Care Home: Colin Care Home

Similar services:

• Townley Road, 2-3
• Foxley Lane (121a)
• Tudor Lodge
• Stacey Street Nursing Home
• Delrose House Ltd
• Clovelly House Residential Home Ltd
• Abbey Road [53]
• Cherry Tree House

What the care home does well People`s needs are fully assessed before they are offered a place in the home to ensure that their needs and expectations can be met there. People`s needs are regularly reviewed to make sure they get the right care and support. When a person`s needs change, the home is good at making sure the appropriate action is taken. This includes consultation with other relevant healthcare professionals and making any necessary adjustments to people`s care and support plans. Staff in the home and other health professionals regularly monitor the health of the people living in the home so that they stay as well as possible. Survey responses told us that people were positive about the care they receive. We received other favourable comments about the home. A care professional said, "the care and support offered to X is of the highest standard.....Their paperwork is of the highest standard." Another care manager said, "as a service we have been greatly impressed by the care and support given by Colin Care to X." The home is well maintained so that people live in comfortable, safe and homely surroundings. The new manager is knowledgeable, experienced and provides good support and leadership. People benefit from a stable staff team who have worked in the home for a number of years. Staff clearly understand each person`s individual needs and know how to support them. Their practices promote individual rights and choice, but also consider the protection of individuals in supporting them to make informed choices. The new manager shows a commitment and drive to provide a good quality service at the home and ensures that people using the service are involved with any future developments. Staff spoken to confirmed that they enjoyed their work and felt well supported by the manager. Comments from staff surveys included, " the company always puts service users at the centre." Another wrote, "the home manager is highly supportive and has built a very good working relationship between staff." What has improved since the last inspection? The manager and staff have worked hard to make the required improvements following our last inspection in May 2008. They have shown commitment and dedication to improve standards in the home and this is reflected by the significant reduction in the number of requirements and recommendations being made. Information about the home has been updated for more accuracy and also produced in other formats to meet specific needs. Plans of care were more detailed and individualised to ensure that people`s needs are met. They give staff clear guidance on how to support individuals with personal care and routines in ways that they prefer. Care records reflected any changes to care or support needs and had been regularly reviewed with the full involvement of the person and their keyworker staff. People now benefit from regularly reviewed risk assessments to ensure that best actions to minimise any risks are in place and followed. The overall standard of record keeping has improved significantly for which the home is commended. Quality assurance systems have improved since we last visited. People have been given questionnaires to seek their views about the home and gave complimentary feedback. Some more activities have been arranged according to people`s needs and choices both within the home and out in the local community. At our last inspection, we identified some concerns around medication practices. During this visit, we saw that systems for managing medication have improved so that people are more fully protected. Progress has been made with regards to training and development for staff. Staff have attended further training to keep their knowledge and skills up to date in meeting the needs of people using the service. All staff haveobtained the NVQ qualification level 3 in care which exceeds the required national minimum standard. Under guidance and support from the manager, the staff now have an improved understanding of their role as a keyworker and their responsibility to support each person with their care needs. Staff now benefit from regular supervision that supports staff to do their jobs well and reflect upon their performance and practice. The staff recruitment processes have been strengthened to ensure that the people who live at the home are safeguarded from possible harm and poor practice. People have been given more opportunities to comment and influence how the home is run and to make decisions about their lives. Regular fire safety checks were being carried out to further safeguard the health, safety and welfare of people living and working in the home. Following this key inspection, we have assessed that the home has improved upon standards in the required areas and judged the home to provide good outcomes for the people who use this service. What the care home could do better: The provider confirmed that the home does not provide a service for people with dementia and must therefore apply to have this registration category removed. This is to ensure that people who wish to use the service have accurate information about the range of needs that the care home can accommodate. Although medication practices have improved significantly, as a further safeguard, a risk assessment is needed for one person concerning the management of their epilepsy and taking their medication. Quality assurance systems have also improved but an annual plan is now needed that outlines the expected aims and objectives for improving the services and that reflects the views of people living in the home and their representatives. We have made some good practice recommendations for the home to consider. Any extra expenses should be recorded more clearly in the contract so that people using the service know what additional costs they are expected to pay for. The statement of purpose is revised again for clarity concerning the type of needs that the home can accommodate. Any previous records of discussions should be reviewed at each house meeting. This is to form an audit trail of decision-making and show how agreed actions are being followed up for people who use the service. The home`s job application form for staff should be revised to ensure that a Full employment history is explored and there is a written explanation for any gaps. This further ensures that all staff who work at the home are safe to do so. The home`s quality assurance survey could be revised so that it offers people, relatives and others an option to remain anonymous if they so choose. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Colin Care Home 19 Garlies Road Forest Hill London SE23 2RU     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Claire Taylor     Date: 0 1 0 5 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 34 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 34 Information about the care home Name of care home: Address: Colin Care Home 19 Garlies Road Forest Hill London SE23 2RU 02086995151 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) : colincarese23@yahoo.co.uk Colin Limited care home 4 Number of places (if applicable): Under 65 Over 65 0 0 dementia mental disorder, excluding learning disability or dementia Additional conditions: 4 4 The maximum number of service users who can be accommodated is: 4 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: Dementia - Code DE Mental disorder, excluding learning disability or dementia - Code MD Date of last inspection Brief description of the care home Colin Care is a care home that provides long, medium and short term residential care to four men and women who have incurred a brain injury aged between 18-65. At the time of our inspection there was one vacancy. The home is situated in a residential road close to good transport links to nearby Catford, Lewisham and Forest Hill areas. The home aims to work with people to improve their overall quality of life and promote independence. The home is a large period property and has four large bedrooms two of which are en-suite and one bedroom is situated on the ground floor and three upstairs. There is no passenger lift within the home and so there is limited access for wheelchair users. Care Homes for Adults (18-65 years) Page 4 of 34 Brief description of the care home People are given information about the service at the point when they have an initial visit to the home as part of the assessment process. Copies of the homes Statement of Purpose and Service User Guide can be obtained directly from the home. Fees for this service ranged from £650.00 to £1472 at the time of this inspection. Care Homes for Adults (18-65 years) Page 5 of 34 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This key inspection visit was completed on 28th April 2009 from 10.30am until 7.00pm. We met with the three people who live at the home, the owner, manager and two staff. We looked at various records in relation to peoples care, staffing and the way the home was being run. We also looked around the building and checked to see that the environment was safe. Prior to the visit, the home returned its Annual Quality Assurance Assessment (AQAA) when we asked for it. This is a self-assessment that must be completed once a year. It is used to tell us about the services provided, how well outcomes are being met for people using the service and any planned developments. Some details from the AQAA are included in this report. Following the homes last key inspection in May 2008, we asked the provider to complete an improvement plan which is used to tell us how the home will meet the required Care Homes for Adults (18-65 years) Page 6 of 34 improvements. We received a detailed response within the correct timescale and checked that the plan had been actioned as part of this inspection. Two people living in the home completed have your say comment cards and the third person chose not to respond to their questionnaire on this occasion. We also received surveys from four staff and two care managers. We told the manager what we found at the end of our visit. All those who took part are thanked for their time and contribution to this inspection. What the care home does well: What has improved since the last inspection? The manager and staff have worked hard to make the required improvements following our last inspection in May 2008. They have shown commitment and dedication to improve standards in the home and this is reflected by the significant reduction in the number of requirements and recommendations being made. Information about the home has been updated for more accuracy and also produced in other formats to meet specific needs. Plans of care were more detailed and individualised to ensure that peoples needs are met. They give staff clear guidance on how to support individuals with personal care and routines in ways that they prefer. Care records reflected any changes to care or support needs and had been regularly reviewed with the full involvement of the person and their keyworker staff. People now benefit from regularly reviewed risk assessments to ensure that best actions to minimise any risks are in place and followed. The overall standard of record keeping has improved significantly for which the home is commended. Quality assurance systems have improved since we last visited. People have been given questionnaires to seek their views about the home and gave complimentary feedback. Some more activities have been arranged according to peoples needs and choices both within the home and out in the local community. At our last inspection, we identified some concerns around medication practices. During this visit, we saw that systems for managing medication have improved so that people are more fully protected. Progress has been made with regards to training and development for staff. Staff have attended further training to keep their knowledge and skills up to date in meeting the needs of people using the service. All staff have Care Homes for Adults (18-65 years) Page 8 of 34 obtained the NVQ qualification level 3 in care which exceeds the required national minimum standard. Under guidance and support from the manager, the staff now have an improved understanding of their role as a keyworker and their responsibility to support each person with their care needs. Staff now benefit from regular supervision that supports staff to do their jobs well and reflect upon their performance and practice. The staff recruitment processes have been strengthened to ensure that the people who live at the home are safeguarded from possible harm and poor practice. People have been given more opportunities to comment and influence how the home is run and to make decisions about their lives. Regular fire safety checks were being carried out to further safeguard the health, safety and welfare of people living and working in the home. Following this key inspection, we have assessed that the home has improved upon standards in the required areas and judged the home to provide good outcomes for the people who use this service. 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 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 9 of 34 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 34 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Overall, the home provides good information about the services offered and introduction opportunities so that people can decide whether the care home can meet their support and accommodation needs. People have an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. Evidence: At our last inspection, we required for the Statement of Purpose to be rewritten as it was unclear as to the range of needs that the home could accommodate. The manager had reviewed the document as well as the Service User Guide in July 2008. Both were clear and reflected all the required information to ensure that people or their relatives know about the service and facilities available to them. Large print and photos had been added to make the information more accessible as well as photos of the staff team and each members role. We looked at the homes registration certificate which included the category of dementia. As an individual with a main diagnosis of dementia could have potentially different care and support needs from those individuals that Care Homes for Adults (18-65 years) Page 11 of 34 Evidence: have mental health needs, the home would need to clearly demonstrate how these would be met. The provider confirmed that the home does not provide a service for people with dementia and must therefore apply to have this category removed. We further recommend that the Statement of Purpose is revised again for clarity. Feedback from two surveys was that both people received enough information about the home before moving there. One person had recently moved in and we looked at their records. The home had undertaken their own assessment and there was a recent Enhanced Care Programme Approach (CPA) detailing their needs and presenting risk factors as well as other reports from professionals including a psychiatric report. The care plan approach (CPA) provided by the placing authority was up to date and the homes care plan was based upon the desired outcomes from the needs assessment. The manager carries out a needs based pre-admission assessment on all prospective residents. We saw that the assessment was detailed and covered a persons whole life needs as well as any known risks to their welfare. These assessments ensure that admissions to the home only take place once the manager is confident that their care needs can be met. We saw in records that people are introduced into the home at a level and pace appropriate to them, through visits, meals and an overnight stay. There is a three month settling in period which allows time for the individual and the home to determine if the service is suitable to meet their needs, wishes and aspirations. We also saw a completed induction checklist which outlined any support a person might require when they first move in. This had been signed by the person and their keyworker. The contracts were clearly written and contained information about fees and the obligations of the provider and person living in the home. We saw that staff had discussed these contracts with people and they had signed their contract, as had the manager of the home. We suggest that the information about any extra costs should be written more clearly within the contract. Care Homes for Adults (18-65 years) Page 12 of 34 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements have meant that care plans are more person centred and staff know how to support peoples needs. People are given good opportunities to influence how the home is run. People are supported to take risks that promote their independence as well as their safety. Evidence: We looked at care records for all three people, one of whom had recently moved in to the home. We saw that there has been significant improvements with record keeping meaning that staff have the information they need to support people in meeting their needs. Each external professional care plan (CPA) was found to be detailed in such areas as psychological / mental health needs, personality and preferences. These included an individual care plan that stated how staff are to support the person to meet their needs and help them achieve their goals. Each care plan contained a personal profile and information relating to peoples physical and mental health, family networks and preferred routines and interests. Care records included clear information Care Homes for Adults (18-65 years) Page 13 of 34 Evidence: about any specific preferences in relation to peoples ethnicity and culture. A requirement has been met for care plans to include more information about peoplesneeds and goals. In response to our last inspection, records showed that regular review meetings involving the person and other significant parties were being held. Any changed needs were clearly documented so that staff have up to date information about the type of support each individual requires. Records showed that keyworkers are now expected to review care plans on a three monthly basis and up date them accordingly to reflect any changes in needs. Staff were familiar with what was written in peoples care plans and could talk confidently about the support they give. We saw detailed reports of discussions held between each person and their keyworker staff. Peoples plans gave a good overview of their holistic needs and clear direction about the most appropriate ways to give the required care and support. In response to our last inspection, the manager has ensured that there are regular opportunities for people to participate in meetings about the home. We saw records of such meetings which were being held every month. Topics included discussions about food menus, outings, activities, staffing and general day to day house issues. These showed that peoples views are valued and they can make decisions about the way the home is run. As good practice, we suggest that the home reviews the previous meeting minutes each month to show how any actions agreed have been acted upon. Staff complete detailed daily notes concerning peoplesgeneral well being and if there have been any changes to their care needs. Any risks to people through general health,needs or activities are assessed and clear action to reduce any risks had been recorded. At our last inspection we required the home to ensure that risk plans were reviewed at least six monthly and that staff received some training around risk management. We saw detailed risk management plans for people that identified what action should be taken to lessen risk, whilst encouraging independence. Examples seen included personal care, safety in the home, accessing the local community, smoking, fire awareness and management of epilepsy for one individual. Each plan was signed in agreement by the person and had been reviewed every three months. All staff have received some training on risk management through completing their NVQ level 3 qualification in care. These requirements had therefore been met. Planned improvements on the AQAA said,We intend to introduce the services of an independent advocate to enable service users have an external and independent means of airing their views, concerns and share aspirations. We received four staff surveys and a 100 response that they were always given up to date information about the needs of the people they support. For what the home does well, one staff wrote, the service treats service users as individuals.Another wrote, individual service user person centred plans are in place and followed.The company promotes service users independence & development. Based on the evidence we saw for this key inspection, the home has made significant improvements to its care planning systems meaning that peoples needs are more fully met. Care Homes for Adults (18-65 years) Page 14 of 34 Care Homes for Adults (18-65 years) Page 15 of 34 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are able to make choices about their lifestyle and on the whole, activities are offered to suit their individual needs and expectations. Visitors are welcome and people are supported to keep in touch with their families and friends. People have nutritious and attractive meals and snacks, at a time and place to suit them. Evidence: In response to our last inspection, the home has made good efforts to increase the range of activities for people that meet their needs and chosen interests. on a daily basis, people take part in a breakfast meetingso they can plan their day. People were leading different lifestyles dependent on what they liked, could and/or wanted to do wherever possible. Two people wrote on their surveys that they always made decisions about what to do each day and one person wrote,usually do my own thing Care Homes for Adults (18-65 years) Page 16 of 34 Evidence: during the day. On the day of inspection one person told us that they now enjoyed going swimming once a week. Another person had expressed an interest in doing voluntary work and had completed an application form with support from their keyworker. Activity records showed peoples aims and ambitions, and how staff are to support each person with their social interests and occupation. Some people are independent in leaving the home to make visits to the local community. Motivation in respect of personal care and attending activities remains low for one person and they are resistive to any encouragement in these areas. This was reflected in their care plan and CPA report. The manager and staff were making good efforts to support the person to try out activities and had made some progress by arranging regular visits to a local barber. In addition, the person has weekly music and head massage sessions. We met with the person but they chose not to speak to us or give any views about the home on this occasion. The manager had also written several letters to the placing local authority to organise a referral to a local day centre for this person but was still awaiting a response at the time of our visit. Care records include details about each persons social needs and who is important in their lives. Families are involved and the staff support people to visit and to keep contact with those that are close to them. One person stays with their family for an overnight stay every other week. Records showed that families and representatives are very involved with the home and their views are taken into account. We saw that peoples right to privacy is respected and that they can choose when to spend time alone or with others in the house. In house activities include television, DVDs and playing dominoes. The manager explained that plans were underway to arrange holidays later in the year and people were in the process of making their choices. We looked at the menus which showed a varied and healthy diet with a choice of meal. People can make their own drinks and snacks and one person had a support plan to help them learn and develop cookery skills with an expected move back to independent living. People we spoke to said that the food was good and we saw that the written menus included their chosen preferences. A choice of meal is provided and people are consulted about changes they want to see on the menus. There is a separate dining room where people can sit together or if preferred, they can eat in their bedrooms. Care Homes for Adults (18-65 years) Page 17 of 34 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples health and welfare is closely monitored to ensure that their physical and emotional needs are met. Medication practices have improved so that people are more fully protected although as a further safeguard, a risk assessment is needed for one person concerning the management of their epilepsy. Evidence: Two people living at the home do not require practical support regarding personal care. One person is resistant to any prompting regarding bathing or changing clothes and their care plan reflected this. We saw good information about healthcare needs in the individual care plans. Records confirmed that each person is fully supported to access relevant mental health services and that the home maintains effective communication links with other relevant professionals. We received complimentary feedback on surveys from two care professionals. When asked are individuals healthcare needs properly monitored and attended to by the care service? both ticked always. For what the home does well, another wrote,observation of any immediate change in Xs mental state. The care plans clearly outlined the support a person may need for health check-ups and health screening. For example, one person has diabetes Care Homes for Adults (18-65 years) Page 18 of 34 Evidence: and guidance was available for staff to support them to manage their condition. The person wanted to try out an alternative way of managing their diabetes and records confirmed that the staff had supported them to achieve this. The AQAA also stated, With the involvement of GP and the local PCT, we were able to help introduce, monitor and manage this lifelong illness by use of tablets as opposed to the daily insulin. People attend health check ups with the dentist, optician and chiropodist to ensure their health needs are met. These allow for any health issues or interventions to be monitored and acted upon. People are able to arrange their own health care appointments or staff provide support where needed. At our last inspection in May 2008 we found that several improvements were needed concerning the management of medication. The manager and staff have worked hard to address the requirements and have put control measures in place to ensure safer practice. We saw that in-house medication training for staff had been completed and the manager had carried out a competency assessment on each staff. At the time of our visit, the home was about to change pharmacy and there were plans for all staff to attend refresher training from the new pharamacist. The manager said that he aimed to achieve this by the end of June 2009. We had also required the home to ensure that stock medication checks were completed and that the temperature of the storage cabinet was regularly monitored. There was a digital thermometer inside the medicine cabinet and records of daily temperatures seen. Each person had a detailed profile which gave staff up to date information about the type of medication, the reasons for its use and any allergies or side effects that they must be aware of. Where as required medication had been prescribed, people had written guidelines to inform staff on what action to take before this type of medication can be given. The relevant GP had also signed to approve these guidelines. Records also told us that a relevant healthcare professional undertakes regular medication reviews for supporting each persons well being and health. All medicines stored in the home on behalf of the people who use the service were stored securely in a metal lockable cabinet in the office. We spoke with one staff and they showed some good knowledge and understanding of the medicines that people were prescribed. In addition we observed safe practice when medication was administered. The Manager reported that none of the current people living in the home manage their own medication but if required, they would be given the support they need. Medication records were accurate for the receipt, disposal and return of medication. The administration charts were all signed and accounted for. Records told us that one person likes to take their medication in private and on occasions, will either take their medicines much later in the day or sometimes refuse them. The person is prescribed a particular medication for the management of their epilepsy and it is therefore important that doses are administered at the correct intervals. Although there was guidance for staff to seek medical advice if the person missed 2 doses, the home must develop a risk plan and consult with the GP on specific timescales. For example if the person did not take their morning medication at the correct time, this Care Homes for Adults (18-65 years) Page 19 of 34 Evidence: would have an impact on them being able to take their evening dose at the prescribed time. To minimise the risk of error and further safeguard the persons welfare, a risk plan is therefore needed that includes the correct time intervals for administering this type of medication. Aside from this issue, the home has made good improvements in managing medication and peoples health and welfare was being more fully protected through safer practices. Care Homes for Adults (18-65 years) Page 20 of 34 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The homes arrangements for dealing with concerns and complaints have improved so that people who use the service feel listened to and their views are acted upon. Other improvements have ensured that people are more fully protected and staff have a better understanding of recognising and preventing abuse. Evidence: The home has a comprehensive complaints procedure and each person is given a copy when they move in. People are able to voice their opinions and have regular meetings and day to day contact with the manager. At our last inspection we required the home to improve upon the way it dealt with and recorded any concerns or complaints. We saw a revised complaints procedure (December 2008) which was also included in the Service User Guide and had been given to each person. People living in the home ticked on their surveys that they knew how to complain and who to speak to if they were unhappy. One person also wrote on their survey there is always someone here. A second person we spoke to also confirmed that they were often asked what they thought about the home and they would tell the manager if they had a problem. Staff ticked on their surveys that they knew what to do if a person or relative raised concerns about the care or services they receive. One care manager wrote, any concerns are dealt with immediately. Another survey response said,on several occasions X raised concerns about the shower. Each time the provider attended and responded immediately to Xs concerns and complaint in a satisfactory manner. The Care Homes for Adults (18-65 years) Page 21 of 34 Evidence: procedure was written clearly and stated who would deal with a complaint and the expected timescale for response. Photos of the owner, manager and current staff team were also included. In addition there was an informal complaints book for recording concerns or issues raised by people who use the service. This included a section to record any outcomes and whether the complaint was resolved or not. The manager had also started a second complaints book for staff to note down any issues. The AQAA stated that there has been one formal complaint made about the service in the past twelve months. Records showed the matter was dealt with appropriately and within the 28 day timescale, and that it was resolved as the complainant was happy with the outcome. Records showed that all staff at the home have undertaken recent training in safeguarding vulnerable adults through the local authority of Lewisham. The manager had also completed a course on safeguarding training for managers. We saw an updated policy on safeguarding that was issued in December 2008. Written in a clear and easy to read format, it gave clear details about recognising different types of abuse and how to refer concerns of this nature to the relevant local authority. All four staff surveys we received confirmed that Criminal Record Bureau checks had been carried out before they started work. The manager confirmed that the home does not have responsibility for managing any of the finances for people at the home. In response to our last inspection, We saw an up to date risk assessment for one person concerning their vulnerability on looking after their own money. We have received no complaints or safeguarding alerts about this home in the last 12 months. Care Homes for Adults (18-65 years) Page 22 of 34 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience 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, homely and safe environment. Bedrooms are designed and furnished to meet peoples individual needs, personal preferences and interests. The premises is clean, hygienic and kept in a good state of repair. Evidence: Colin care home is well placed to access local transport links, community facilities and shops. Since our last inspection, there have been some home improvements within the premises. The stair carpet has been replaced and all of the bedrooms have been redecorated. Two people using the service ticked that the home was always fresh and clean and the third person chose not to respond to the survey. There is a spacious lounge with comfortable furniture and decor. People have access to a well maintained garden through double doors in the lounge. The kitchen is domestic in nature and we observed that people can freely use the facilities to prepare their drinks and meals. One person showed us their bedroom which had been furnished as they liked. They said they had everything they needed and that the owner repaired things when necessary. Some people smoke in their bedrooms and appropriate risk assessments were in place to ensure a safe environment. We saw that the home was both clean and tidy with good hygiene practices in place. Cleaning materials and other hazardous substances were securely locked in a cupboard. Some fire precautions need improving Care Homes for Adults (18-65 years) Page 23 of 34 Evidence: however. We saw that one bedroom fire door was propped open with a rubber wedge and staff explained that the person likes to keep their door open most of the day. As this practice could compromise peoples safety in the event of a fire, an appropriate door closure device that connects directly to the fire alarm system needs to be fitted. The manager took prompt action to address this and sent us evidence that a dorgard fire door retainer was installed on the 2nd May 2009. Care Homes for Adults (18-65 years) Page 24 of 34 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported by a stable staff team who have a range of skills and experience to meet their needs. Improved recruitment practices have meant that people are more fully protected from unsuitable workers. Increased training and regular supervision for staff has resulted in a more skilled workforce to meet peoples individual and collective needs. Evidence: This is a small service and people are supported by a small but stable staff team that has remained largely unchanged in the last twelve months. The manager advised that there was only one full time vacancy and that agency staff are never used as the regular staff will cover shifts where needed. The low turnover of staff showed that people benefit from stability and consistent care. Rotas showed that staffing levels were between 1-2 staff during the day with a sleep-in duty at night. At our last inspection we identified some areas for improvement concerning staff recruitment, training and supervision. We also asked the provider to ensure that there was sufficient arrangements for management cover at all times. We saw that the manager had done a great deal of work to meet our requirements. Rotas confirmed that either the manager or provider was available on call in the event of an emergency and staff had clear direction on how to summon assistance if needed. We looked at two staff Care Homes for Adults (18-65 years) Page 25 of 34 Evidence: files which included the most recent employee. Files were well organised and contained the necessary information. Records confirmed that staff had undergone appropriate checks such as a CRB disclosure and check against the Protection of Vulnerable Adults register. Staff files contained all the required checks to evidence their fitness to work with this service user group as well as individual training certificates. The homes recruitment procedures are thorough and designed to ensure that staff are vetted correctly and people are safeguarded. People living in the home are involved with recruiting new staff and we saw that one person sat in on an interview with the manager to ask questions. We suggest that the homes job application form should be revised to request any future employees full employment history and not the previous ten years. Good progress has been made with regards to staff training and previous requirements addressed. All care staff have obtained the NVQ qualification level 3 in care. This exceeds the national minimum standard for which the home is commended. The manager had completed a training schedule to show what courses staff have done, when they did them and when they must refresh. Most of the training is accessed through Lewisham local authority who offer a wide range of courses that covered key health and safety issues as well as courses geared towards the specialist needs of the people who use the service. For example, epilepsy, challenging behaviour and mental health. We looked at training certificates for two staff. Since our last inspection, some of the recent raining has included mental health in later life, first aid, safeguarding, drug and alcohol awareness and in house fire safety. In addition, a district nurse had visited the home to provide some training on diabetes. Records showed that staff were in need of some refresher training on epilepsy however. This will ensure that they are up to date with current developments and ways of working with people who have such specific needs. Following our inspection, the manager wrote to confirm that training was scheduled for completion by the end of June this year. Two people ticked that staff always treat them well and that staff always listen and act on what they say. Four staff who works at the home replied to our questionnaire and responded that they each had appropriate recruitment checks carried out prior to starting work. They ticked that they were given training relevant to their role and that there were always enough staff to meet the individual needs of the people using the service. One health professional wrote I have found the staff to be skilled, proactive and diligent in managing X. This indicates that people using the service are supported by a trained and competent staff team who know their needs, preferences and aspirations. Records showed us that staff receive a thorough induction to the post and are supported in their jobs through regular supervision and an annual appraisal of their work. All four staff surveys confirmed they meet regularly with their manager to offer support and discuss their work. One staff wrote, the home manager is highly supportive and has built a very good working relationship between staff. Through supervision with the manager, staff had been given a copy of the roles and responsibilities of a keyworker. This is good practice and ensure that staff are clear Care Homes for Adults (18-65 years) Page 26 of 34 Evidence: about how to support each person and what the role entails. Staff meetings are held regularly. We looked at some minutes of these meetings which showed clear discussions for keeping everyone up to date and sharing information about developments and practices in the home. For how the home has improved, the AQAA stated, Staff team have been involved in the setting up of new care plan formats and they have regular key work sessions with the users and this has increased their knowledge on such administrative tasks required in care settings. Care Homes for Adults (18-65 years) Page 27 of 34 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is a new manager who has a good leadership approach to run the home in the best interests of the people who live there. People are often consulted about quality of the services provided and have influence over the way the home is run. There are good arrangements for monitoring the quality of care provided although an overall plan is needed to show how any outcomes are acted upon. Record keeping has improved to ensure that peoples rights and best interests are safeguarded. The environment is safe for people and staff because health and safety practices are carried out. Evidence: Since this home opened in 2006, there has been several changes of manager and the lack of consistency had a rather detrimental effect on the running of the home. This led to a number of repeated requirements being made due to some failures to meet them within the given timescale. We therefore asked the home to send us an improvement plan following our last inspection in May 2008. The new manager, Mr Martin Makweti was appointed in March 2008 and over the last year, he has taken Care Homes for Adults (18-65 years) Page 28 of 34 Evidence: action to meet our requirements and improve outcomes for the people who use the service. He has many years experience in working with people who have learning disabilities and has managed services for people with both learning disabilities and associated mental health needs. Certificates confirmed that he successfully completed the required NVQ level 4 qualification and has attended some training courses relevant to his role. Discussion showed that he is knowledgeable about each persons unique needs and understands the importance of person centred care and effective outcomes for people who use the service. He had applied to register but has been asked to resubmit the application form as some of the required records were out of date. At the time of our visit, Mr Makweti confirmed that he has made a second application to register with us. The manager offers clear leadership, guidance and direction to staff. Staff spoken with told us the manager is always approachable and supportive and has made a real difference here. A staff survey said, he has been quite consistent at sharing his knowledge and expertise in order that staff may improve on the quality of care which is being provided to the residents. People living at the home told us they were happy with how it is run. On how the home has improved over the last 12 months, the AQAA stated, The acting manager and proprietor are currently undertaking the Leadership and Management NVQ L4 course as a means of enhancing the quality of management. The manager advised that he hoped to complete this qualification by the end of November this year. As previously required, the home made some progress to develop a quality assurance system. Peoples views are sought through regular reviews and monitoring of their care, and monthly house meetings encourage people to make decisions and choices about the way they want to live. In September 2008, satisfaction questionnaires were offered to people, their families, the staff and some professionals involved with peoples care. We sampled some of the completed surveys which were all positive. Although the manager had analysed the survey results, an overall annual plan now needs to be written up. This should identify the strengths and weaknesses in the service and show how the home plans to make improvements over the forthcoming year. We also suggest that the questionnaire is revised to offer people anonymity if they so choose. The registered provider visits the home once a month and completes an audit of the service. We sampled these reports which showed that the owner monitors the conduct of the home and takes action on areas that need attention. The returned AQAA gave a realistic summary of the home and we saw evidence to support this during our inspection. Previous inspection requirements (May 2008) that centred around fire safety checks have been addressed meaning that the health, safety and welfare of people living and working in the home is better safeguarded. We saw records of regular tests on fire alarm call points, emergency lighting and also that staff had been involved in practice fire drills at least annually. The home has good systems in place that aim to promote the health, safety and welfare of the people using the service, staff and visitors. In addition, there is clear policy guidance for staff to follow regarding a range of health and safety Care Homes for Adults (18-65 years) Page 29 of 34 Evidence: activities. As required by law, the service keeps us informed of any reportable events and we saw clear reports for any incidents or accidents. The completed AQAA stated that all relevant safety checks were up-to-date. We confirmed this when we checked the homes servicing and maintenance records including gas and electrical safety. Records showed that equipment had been regularly tested to make sure it was safe to use. Detailed risk assessments, including one for fire were available. Health and safety training opportunities are offered to staff at all levels and records were in place to reflect this. The home manager now keeps records to show what training courses staff have done, and when they are due to refresh. Certificates showed that training undertaken since the last inspection has included infection control, first aid, moving and handling, food hygiene and an in house session on fire safety. Plans were in place for staff to update at suitable intervals. We saw that staff had not received any formal fire training and after our visit, the manager promptly sent us evidence that staff were booked on a course run by Lewsiham local authority for June 2009. Care Homes for Adults (18-65 years) Page 30 of 34 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 31 of 34 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 1 4 That the provider makes an application to have the category of dementia removed from the services registration. So that people who wish to use the service have accurate information about the range of needs that the care home can accommodate. 30/09/2009 2 20 13 For the person who has epilepsy, a risk assessment is needed that includes the correct time intervals for administering their medication. To further safeguard the persons health and welfare and minimise the risk of error. 30/07/2009 3 39 24 An annual quality assurance plan is needed that is based upon the homes quality management systems and findings. 30/09/2009 Care Homes for Adults (18-65 years) Page 32 of 34 To show what action has been taken to improve the quality and delivery of services for people and highlight where any further improvements are needed. 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 1 That the statement of purpose is revised again for clarity concerning the type of needs that the home can accommodate. Any extra expenses are recorded more clearly in the homes contract so that people using the service know what additional costs they are expected to pay for. That there is a clear record of discussions held of house meetings. This is to form an audit trail of decision-making and show how these are being followed up for people who use the service. The job application form for staff is revised to include a request for a Full employment history and written explanation of any gaps. This further ensures that all people who work at the home are safe to do so. That the homes quality assurance survey is revised so that it offers people, relatives and others an option to remain anonymous if they so choose. 2 5 3 7 4 34 5 39 Care Homes for Adults (18-65 years) Page 33 of 34 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 34 of 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!