Care Home: Clarence House

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What the care home does well Lots of information about people is gathered before they move into the home so that staff know the best way to care for people. Relevant people are involved in this process. People living at the home are involved in planning their care and there is excellent information about how people should be supported. People are supported to take reasonable risks so that they can lead as independent a lifestyle as possible. People`s aspirations and goals are clearly recorded, and they are supported to achieve them. People living at the home make lots of choices about their everyday lives and lead fulfilling and active lives.Clarence HouseDS0000070631.V375950.R01.S.docVersion 5.2People living at the home are happy with the care they receive. One person said, "All the staff are brilliant, good, kind and very helpful to me with all of my needs" Support is given to help people to maintain links with family and friends and make new friends. A healthy and balanced diet is available. People are supported to keep healthy and attend health care appointments when necessary. People know how to make a complaint and say that staff listen to what they have to say. Clarence House has a caring and competent staff tem that get on well with the people who live there. Clarence House is clean and comfortable, and people like living there. The home is well managed by an approachable and experienced manager. A member of staff said, "We have a really good staff team and the home manager is very approachable and reasonable". People are protected from harm. What has improved since the last inspection? A Service User Guide has been produced so that people have good information about what Clarence House has to offer. Records are more organised, so that the manager can run the home more efficiently. Robust procedures for responding to suspicion or evidence of abuse are in place. All staff have had training and information about these procedures. This will make sure people at the home are protected. The kitchen on the first floor has been moved to a larger room so there is enough space for staff to be able to provide the necessary support. The bathroom on the first floor has been made into an extra lounge area at the request of people living at the home. Everybody still has access to their own en-suite bathroom; a bath has been installed in one en-suite at the request of the individual. Parts of the home have been re-decorated, re-carpeted and new equipment and furniture has been purchased.Clarence HouseDS0000070631.V375950.R01.S.docVersion 5.2An additional laundry has been installed so that each floor has its own laundry facilities. The temperature of the hot water has been reduced so that people do not get scalded. What the care home could do better: The recording of medication needs to be improved to make sure that people are receiving their medication exactly as prescribed. A requirement has been made in respect of this. The followings areas that could be done better have been discussed in full with the manager. Based upon previous experience of the provider and assurances that the manager gave at the time of the visit, no requirements or recommendations have been made about these matters. The garden area for the people living on the first floor needs to be improved so that it is more useable. The bathrooms need to be kept clean, and toilet roll, soap and towels must be available at all times. The manager should apply to become registered with the Care Quality Commission. Records of supervision meetings between the manager and her manager should be kept, so that there is clear evidence that these meetings are taking place. Key inspection report CARE HOME ADULTS 18-65 Clarence House 14 Cemetery Road Dewsbury West Yorkshire WF13 2RY Lead Inspector Alison McCabe Key Unannounced Inspection 29th July 2009 10:15 Clarence House DS0000070631.V375950.R01.S.doc Version 5.2 Page 1 This report is a review of the 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. 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 home adults 18-65 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. Clarence House DS0000070631.V375950.R01.S.doc Version 5.2 Page 2 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 Clarence House DS0000070631.V375950.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Clarence House Address 14 Cemetery Road Dewsbury West Yorkshire WF13 2RY 01924 453643 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) clarence@milewood.co.uk Care Network Solutions Ltd Vacant Care Home 10 Category(ies) of Learning disability (10) registration, with number of places Clarence House DS0000070631.V375950.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC, to 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: 10 7th August 2008 2. Date of last inspection Brief Description of the Service: The home is registered to provide personal care for 10 people with a learning disability who may also have complex behaviours. Clarence House is a large detached property near the centre of Dewsbury. The property and gardens are enclosed. There is a small car park and on road parking. The home is on a good bus route to Dewsbury, Mirfield and Huddersfield and is within easy walking distance to Dewsbury town centre and all of its shopping and leisure facilities, there is a park nearby. The property is on two floors with four single bedrooms to the ground floor and six single bedrooms to the first floor. The home is divided into two units, and operates as two separate units. Each unit has its own lounge/dining area, bathroom, laundry and fully equipped kitchen. At the time of the inspection five people were living at the home. The home provides a first floor unit to accommodate six women and a ground floor unit to accommodate four men. All bedrooms have an en-suite facility. Three have been fitted with wet rooms, one has recently been fitted with a bath, the others have shower cubicles and all have toilets and sinks. All bedrooms are lockable. A Statement of Purpose and Service User Guide is available giving up to date information about the home. On 29th July 2009, the weekly fees were between £1388.31 and £3500.00. Additional charges include hairdressing, private chiropody, activities and holidays although £100 is provided to each person Clarence House DS0000070631.V375950.R01.S.doc Version 5.2 Page 5 towards the cost of the holiday. Clarence House DS0000070631.V375950.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is two star. This means the people who use this service experience good quality outcomes. This report refers to an inspection, which included an unannounced visit by one inspector on the 29th July 2009, commencing at 10.15 am, and the length of the inspection was eight hours. There were five people living at the home on the day of the visit. As part of the inspection in order to provide information to help us form judgments about the quality of the service, the manager was asked to complete an annual quality assessment (AQAA) document. To enable people who use the service to comment on the care it provides, we sent surveys to six people living at the home, four of which were returned, eight to staff, five were returned, and eight to other professionals involved with people living at the home, one of which was returned. We focused on the key standards and what the outcomes are for people living in the home, as well as matters that were raised at the last inspection. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. What the service does well: Lots of information about people is gathered before they move into the home so that staff know the best way to care for people. Relevant people are involved in this process. People living at the home are involved in planning their care and there is excellent information about how people should be supported. People are supported to take reasonable risks so that they can lead as independent a lifestyle as possible. People’s aspirations and goals are clearly recorded, and they are supported to achieve them. People living at the home make lots of choices about their everyday lives and lead fulfilling and active lives. Clarence House DS0000070631.V375950.R01.S.doc Version 5.2 Page 7 People living at the home are happy with the care they receive. One person said, “All the staff are brilliant, good, kind and very helpful to me with all of my needs” Support is given to help people to maintain links with family and friends and make new friends. A healthy and balanced diet is available. People are supported to keep healthy and attend health care appointments when necessary. People know how to make a complaint and say that staff listen to what they have to say. Clarence House has a caring and competent staff tem that get on well with the people who live there. Clarence House is clean and comfortable, and people like living there. The home is well managed by an approachable and experienced manager. A member of staff said, “We have a really good staff team and the home manager is very approachable and reasonable”. People are protected from harm. What has improved since the last inspection? A Service User Guide has been produced so that people have good information about what Clarence House has to offer. Records are more organised, so that the manager can run the home more efficiently. Robust procedures for responding to suspicion or evidence of abuse are in place. All staff have had training and information about these procedures. This will make sure people at the home are protected. The kitchen on the first floor has been moved to a larger room so there is enough space for staff to be able to provide the necessary support. The bathroom on the first floor has been made into an extra lounge area at the request of people living at the home. Everybody still has access to their own en-suite bathroom; a bath has been installed in one en-suite at the request of the individual. Parts of the home have been re-decorated, re-carpeted and new equipment and furniture has been purchased. Clarence House DS0000070631.V375950.R01.S.doc Version 5.2 Page 8 An additional laundry has been installed so that each floor has its own laundry facilities. The temperature of the hot water has been reduced so that people do not get scalded. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. 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. Clarence House DS0000070631.V375950.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Clarence House DS0000070631.V375950.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience excellent quality outcomes in this area. People are assessed prior to them moving into the home to ensure that their needs can be met. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Information provided in the annual quality assessment (AQAA) document, suggests that the home is good at assessing peoples needs before they move in. It tells us that a visit is made to the person by the home manager and regional director, with any other professionals involved, so that information about what the person’s needs are can be gathered. The person is invited to visit the home, to help them decide if it is the right place for them Three of the four surveys returned by people living at the home indicated that they were given enough information about the home before they moved in; one person did not feel that this was the case. It was established at the inspection visit that this person had been admitted on an emergency basis. Two people spoken to confirmed that their needs were assessed before they moved in. A great deal of effort has been put in by the provider to get as much information about individuals as possible so that their needs can be met. Evidence was seen in the records that contact had been made with previous Clarence House DS0000070631.V375950.R01.S.doc Version 5.2 Page 11 providers, healthcare professionals and Social Service departments to gain as full a picture as possible of individuals needs. Where information was unclear for an individual, the provider funded a private assessment, with the individuals consent, to provide further pre-admission assessment information. Evidence of input from individuals, their families or representatives was seen in the records, along with Care Management Assessments. Evidence was seen in the records that arrangements for maintaining contact with family and friends are agreed as part of the assessment process. Through discussion with people living at the home and the manager, it was evident that restrictions on people’s freedom and choice had been agreed in advance and that this was kept under regular review. Other professionals involved in individuals care had also been part of these discussions and agreements; evidence of this was seen in the records. A service user guide specific to Clarence House has been produced since the last inspection so that people know what to expect from the home before they move in. A statement of purpose is also given to individuals setting out the aims and objectives of the home. Clarence House DS0000070631.V375950.R01.S.doc Version 5.2 Page 12 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience excellent quality outcomes in this area. People are actively involved in the care planning process, are supported to take reasonable risks as part of an independent lifestyle and make choices about their lives. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Care plans for three people living at the home were looked at. Each contained excellent detail about the person’s needs and how they should be met, and were set out clearly. There was evidence that individual’s, their family or representative, and relevant agencies/specialists had participated in the care planning process. A care planning tool called ‘my plan, my life, my prospect’ is completed with individual’s identifying goals. People told us they had a good knowledge and understanding of their care plans, including restrictions placed upon them. People presented as having control over their lives; they had clear goals about how to increase their independence and freedom. Clarence House DS0000070631.V375950.R01.S.doc Version 5.2 Page 13 A draft copy of a behaviour management plan was seen. This provided excellent detail about an individual’s needs, how to interpret complex behaviours and plans about how to manage aggressive behaviours. Pictures of agreed physical interventions were also included as part of the behaviour management plan, to give staff clear guidance about how they should respond. The manager reported that physical intervention plans are agreed with the individual concerned and the persons social worker and if appropriate their family/representative. All the staff have received appropriate training in the use of physical intervention. Observation of staff interaction with people living at the home, confirmed that care plans were being followed as agreed. All people spoken to said that they were happy with the care they received, and that they are supported to make choices about their lives. Each person has a named keyworker, and people confirmed that they had chosen which member of staff they would like this to be. Four surveys were completed by people living at the home, and all stated that they make decisions about what they do each day, and can choose how to spend their time. Each person’s file has a section for infringement of rights where any restrictions are clearly identified. An individual discussed a specific infringement and appeared to have a good understanding of the reasons for this. This person said they were happy with the current arrangement. The infringement was well documented. People are supported to take reasonable risks, and clear risk assessments were seen in individuals’ records. These clearly set out the identified risk and agreed measures to reduce the risk. All documentation was signed and dated, and evidence of monthly reviews was seen. The AQAA states that people living at the home are reluctant to take part in residents meetings, preferring to raise matters on an individual basis with staff; monthly meetings continue to be offered. It was apparent on the day of the inspection visit that people living at the home are comfortable in approaching the manager and staff whenever they wish; they said the manager and staff were approachable. Five surveys were returned by staff working at the home. A member of staff commented under ‘What does the home do well?’, “clients are enabled to progress and given opportunities they may not get elsewhere, allowing each individual to be supported and prepared for independent living without discrimination”. Clarence House DS0000070631.V375950.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): This is what people staying in this care home experience: People using the service experience excellent quality outcomes in this area. People living at the home lead active and fulfilling lifestyle, are provided with excellent support to maintain relationships with family and friends and have a healthy and balanced diet. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Information from the AQAA, discussion with people living and working at the home and records seen indicate that people lead a fulfilling and stimulating lifestyle. Three of the five people living at the home have college placements, and two have previously had work placements, although these have come to an end at the moment. During the visit, staff were observed to support individuals to keep occupied by going on individual shopping trips, going out for lunch, and spending time with people engaging in activities in the home. People living at the home require varying degrees of support to access community based activities; some people require 1:1 or 2:1 staffing levels, Clarence House DS0000070631.V375950.R01.S.doc Version 5.2 Page 15 whilst some people manage to go out without staff support but with agreed safeguards in place. People’s goals and aspirations are clearly documented and there was evidence in the records and through discussion with people living at the home that support is provided to help people to achieve these. Each person has a weekly activity plan to ensure that they are taking part in valued and fulfilling activities, and to enable the manager to plan resources. The activity plan is completed with the individual and their keyworker; people living at the home reported finding this helpful. Two vehicles are available for people living at the home to use when accessing community based activities, although the AQAA states that for local activities, people are encouraged to walk or use public transport. One person said that they enjoy going to the Bingo with staff, and do this on a regular basis. People are supported to maintain contact with family and friends. People told us that they invite friends to their home and can invite people for a meal if they choose to do so. The home’s phone is available so that they can stay in touch with family and friends and an individual was seen to access this facility on a number of occasions at the time of the visit. None of the people living at the home are from the area, and the manager reported that families are welcome to visit, and stay overnight if there is a vacant room. Records showed that this has taken place. The manager also reported that people are provided with support to go to visit their families, including transport being provided, staff support where needed, and arrangements being made. Two of the individuals spoken to confirmed this. People’s wishes regarding contact with family and friends, including the support needed to do this, is recorded clearly in the care plans and where necessary risk assessments have been completed in respect of this. As a way of keeping families up to date and involved, some of the people living at the home have agreed that a monthly update report will be sent to their family to let them know how they are getting on. The manager reported that this has only just been agreed, and individuals will be involved in the process when it starts. People’s rights and responsibilities are respected and recognised. The daily routines and house rules promote independence and individual choice. Where restrictions are necessary, these are clearly documented, agreed and reviewed. People living at the home have a key to their bedrooms, and staff asked permission before entering. Staff were observed to interact with people living at the home as well as with each other, and people were included in decision making about the days planned activities. For example, bedrooms were being re-decorated at the time of the visit, and individuals had decided on the décor, carpet colour and curtains. Staff were seen offering support to plan which shops they needed to go for curtains, how much money they needed and the style they would prefer. During the visit, it was apparent that individuals Clarence House DS0000070631.V375950.R01.S.doc Version 5.2 Page 16 choose whether to be alone or in company, and staff were seen to respect these decisions. Comments received from a visiting social care professional in response to the question ‘what does the service do well?’ include, “promoting independence and working with individual service users in order to provide them the best care available. The company is customer focused and always looks at individual needs”. People told us they enjoyed the food at Clarence House, and that they are involved in the planning, shopping and preparation of meals. People said that meals tend to be cooked from scratch and that they are healthy and balanced. Weekly menus are completed by people living at the home, with support from staff. Healthy meals are encouraged, and one person said they usually have the recommended five portions of fruit or vegetables each day. The AQAA states that healthy snacks are always available, and whilst looking around the home, it was noted that bowls of fresh fruit were available. The manager and people living at the home confirmed that mealtimes are flexible depending upon what activities are going on. The manager states in the AQAA that efforts are being made by staff to encourage people to eat at appropriate times, as sometimes they are eating very late if they have been out for the evening with friends. Clarence House DS0000070631.V375950.R01.S.doc Version 5.2 Page 17 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. People’s health and personal care needs are generally well met. The home deals with people’s medication well overall. More care must be taken to keep accurate records at all times. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The AQAA indicates that very little support with personal care is required by the people living at Clarence House. Hands on support is not needed, though prompting and guidance is necessary for some. Comments included in surveys completed by people living at the home include, “All the staff are brilliant, good, kind and very helpful to me with all of my needs”; “They look after me even though I try to look after myself, but at my age it’s hard”. Times for getting up, going to bed, meals, baths and other activities are flexible, and there was evidence in the records, and through discussion with the manager and people living at the home, that sensitive guidance and support is offered. Evidence of this was observed at the time of the visit. Clarence House DS0000070631.V375950.R01.S.doc Version 5.2 Page 18 People receive specialist support and advice as needed from psychologists, psychiatric services, social workers, community nurse etc, and this was recorded in the records and confirmed by the manager. The home is good at providing consistent support through partnerships with advocates, family, friends and relevant professionals from outside the home; good records are kept to confirm people’s consent to this. The AQAA states that upon admission to Clarence House, a full health check is completed and people are registered with a GP, optician etc. Health action plans are in place for everybody living at Clarence House, and people are involved in completing these, as well as giving information about their health history. People spoken to confirmed this and said they were supported to attend health care appointments. The manager states on the AQAA that six monthly medication reviews and health check-ups have been implemented in the last twelve months. Each person’s file has a healthcare section and the records showed that health and welfare are monitored. The manager is also in the process of putting together a ‘my health’ booklet, which is a summary of current health needs and personal details. The manager explained that this will be taken to each appointment so that individuals and the staff supporting them have access to all the relevant information they might need. Weight is monitored, and detailed records are kept of appointments attended, any changes in people’s health needs and any significant events. The AQAA states that as a result of listening to people who use the service, “We have compiled an information file for each service user which consists of: what is abuse and how to recognise abuse, breast awareness, testicular cancer awareness, advice on weight ,exercise, visiting the GP, smoking and alcohol, sexual awareness and safe sex.” A copy of this was also displayed on the notice board. Medication systems were looked at. The home uses a monitored dose system, and all staff have received medication administration training from ‘Boots’ the chemist. Evidence of this was seen in staff training records. Clear guidance was in place in one file looked at describing in detail under what circumstances an individual should be given an ‘as required’ medication to help reduce agitation. A copy of this was also kept in the medication folder. A self medication assessment is completed with each person living at the home to establish whether people can administer their own medication with appropriate support. An individual said that they were in discussion with staff about this at the moment, in the hope that with the right level of support this is something they could manage independently in the future. Medication was stored securely and at the correct temperature. Whilst there are good procedures in place for auditing medication, a number of errors were found. These were: Clarence House DS0000070631.V375950.R01.S.doc Version 5.2 Page 19 Medication for one person recorded in the controlled drugs record, did not tally with the record on the Medication Administration Sheet (MAR). Although the tablets could be accounted for, the recording was not clear. A list of staff responsible for administering medication is kept in the medication folder, along with the signature they would use on the MAR. However, the signatures used on the MAR did not correspond with those on the list, and not all staff who give out medication had been included on the list. It was not always clear whether an entry was a signature or a code used to indicate why a medicine had not been given. Not all medication was being administered as prescribed. The MAR suggested that a regular medication was being administered on an ‘as required’ basis rather than at regular intervals as prescribed; counts of an individual’s tablets indicated that although the MAR had been signed to say the medication had been given, it had not been; an individual missed their lunchtime medication two days in a row because they were out with staff for longer than expected and it had not been taken out with them. Since the inspection visit, the home manager has provided evidence to the commission to demonstrate that appropriate steps have been taken to address the matters raised. Clarence House DS0000070631.V375950.R01.S.doc Version 5.2 Page 20 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. People living at the home can be confident that their complaints will be listened to, taken seriously and acted upon. People are protected from abuse. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Information from the surveys and discussion confirmed that people know who to talk to if they are not happy, and how to make a complaint. Individuals have a copy of the complaints procedure, in easy read format, and it is also displayed on the notice board. The AQAA states that three complaints have been received in the last twelve months, and that each had been dealt with within twenty eight days. The manager explained that although she had recorded them as complaints, the individuals concerned had raised matters that they wanted addressing rather than making a complaint, e.g. a sink to be unblocked. The records showed that each of the three matters raised had been dealt with quickly by the manager. Since the last inspection visit, clear procedures have been put into place about how to safeguard vulnerable adults. The home manager was clear about her responsibilities to refer any allegations of abuse to the local authority, and contact details about who to contact were displayed on the staff notice board. All staff have received training in the protection of vulnerable adults and evidence of this was seen in the staff training records. There was also Clarence House DS0000070631.V375950.R01.S.doc Version 5.2 Page 21 evidence that safeguarding is discussed in detail in one to one supervision meetings, and at staff meetings. The manager is in the process of arranging external training about safeguarding. All staff who completed a survey said that they knew what to do if they had concerns about the home. Since the last inspection visit a safeguarding investigation has been conducted by Kirklees Local Authority, and it was found that there was inadequate procedures and staff training regarding safeguarding. A follow up to the investigation found that these matters had been addressed satisfactorily and that requirements made by the local authority had all been actioned. Physical intervention is occasionally used at the home. Clear behaviour management plans are in place, and all staff have received appropriate training. Some staff within the company are qualified trainers, using a course that is accredited by the British Institute of Learning Disabilities (BILD). Clear records of physical interventions are kept, and the home notifies the commission when it has been used. Clarence House DS0000070631.V375950.R01.S.doc Version 5.2 Page 22 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. Clarence House offers people a homely, comfortable and clean environment. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Clarence House provides comfortable, homely accommodation. As part of the inspection visit, a tour of most parts of the premises took place, with the assistance of one of the people living at the home for part of this. Since the last inspection, a decision to move the women from the ground floor unit to the first floor and the men to the ground floor has been made. The manager explained that this was due to them receiving more referrals for women, and the first floor provides more accommodation. On the day of the visit, bedrooms were being decorated to the specifications of the people living at the home, in preparation for the move. New carpets, wall covering, curtains and furniture had been purchased, and people living at the home were clearly Clarence House DS0000070631.V375950.R01.S.doc Version 5.2 Page 23 making the decisions about how they wanted their bedrooms to be furnished and decorated. Since the last visit, the first floor lounge has been redecorated, and a new large screen TV purchased. A new kitchen has been installed to provide more space, and the bathroom on the first floor is in the process of being converted to a quiet lounge; people living at the home were involved in the decision making about this change, and confirmed this during discussions. The manager explained that everybody has en-suite facilities, and a bath has been installed in the en-suite bathroom of an individual who prefers to have a bath. An office with a staff toilet is being installed on the first floor. Separate laundry facilities have also been installed, so that units do not have to share this facility. Plans for the garden for the first floor have been made, and the regional director said that a patio area would be provided, and news steps leading to the garden would be built. A large paved garden is available for people living on the ground floor. The ground floor lounge area and bedrooms are due to be decorated soon. The manager says in the AQAA that since the last inspection the company has made changes to the maintenance team, resulting in decoration of Clarence House being delayed. However due to improvements to the maintenance scheme, it is planned that the property will be decorated to a high standard within the next two months. People living at the home who completed a survey said that the home is always clean and fresh. The home was free from offensive odours. It was noted that the bathroom on the ground floor was not clean, had no soap, towels or toilet roll. This was pointed out to the manager at the time and she gave assurance that this would be discussed with the staff team. The requirement made at the last inspection to make sure hot water is at a safe temperature has been addressed. A sample of hot water outlets were checked and the regional director confirmed that the necessary adjustments had been made. Clarence House DS0000070631.V375950.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. People living at the home benefit from being supported by caring, competent staff that have had all the necessary checks before working with people so that they are kept safe. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Staff were observed to have positive, respectful relationships with people living at the home. All those who completed surveys and that were spoken to described having good relationships with the staff. Some of the comments included in the surveys are: “All the staff are brilliant at their job within the home for different kinds of needs and abilities”; “All the staff are excellent at caring”. A comment from a visiting professional who completed a survey is, “The service they provide is magnificent”. The duty rotas and staff training files were inspected and there was evidence to suggest that the staffing levels and skill mix were sufficient to meet the number and needs of people living at the home. Clarence House DS0000070631.V375950.R01.S.doc Version 5.2 Page 25 Two staff currently have NVQ 2 or above in care, although all staff have now registered as candidates for this training. Staff training records showed that staff had also received training in fire safety, infection control, first aid, medication, food hygiene, risk assessments, adult protection and physical intervention. Clear records are kept of training that has been received and training that is required. All staff receive induction training. Staff work twelve hour shifts so that they have uninterrupted time with people living at the home. The manager reported that there are sufficient staff on duty to enable people to have a break when they need one, although set breaks are not in place. Of five staff that completed a survey for the inspection, four said that there are always enough staff on duty to meet the individual needs of all the people living at the home, and one said this was usually the case. All said that they felt they had enough support, experience and knowledge to meet the different needs of the people living at the home. There are currently six members of staff, including the manager. The regional director, and a manager from another home that is not yet open, also work at Clarence House almost on a full time basis. The manager reported that gaps in the duty rota are covered by staff from other homes; the same staff are used each time so that continuity is achieved. Four new staff have just been appointed, and the manager said that they were in the process of getting references and police checks. She said that they still have a further two support workers and a deputy manager to recruit. Recruitment records for three staff were examined. These were well organised and clear. Each had a completed application form, two satisfactory references, (CRB) Criminal Records Bureau check and evidence of the interview. There were unexplained gaps in the employment history, and referees that did not match those on the application form for one employee. The manager explained that this person had been employed by the previous manager, however agreed to discuss this with the individual following the inspection. The manager has since confirmed that the gaps in the employment history have been satisfactorily explained. Following a safeguarding investigation conducted by the local authority since the last inspection where recruitment procedures were found to be unsatisfactory, copies of the recruitment policies and procedures have been provided to the commission. These describe robust procedures that if followed correctly will ensure that the right people are employed for the job and people living at the home are protected. People living at the home said that they are involved in the recruitment of new staff, and have an opportunity to meet candidates, ask them questions and give their views and impressions to the manager. One individual Clarence House DS0000070631.V375950.R01.S.doc Version 5.2 Page 26 acknowledged that the manager also has to take into account the formal interview, application form and checks before a decision is made. The manager explained that all new staff work alongside experienced staff so that they receive the appropriate guidance and supervision. Regular meetings take place between new staff and the manager or senior staff, where mentoring forms are completed. These are used to record areas that have been identified as needing further development, and areas of good practice. Evidence of these was seen in staff records. Clarence House DS0000070631.V375950.R01.S.doc Version 5.2 Page 27 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. The home is well managed by an experienced, competent manager. The health, safety and welfare of people who live at the home are protected. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Since the last inspection visit, the registered manager has left Clarence House. The deputy manager is now in the position of acting manager, and she reported that she will be applying to the commission to be the registered manager. The acting manager (referred to as the manager throughout this report) has experience of working in care and has an NVQ 2 in care. She is currently working towards the Registered Managers Award and is confident Clarence House DS0000070631.V375950.R01.S.doc Version 5.2 Page 28 that she will have completed this by November 2009. She is also completing NVQ 4 in care. The manager has completed a number of training courses relevant to her role, including, protection of vulnerable adults, physical intervention, first aid, health and safety, confidentiality, first aid, Autism and Bi-Polar disorders, disability awareness, person centred planning. The regional director has based himself at Clarence House since the registered manager left, so that ongoing support and guidance can be given to the manager. Although the manager reported that she has supervision with the regional director on almost a daily basis, it is not recorded. It is recommended that a formal record be kept of management supervision meetings so it can be demonstrated that appropriate supervision is taking place. The manager presented as organised, competent and extremely enthusiastic. People living at the home reported that she is approachable and supportive. Staff who completed surveys told us that the home is well managed, and some of the comments include: “The home manager is approachable and it makes it a lot easier when concerns are raised”, “The home does well in most aspects, especially providing care and support to both service users and staff. We have a really good staff team and the home manager is very approachable and reasonable. She will support staff in any way possible”. As part of the inspection in order to provide information to help us form judgments about the quality of the service, the manager was asked to complete an annual quality assessment (AQAA) document. This she did, and the document provided the Care Quality Commission (CQC) with a lot of information about the way the home is run, and what they hope to achieve in the future. The AQAA tells us that monthly audits of a range of matters are completed, for example, Health and Safety and Medication. Senior management review these and put any actions in place that are necessary to improve the service. Every six months a satisfaction questionnaire is sent to people living at the home, their relatives and professionals involved in their care. These are sent directly to senior management for evaluation. At least once a month a senior manager of the company has visited the home to make sure it is being properly managed. These are called Regulation 26 visits, and a report of the visit is kept. The AQAA indicates that health and safety checks are carried out at the required intervals, and the manager reported that a health and safety check of the building is done on a daily basis. No concerns around safe working practices were seen on the day of the inspection. Clarence House DS0000070631.V375950.R01.S.doc Version 5.2 Page 29 Clarence House DS0000070631.V375950.R01.S.doc Version 5.2 Page 30 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 4 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 4 X 4 X LIFESTYLES Standard No Score 11 X 12 4 13 4 14 X 15 4 16 4 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 X 3 X X 3 X Version 5.2 Page 31 Clarence House DS0000070631.V375950.R01.S.doc No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA20 Regulation 13 Requirement Arrangements must be made for the correct recording and administration of medication This is to make sure that people are receiving their medication exactly as prescribed. Timescale for action 26/08/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Clarence House DS0000070631.V375950.R01.S.doc Version 5.2 Page 32 Care Quality Commission North Eastern Citygate Gallowgate Newcastle upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries.northeastern@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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