Care Home: Cherre Villa Care Home

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What the care home does well Residents have helped to produce a very reader friendly Service Users Guide to help potential residents understand the Home`s services in the future. Cherre Villa is able to support individuals from a diverse cultural background and supports residents to have relationships they want to have. Staff act on residents health conditions to help them when they are ill. Residents live in a stable community. They are satisfied with all the services provided by the home as expressed by the Quality Assurance surveys the home has carried out. Their opinions are sought as indicated by staff talking with them and by residents meetings. They are supported and encouraged to enjoy a positive lifestyle through varied activities, contact with the local community, and contact with family. There are few rules and they have freedom to have their bedrooms the way they like. Staff know about the needs of each resident and this is helped by having very detailed care plans outlining residents needs. Residents are encouraged to live an independent life. An example being a resident being able to go to town every day to meet his friends. Staff are properly recruited and receive a training in order to support the residents living in the home. A resident has become a person centered trainer with the support of the Manager, to help other people live independent and fulfilling lives. What has improved since the last inspection? Facilities have been improved. What the care home could do better: Activities should be reviewed to ensure all residents receive the stimulation they need. A resident wanted the lounge TV to have the freeview service so he had more options when watching the TV. Incidents of a potentially serious nature need to be reported to relevant Agencies to ensure residents have full protection from harm. The Complaints Procedure needs to give residents the option to first go to the Lead Agency, not the home if they do not want this. The training programme needs to be extended to include a small number of issues. Health and safety system risk assessments need to be more detailed to fully protect residents from harm. Key inspection report Care homes for adults (18-65 years) Name: Address: Cherre Villa Care Home 168 Fosse Road South Leicester LE3 0FR     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Keith Charlton     Date: 2 6 0 8 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 29 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 29 Information about the care home Name of care home: Address: Cherre Villa Care Home 168 Fosse Road South Leicester LE3 0FR 01162239374 F/P01162239374 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Miss Hema Malini Patel care home 3 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: No additional conditions of registration apply. Date of last inspection Brief description of the care home The last key inspection of this service was on the 19th September 2007. Cherre Villa is registered to provide care for three adults with learning disabilities. The home is situated close to Leicester city centre and within easy reach of a range of local amenities. Residents are accommodated in one single and one shared bedroom. In addition to their rooms, residents have access to a lounge and a large kitchen / dining room. There is a tarmaced area to the rear of the property. Cherre Villa is run as a small family home. Residents attend colleges and day care during the day if they choose. They have access to a range of leisure and recreational activities both within the home and in the local community. The weekly fees are from #351 to #499 per week. This information was provided on the day of the inspection. There are additional costs for individual expenditure such as hairdressing etc. The home provides information to residents and prospective residents in the form of a Service Users Guide that describes the services it offers, and a copy of the Statement of Purpose and last Inspection Report is available on request, so as to give a view as to the quality of life Care Homes for Adults (18-65 years) Page 4 of 29 Over 65 0 3 Brief description of the care home for residents. Care Homes for Adults (18-65 years) Page 5 of 29 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 quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. We, as it appears throughout the Inspection Report, refers to The Care Quality Commission (CQC). The inspection process consisted of pre-planning the inspection which included reviewing the Annual Quality Assurance Assessment (AQAA), which is self assessment tool completed by a representative of the service. We have sent surveys to people who use the service along with staff. When we receive these surveys back we will include the results of them if received before the final Report is published. The unannounced site visit commenced on the 26th August 2009 and was carried out by Keith Charlton Care Homes for Adults (18-65 years) Page 6 of 29 The focus of the inspection is based upon the outcomes for people who use the service. The method of inspection was case tracking. This involved identifying people with varying levels of care needs and looking at how these are being met by the staff at Cherre Villa. Two residents were selected. Discussions were held with a member of staff, and the Area Manager. We spoke with all the residents. No visitors were present at the inspection. Care Homes for Adults (18-65 years) Page 7 of 29 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking Care Homes for Adults (18-65 years) Page 8 of 29 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 29 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 29 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. People living at Cherre Villa have had their needs properly assessed before moving into the home. Evidence: We case tracked a person living in the home who had moved in to Cherre Villa. We checked that he had received information to help him with the choice of home, but because the person had been at the home a long time it was not possible for him to recall this information. The Manager stated in the AQQA that a thorough assessment will be done when a new resident moves in and that the service had provided more accessible information for residents who could not read by way of residents producing the Service Users Guide, which we saw and which was detailed, well laid out and told the story from the residents point of view with lots of pictures in it. We also checked that a person now living at the home had their needs properly assessed prior to moving to Cherre Villa to ensure that the staff at the home could Care Homes for Adults (18-65 years) Page 11 of 29 Evidence: meet their needs. We found this to be the case as the assessment covered all important issues such as health, behavior, medication, work and play, personal care etc. Care Homes for Adults (18-65 years) Page 12 of 29 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The individual needs and choices of each person living at Cherre Villa are well documented and acted upon by staff. Evidence: Residents said that they had care plans: We look at them sometimes to make sure they are right, one resident said. We looked at the care records of two people living at Cherre Villa. We found very detailed plans to support the care given to people who live at the home. There was a variety of useful information available to staff - Person Centred Plans which included why people like and admire about me, whats important to me, how to best support me, daily routine, activities, Health Action Plans, Daily Logs etc. There are also a number of risk assessments so that residents can be protected from identified risks. The staff said that she was encouraged by management to read Plans to ensure staff can meet residents needs and she said she had read all the care plans. We saw that Care Homes for Adults (18-65 years) Page 13 of 29 Evidence: care records were routinely reviewed to ensure they reflected the changing care needs of people living in the homes. During our visit we observed staff being friendly to residents. There was evidence that residents are able to live their own lives, e.g. going out to places in the community, choice of meal, choice of activity, going home to see relatives etc. Staff said that during the week residents were expected to go to the sister home nearby to have day care but if they refused to do this then staff would instead stay with them at home as long as they wanted to. Care Homes for Adults (18-65 years) Page 14 of 29 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. People living at Cherre Villa have opportunities to have a varied lifestyle though this needs to be reviewed for one person. Evidence: I can do what I want to do, one resident said. The AQAA stated that the aim is to help residents get voluntary or paid work and they all have individual programmes of activities, which we saw evidence of. We looked at the plans of people who live at Cherre Villa. These contained details of activities recorded so that these can be checked and reviewed as needed to ensure residents needs are met. These showed us that residents are able to experience a varied social life. They showed people undertaking activities such as going to the pub, going to a drop in centre, into town every day etc. One resident goes to the sister home every day for day care. There was a comment that all he does there is watch TV Care Homes for Adults (18-65 years) Page 15 of 29 Evidence: as there are too many other residents at that home that need more attention. Also that he would benefit from doing activities like cooking and sport as he likes these activities. This comment needs to be followed up. Another resident is a person centre trainer and wants to start up his own business and there was evidence that he had had advice on this, and he also goes to a drop in centre to take part in activities. There was a comment in notes that a resident was bored so staff offered him the chance to do voluntary work or other activities. Residents talked about a holiday they were going on to Spain and they had annual holidays of their own choice arranged by the Manager. We saw staff talk to and interact well with people who live at the home. All residents said they liked the food. Staff said residents are asked about their food choices and that residents shop for food and help to cook. We saw tea being served and people living at the home having a meal of pizza, garlic bread, salad and potato salad, with fruit for dessert. Menus were in place and had sufficient variety. Care Homes for Adults (18-65 years) Page 16 of 29 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at Cherre Villa receive good support with their personal and healthcare needs. Evidence: Residents said that if they were not well the staff arranged for them to see a GP. Staff will ring the doctor if we are not well, one resident said. The AQAA stated that all residents have health action plans, which we saw evidence of, and that regular health check ups are followed. This helps to ensure residents health is protected and promoted. We looked at the personal and healthcare records of people who live at Cherre Villa. We saw that they have good access to healthcare services to meet their personal and healthcare needs as described in individual Health Action Plans. On talking to staff as well as looking at the records, we found that staff act quickly on concerns they have about peoples needs, and these prompt actions have resulted in a better quality of life for those concerned. Accident records showed that medical services had been contacted if a resident had a potentially serious injury. Care Homes for Adults (18-65 years) Page 17 of 29 Evidence: There was evidence in notes that people are accompanied by staff to the GP if they cannot explain their symptoms and that staff arranged appointments which resulted in an operation for a resident, which he said had helped him a lot as he does not have pain any more, which he was very relieved about. We looked at medication management and found that staff are administering medication appropriately to people who live at Cherre Villa, with no instances where medication was not signed as given. Records did not show valuable information regarding allergies to ensure residents health is comprehensively promoted. We also looked at how medication is stored and this was stored securely. We saw staff records - there was no evidence that staff have undertaken training in the administration of medication. We were informed by the area manager that this evidence would be sent to us and staff can only administer medication to people who live in the home when they have either passed an accredited course or have received in house training and been assessed as being able to issue medication correctly by the management of the home. Care Homes for Adults (18-65 years) Page 18 of 29 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. People who live at Cherre Villa can be confident that their concerns will be noted and acted upon, though staff need to always refer to appropriate Agencies to ensure residents are fully protected. Evidence: Residents said that they did not have any complaints but if they ever did they said they would be taken care of. Hema would get it sorted, one resident said. We looked at the complaints procedure and saw that this was displayed for residents and was written in a format which is helpful for people living at Cherre Villa to understand, though the procedure does not give the complainant the choice to first go directly to the Lead Agency if they wish, instead of the home. There is a Complaints folder though no records as there have been no complaints according to management. A suggestions book is recommended to be in place to show that peoples ideas are recorded and acted upon. We saw by looking at staff training records, and by talking to a staff member that this staff member had a good understanding of safeguarding policies and procedures and knew what to do if there was a suspicion that a person who lives in the home is being abused in any way. We saw in the accident records that some time ago there appeared to be an incident between residents, which resulted in a resident being injured. Although he did not Care Homes for Adults (18-65 years) Page 19 of 29 Evidence: wish to make a complaint, nevertheless this is an issue that must be reported to the relevant Agencies to ensure a proper protection plan is in place. The AQAA told us that people who live in the home have their own bank accounts. Staff support people living at Cherre Villa in dealing with their money. We checked the financial records of two people living at the home, and found good recording of money transactions. Care Homes for Adults (18-65 years) Page 20 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Cherre Villa live in a homely, comfortable environment. Evidence: All residents said they liked their bedrooms: We have everything in them that we need, one resident said. A resident said he would like freeview installed to the TV in the living room. We looked at the communal areas of the homes and the bedrooms of people who live there. We found the communal areas to be satisfactorily decorated and homely, though there has been a flood and damage to the lounge ceiling. The staff member said this would be shortly repaired by the maintenance person. The bedrooms were decorated to reflect the personalities and preferences of the people using them. A glass panel to one bedroom has been replaced so that there is now proper privacy for a resident. The AQAA told us that residents choose how they like their bedrooms to be by choosing the decor etc. We saw that the home was well maintained in general. The garden to the rear is termaced and looked in a kept condition, with garden furniture so that residents could use it in good weather. Care Homes for Adults (18-65 years) Page 21 of 29 Evidence: There has been new decor and a new carpet to the hallway, landing and stairs. The AQAA stated that new carpets will be installed to bedrooms and there is a six monthly health and safety audit, which should keep residents safe. The home was clean and odour free. Care Homes for Adults (18-65 years) Page 22 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at Cherre Villa have satisfactory support to meet their needs with sufficient staffing levels and a trained staff team. Evidence: Staff are our friends and we all get on, one resident said. The staff rota indicated that when residents are in the home, there was a staff member on duty with a staff member sleeping in at night. We talked to staff and saw her supporting people who live in the home. We saw good interaction between them and she demonstrated a good understanding of the needs of people living there. Staff said she was supported to do her job by management, and there is induction training and on going training relating to the job she does, which we found to be the case when we looked in staff training records. We have received one comment that some staff do not always communicate what has happened on shift at the handover between shifts, so this could mean residents are not getting the care they need. The Manager needs to follow this issue up. The AQAA stated that the recommended Skills for Care induction is used and that there is regular supervision. Care Homes for Adults (18-65 years) Page 23 of 29 Evidence: We looked at a sample of staff records, and saw that all the necessary checks were made to safeguard people who live at the home. We looked at training records and this confirmed that staff have undertaken relevant training to help them in their roles. Training included health and safety, infection control, fire, food hygiene, challenging behaviour training etc and the area manager explained how staff are trained to handle medication properly.The majority of staff have NVQ training which gives them skills to meet residents needs. The main omission was there was no specific training on people with learning disabilities. Care Homes for Adults (18-65 years) Page 24 of 29 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. Health and safety systems are in place to protect residents welfare. Evidence: The Registered Manager, Hema Patel, has years of experience in providing care, she has the Registered Managers Award and is a Person Centred Trainer. Hema was seen by staff and residents to be efficient and effective. There are quality assurance and monitoring systems in place, and we saw the questionnaires that go out to residents though no evidence that they go out to all relevant parties - GPs, Social Workers etc to ascertain all views of the service so that improvements can be made if needed. There are systems in place to support staff with staff meetings being held and relevant issues discussed regarding residents welfare, to help staff to strive toward the best quality practice to make sure residents quality of life is as good as it can be. We checked some residents monies records, which were found to be detailed and in Care Homes for Adults (18-65 years) Page 25 of 29 Evidence: order. The AQAA informed us of the policies and procedures the service works to, to ensure good health and safety practice in the home. Risk assessments are in place for safe working practices though some issues were not fully complete as the level of risk had not been assessed. Fire risks were seen to be covered by regular testing and a fire risk assessment being in place. The staff member we spoke to was aware of how to properly follow the fire evacuation procedure. Care Homes for Adults (18-65 years) Page 26 of 29 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 27 of 29 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 23 13 Any possible safeguarding issues need to be reported to the relevant Agencies. To ensure full protection of residents. 28/09/2009 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 12 There needs to be a review of one residents day care activities to ensure that activities he likes are provided to him. The Complaints Procedure needs to give the complainant the choice to first go directly to the Lead Agency if they wish, instead of the home. Specific training on people with learning disabilities should be provided. The level of risk for all safe working practices needs to be assessed so that action to meet these risks is completely clear. 2 22 3 4 35 42 Care Homes for Adults (18-65 years) Page 28 of 29 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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