored by the training manager. This includes study for NVQ qualifications in Health and Social Care. The training manager confirmed that, of 14 staff, 6 presently possess a minimum of an NVQ Level 2 while 4 staff are currently studying for an NVQ Level 2. The inspection of staff files evidenced that staff supervision is taking place, and that supervision is being undertaken by the manager or deputy manager. Probationary reviews are completed with all new staff after their first 3 months of employment.There is also a system for appraisal in place, this being scheduled to take place in September 2009. This standard will be more fully assessed on the next inspection. Care Homes for Adults (18-65 years) Page 29 of 34 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 is being run competently, and in the best interests of the homes residents. Following the departure of the previously appointed manager, the senior manager for Chatsworth Care is presently managing the home. A new manager has just been appointed, and will be applying to register with CSCI as the Homes registered manager. Residents rights and best interests are being protected by the homes record-keeping and by its policies and procedures. The health, safety and welfare of residents and staff are being appropriately promoted and protected. Evidence: Following the departure of the previous manager, the home is currently being managed by the senior manager for Chatsworth Care, Kerrie Roach. A new manager, Beverley Clacey, has just been appointed, and is presently working alongside Ms Care Homes for Adults (18-65 years) Page 30 of 34 Evidence: Roach. It was confirmed that the new manager will be applying to become registered with CSCI. The home also has a well-qualified deputy manager. The home is presently being managed in a competent way, there being evidence of a positive and enabling ethos within the home. There was indication of good working relationships with staff, and of a skilled and professional approach to managing the home. Ms Roach is managing the home on a short-term basis, and has considerable experience and expertise in this area. The home is due to be managed by Ms Clancy, who will be gradually taking over the management role and responsibilities from Ms Roach. Chatsworth Care has tried and tested quality assurance processes in place, but the home has not, as yet, had the opportunity of implementing these. This standard will be assessed at the next inspection. The home will need to have completed surveys with residents, relatives and professionals, and to have compiled a QA audit report by the end of 2009. From the evidence of this inspection, residents and staff records are being wellmaintained Records and documentation were found to be comprehensive, up-to-date and accurate. Residents are able to gain access to their records, and are fully consulted and involved in the process of information-gathering and the drawing up of care plans. In line with data protection, all records are kept in lockable cabinets within the first floor office. The home has a comprehensive range of policies and procedures in place. These will need to be reviewed annually, and a full record maintained. This should indicate the date when each staff member has read each policy and procedure that has been initiated or reviewed. Generally, the home presents as a safe place in which to live. Health and safety, and Fire Risk assessments have been completed and safety certificates are in place for electricity, gas, fire and emergency lighting. An inspection for portable electrical appliances was due to be carried out, and has since been certified. All staff at the home undertake certified fire safety training twice a year, and there are periodic fire drills. Other health and safety checks such as water temperature and fridge/freezer checks, and fire alarm tests, are carried out on a regular basis. Care Homes for Adults (18-65 years) Page 31 of 34 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 34 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 33 of 34 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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