Care Home: Clarence House And The Granary

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What the care home does well People told us they are happy and like living at the home because it is comfortable.People can make their own decisions and choices.People are helped to be more independent.People are asked for their opinions about how the home should run.The staff are well trained and know how to look after people.The manager is very helpful and supportive. What has improved since the last inspection? There are more opportunities for people to use local community facilities.There is more training provided for staff. What the care home could do better: There could be more details in care plans about how people like to take their medicines.There could be more information about how to give people medicines that they only need now and again.There could be a report written about what the manager finds when she checks the care plans. Key inspection report Care homes for adults (18-65 years) Name: Address: Clarence House And The Granary 53 West Street Horncastle Lincs LN9 5JE The quality rating for this care home is: three star excellent service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Wendy Taylor Date: 0 5 0 2 2 0 1 0 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. The first part of the review gives the overall quality rating for the care home:  3 stars – excellent  2 stars – good  1 star – adequate  0 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. They reflect the things that people have said are important to them: This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement Care Homes for Adults (18-65 years) Page 2 of 35 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 35 Information about the care home Name of care home: Address: Clarence House And The Granary 53 West Street Horncastle Lincs LN9 5JE 01507524466 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : clarencehouse@prime-life.co.uk info@prime-life.co.ukwww.prime-life.co.uk Prime Life Ltd care home 21 Number of places (if applicable): Under 65 Over 65 18 3 learning disability Additional conditions: Date of last inspection Care Homes for Adults (18-65 years) Page 4 of 35 A bit about the care home Clarence House is near to the town of Horncastle. It is near to the local shops, pubs and bus routes. 21 Clarence House can be home for up to 21 people with a learning disability. Across a courtyard from Clarence House is another part of the home called The Granary. Eight Care Homes for Adults (18-65 years) Page 5 of 35 8 people can live in this house. There is some space to park cars in the courtyard, and there are gardens for people to use, and a patio area. It costs between £421:00 and £637:09 each week to live at the home. Information about these costs and the management of the home are available in the main office of the home. Care Homes for Adults (18-65 years) Page 6 of 35 Care Homes for Adults (18-65 years) Page 7 of 35 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home Care Homes for Adults (18-65 years) Page 8 of 35 How we did our inspection: This is what the inspector did when they were at the care home The quality rating for this home is 3 stars. This means that people get excellent quality outcomes. We had a lot of information before we visited the home, like surveys that people sent to us. This helped us to know what the home is like. *** An inspector visited the home to see how things are done. Care Homes for Adults (18-65 years) Page 9 of 35 We spoke to the people who live there. We spoke to the manager and staff, and watched how they did their jobs. We looked at things like care plans, staff records, and how people are helped to look after their money. Care Homes for Adults (18-65 years) Page 10 of 35 What the care home does well People told us they are happy and like living at the home because it is comfortable. People can make their own decisions and choices. People are helped to be more independent. Care Homes for Adults (18-65 years) Page 11 of 35 People are asked for their opinions about how the home should run. The staff are well trained and know how to look after people. The manager is very helpful and supportive. What has got better from the last inspection Care Homes for Adults (18-65 years) Page 12 of 35 There are more opportunities for people to use local community facilities. There is more training provided for staff. What the care home could do better There could be more details in care plans about how people like to take their medicines. Care Homes for Adults (18-65 years) Page 13 of 35 There could be more information about how to give people medicines that they only need now and again. There could be a report written about what the manager finds when she checks the care plans. If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the Page 14 of 35 Care Homes for Adults (18-65 years) inspector please contact Wendy Taylor CQC East Midlands Citygate Gallowgate Newcastle upon Tyne NE1 4PA Tel: 03000 616161 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 - 0870 240 7535. Care Homes for Adults (18-65 years) Page 15 of 35 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 16 of 35 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A clear assessment process means that people know that the home can meet their needs and wishes. Evidence: We looked at the files for three people who live at the home. The files show a detailed assessment of the things that they need help with, and the things they like to do. The assessments include things like the daily routines that people prefer to follow, important people in their lives, and their likes and dislikes. There is also lots of information about things like how they communicate, and how they move around. People told us through surveys, and by talking to them that they had chosen to live at the home, and they had been asked about the things they needed and wanted. Information we had before we visited shows that senior staff complete assessments with people before they come to live at the home, and we know that there is a checklist in peoples files to show that people have been introduced to the home in a way that suits them. We saw that all of the information about the home is available in different formats so that every one can use them. Care Homes for Adults (18-65 years) Page 17 of 35 Care Homes for Adults (18-65 years) Page 18 of 35 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Robust care planning and knowledgeable staff mean that people receive personalised support. Evidence: We saw that everyone has a set of care plans that help them to get the support they need. The care plans include information about things like how people are kept safe, how they are supported with their behaviour, and how they like to be supported with their personal care. Files have personalised photographs to help the person understand the information, and people sign their care plans where they are able to. People told us that they know about their care plans and staff help them to complete the plans. One person told us that they have just changed their activity plan as they wanted to do something different. Files also contain assessments and plans for anything that might put the person at risk, including things like road safety. These plans cross reference with care plans so that information is easy for people to follow. Care Homes for Adults (18-65 years) Page 19 of 35 Evidence: Everyone we spoke to, and people who sent us surveys told us that they are able to make their own decisions about their daily lives. Peoples personal files contain assessments about how they make their decisions and choices. Other records that we saw show that staff are trained about how to provide care in an individual way, help people live the life they chose to, and make sure that their rights are upheld. Staff were able to describe peoples needs in a lot of detail, including how people react in various situations. Care Homes for Adults (18-65 years) Page 20 of 35 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are able to follow their chosen lifestyles, and they enjoy a range of activities and foods that suit their needs and wishes. Evidence: People and their relatives told us through surveys, and by speaking to them that people can choose what activities they like to do, and they can become more independent if they want to be. People told us about college courses that they are doing, and also work placements. They also told us that they help to do household chores such as cleaning and shopping, and everyone takes a turn to do this. People told us that they are supported to keep up their relationships with family and friends, and we saw that there are care plans in peoples files that show staff how to do this. People told us that they get their own mail, and staff will help them to read and understand letters if they need to. We saw plans and information about social activities that people can join in with, and Care Homes for Adults (18-65 years) Page 21 of 35 Evidence: there were lots of photographs around the home showing people enjoying outings and holidays. Whilst we were at the home we saw people working in the kitchen, going out to do personal shopping, doing art work, and watching TV. A person who lives at the home showed us around the kitchen and explained that menus are planned around what people like to eat. They told us that people can choose to eat different things if they dont want what is on the menu. We were told that people who live in the home take turns to work in the kitchen with the cook, and we saw this during our visit. We saw people enjoying a balanced meal at lunchtime, and we saw that there was a wide range of food available in the kitchen for people to choose from. People said that they like the food at the home. Staff were providing individual support with meals to those people who needed such, and they demonstrated that they knew how people like that support to be given. Care Homes for Adults (18-65 years) Page 22 of 35 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Satisfactory systems are in place to make sure that people get the health and personal support that they need and want. Evidence: Everyone who lives at the home has a health action plan that shows how they like to be supported with things like going to the doctors, or how often they see an optician. There are also care plans for other health needs such as helping people to develop their self esteem. Records show that the care plans are reviewed and updated regularly by keyworkers. Information we had before we visited shows that when people come to live at the home they have an assessment of their diet so that staff can make sure they get the right foods. Whilst we were at the home we saw that people were being supported to go to well man and well woman clinics. We also saw records of when people had been to see healthcare professionals such as their GP or dentist. Each person has a personal information sheet that they can take to healthcare appointments or hospital visits which show things like the medicines they are taking at the time. The people we spoke to told us that they can see their GP whenever they need to and staff help them to make appointments. There are records to show what medicines people have taken in the past, and an up to Care Homes for Adults (18-65 years) Page 23 of 35 Evidence: date record of what medicines people are taking now. The records show what the medicine is used for and how the person recognises the medicines. We spoke to the manager about recording more details about how people like to take their medicines, and she said that she will update the information in peoples files. We also spoke to the manager about recording how people take medicines that they may only need occasionally. We saw that staff follow the medication policy when they give people their medicines, and the records to show that people have had them were up to date. We also saw that the medicines that are kept in the home are checked weekly by staff to make sure that they have enough for people to take. The manager told us that the local pharmacy regularly visits to check medication processes. Staff records show that they are given training and supervision to help them support people with their medication in the right way. Care Homes for Adults (18-65 years) Page 24 of 35 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are protected by clear systems and policies, and a knowledgeable staff team. Evidence: Records show us that there have been no complaints made about the service provided at the home since the last inspection visit. Records also show that people are given a copy of the complaints procedure when they come to live at the home, and we saw poster about how to make a complaint during our visit. People told us through surveys and by talking to them that they know how to make a complaint and who to talk to if they are not happy with anything. They said that staff listen to them and help them to sort out any problems. Relatives of people who live at the home told us that any concerns they have raised have been dealt with in the right way. Since our last inspection visit the home has made one referral to the Local Authority Safeguarding Adults Team. Records show that the home took the right actions to make things safer for people and the Safeguarding Team were satisfied with those actions. Staff records show that they are given training about how to keep people safe, and when we spoke to staff they were able to tell us how they would identify and manage any situation where they thought people were at risk of harm. We saw that there is a copy of the Local Authority guidance for keeping people safe for people to follow, and the home also has its own policy about this. Care Homes for Adults (18-65 years) Page 25 of 35 Evidence: We looked at the way peoples money is looked after by the home. There is a clear system to record when money goes into peoples account and when it is taken out. Money is kept in a locked safe which only two senior staff have access to. Receipts are kept to cross reference any money used. One person who lives at the home told us all about the procedures that are in place to keep their personal money safe. Care Homes for Adults (18-65 years) Page 26 of 35 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a comfortable and clean home, that suits their needs and wishes. Evidence: The home was very clean and tidy when we looked around, and the furniture and decoration was in a good state of repair. People told us that they were very comfortable living in the home, and they showed us how they had personalised their own bedrooms with things like the decorating, pictures, photographs and soft furnishings. They said that staff respect their privacy and always wait to be invited into their rooms. Some people told us that they choose to have a key to lock their room and other people choose not to have one. There is a choice of several communal lounges and a dinning room for people to use, and the manager told us about possible plans to rearrange the use of rooms based on how people currently use them. For example, adding an informal sitting area in the current dinning room. Information we had before we visited the home shows that there is an ongoing maintenance plan for the home, and we saw records to show that repairs and maintenance are carried out in a timely manner. A person who lives at the home told us how they help to lessen the risk of spreading Care Homes for Adults (18-65 years) Page 27 of 35 Evidence: infection by using things like aprons and gloves when they need to, and how they wash their hands thoroughly. During the visit we saw staff and people who live at the home using these things in the right way. We saw that substances that could cause harm to people were locked away, and there was information available about these substances that show people how to use them in a safe way. Staff records show that they are given training about how to lessen the risk of spreading infection, and how to manage harmful substances in the right way. Care Homes for Adults (18-65 years) Page 28 of 35 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from a well trained and safely recruited staff team. Evidence: We watched how staff did their jobs during the visit. We saw that they supported people in a personalised way, and that they responded quickly to any requests for support. People told us that staff treat them very well and one person said they are like friends. Relatives of people who live at the home said that staff are approachable and helpful, and they are well trained. Staff told us that they have a good training programme that helps them to do their jobs well, and one staff member said its a great place to work. They also told us that there are enough staff on duty to give people the support they need. Training records show that staff learn about things like epilepsy, nutrition, mouth hygiene, how to supervise other staff, and first aid. The records also show that staff are given a thorough induction to the home, and one staff member said that this helped them to understand their role. Staff said that they went through a thorough recruitment process, and their files show that that things like application forms, two references, identification, and criminal record bureau checks are obtained before they start work. Care Homes for Adults (18-65 years) Page 29 of 35 Evidence: We know that there is a system in place to supervise and support staff in an individual way. Records show that staff receive regular supervision, and staff confirmed this when we spoke to them. They said that they find the sessions useful and can sort out any issues they may have. Care Homes for Adults (18-65 years) Page 30 of 35 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home continues to be well managed, and people who live there benefit from being are involved in its day to day running. There are robust systems in place to promote peoples health, safety and welfare. Evidence: The current registered manager has been in post for over eight years. Our records show that she has maintained a consistent management approach within the home, and during this inspection people who live there and staff told us that she continues to give them lots of support, and she is always available when needed. One person said she is excellent. Records kept in the home show that since the last inspection she has completed training in subjects such as dementia, supporting people to make decisions, and nutrition. Our records show that the manager tells us about all of the things that happen in the home that effect the lives of the people who live there. She also sent us a self assessment of the service when we asked for it, which shows all of things that have improved in the home in the last year. For example, they have increased the opportunities for people to use local community facilities, and increased the staff training opportunities. Care Homes for Adults (18-65 years) Page 31 of 35 Evidence: We know that the provider organisation has a detailed quality assurance programme, which includes carrying out surveys of what people who live there think of the home. There are also records of audits for things like finance, maintenance, and medication records. The manager told us that she audits care plans regularly but there was no formal recording of this. We saw records of regular visits from the providers area manager, and the reports of the visits show that people who live in the home have a chance to say what they think, and that things like the quality of care plans is looked at. People told us that they always get a say in how things are done in the home, and that staff and the manager ask them for their opinions. We looked at the general record keeping within the home. For example we saw that there were risk assessments in place for things like falls, grass cutting, using sharp objects, and moving and handling. There is a clear accident reporting system, and these records were detailed. We saw that there is a fire risk assessment in place, and fire safety records were up to date. People who live in the home, and staff were able to explain what to do if the fire alarm sounded. Care Homes for Adults (18-65 years) Page 32 of 35 Are there any outstanding requirements from the last inspection? Yes  No  Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 33 of 35 Requirements and recommendations from this inspection Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No Standard Regulation Description 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 Description 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 1 20 It is recommended that protocols for the administration of medicines given only when necessary are in place. This is to make sure that the administration and monitoring of these medicines is consistent, and helps to keep people safe. It is recommended that regular audits of care plans are formally recorded. This is so that outcomes can be evaluated and used make improvements to the care planning process. 2 39 Care Homes for Adults (18-65 years) Page 34 of 35 Helpline: Telephone: 03000 616161 or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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