Care Home: Conifers

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What the care home does well Each person had a care plan which described what they like, dislike and how staff are to support and care for them. Residents are involved in making decisions about how they live their lives and how the home is run. They attend regular meetings to make decisions about the things that are important to them such as menus, meals, activities and the manager trys to improve on ways that will enable residents to voice their views. Each resident has a health action plan and information about their health care needs is recorded. Staff ensure that people living in the home receive the medicines they need, attend routine appointments for health checks and that they see the doctor if they are unwell. Residents general health and well being is monitored and they are encouraged to eat healthily and to participate in exercise as part of a healthy lifestyle. People living in the home can go out to local pubs, restaurants and places of interests. They have regular visits to and from family,friends and spend time with other people who are important to them.ConifersDS0000017958.V377022.R01.S.docVersion 5.2 What has improved since the last inspection? The manager has improved the daily report format to enable staff to review the content easier. He has improved the environment to help residents to enjoy life safely wider doors in the lounge. All staff are trained to a NVQ level or have started training for the NVQ. What the care home could do better: Issues were raised by us about the standard and frequency of general renewals, replacement and redecoration of the home. Key inspection report CARE HOME ADULTS 18-65 Conifers Harriets Farm Bungalow Church Street Bocking Braintree Essex CM7 5LH Lead Inspector Sarah Axam Key Unannounced Inspection 6th August 2009 09:00 Conifers DS0000017958.V377022.R01.S.doc Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care home adults 18-65 can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Conifers DS0000017958.V377022.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Conifers DS0000017958.V377022.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Conifers Address Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Harriets Farm Bungalow Church Street Bocking Braintree Essex CM7 5LH 01376 550779 01376 550779 saliya@saliya2.wanadoo.co.uk Mr Upul Saliya Sumaranayake Mr Upul Saliya Sumaranayake Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Conifers DS0000017958.V377022.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 9th September 2008 Brief Description of the Service: Conifers is a detached bungalow situated in a quiet residential area on the edge of Bocking village. This home accommodates 6 people who are between the ages of 18 and 65 years of age who have learning and physical disabilities. The registered owner and manager is Mr Sumaranayake. Residents’ private rooms are for single occupancy. The home has a large private and well-maintained garden at the rear of the property and ample car parking facilities at the front. There is a local shop and local transport, the centre of Braintree being only a short distance away. The home also has a mini bus, which is in use daily. As at 21st November, the manager stated the fees as being £850 per week and extras to the fees include hairdressing and toiletries. Conifers DS0000017958.V377022.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is *2 star. This means that the people who use this service experience Good quality outcomes. The unannounced site visit took five hours to complete and was carried out as part of the annual inspection programme for this service. This visit was conducted with assistance from the manager/Provider. As part of the process a number of records relating to residents, care staff and the general running of the home were examined. We looked at all the information that we had received, or asked for, or what the service has told us about things that had happened in the service since the last inspection. Two staff were spoken with during the site inspection. Prior to this site visit, CQC (Care Quality Commission) sent out surveys to all interested parties. Additionally the manager was sent an (AQAA) Annual Quality Assurance Assessment form by us. This is a self assessment required by law that asked how well the service is meeting the needs of the people who live at Conifers Care Home. All information obtained was triangulated and reviewed against the commissions key lines for regulatory activity. This helps us to use the information to make judgments about the outcomes for the people who use this service in a consistent and fair way. The last key inspection for this home was carried out on the 9th September 2008. What the service does well: Each person had a care plan which described what they like, dislike and how staff are to support and care for them. Residents are involved in making decisions about how they live their lives and how the home is run. They attend regular meetings to make decisions about the things that are important to them such as menus, meals, activities and the manager trys to improve on ways that will enable residents to voice their views. Each resident has a health action plan and information about their health care needs is recorded. Staff ensure that people living in the home receive the medicines they need, attend routine appointments for health checks and that they see the doctor if they are unwell. Residents general health and well being is monitored and they are encouraged to eat healthily and to participate in exercise as part of a healthy lifestyle. People living in the home can go out to local pubs, restaurants and places of interests. They have regular visits to and from family,friends and spend time with other people who are important to them. Conifers DS0000017958.V377022.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Conifers DS0000017958.V377022.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Conifers DS0000017958.V377022.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 2 People using the 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 have all their care and support needs assessed before moving in. EVIDENCE: The manager told us in the Annual Quality Assurance Assessment that all prospective residents are visited and their suitability assessed. That an overnight or weekend stay can be arranged if required. We looked at all peoples care plans and saw that the home carried out detailed assessments with people who were considering using the service. We saw within this information that the person, their family, healthcare professionals and any others involved in supporting them were part of this process. Information looked at told us that some people had made overnight and weekend visits to see if the home was suitable for them. Residents who returned surveys to us told us that they had good information given to them prior to moving in and that this had included a statement of purpose and service user guide. During the visit we saw that these documents was in place and were up-to- date. We saw that this information was available in a pictorial format for those people who found it difficult to read. Conifers DS0000017958.V377022.R01.S.doc Version 5.2 Page 9 Conifers DS0000017958.V377022.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 People using the 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 have an independent lifestyle, are supported in decision making and informed risk taking. EVIDENCE: The manager told us in the Annual Quality Assurance Assessment that care plans provide goals for individual residents to enable choice, independence as much as possible. We saw in documentation looked at that before any service is offered, information about residents support needs is gathered. We saw by looking through all peoples care plans that this information then forms the initial basis of the service users care package and risk assessments. We saw that these were developed further overtime. This to ensure the staff can provide the right level of support at all times regardless of a persons changing needs. We saw Conifers DS0000017958.V377022.R01.S.doc Version 5.2 Page 11 that reviews of care and risk assessments and medication are undertaken yearly. These reviews included the person, social worker, family and consultant if need be. Additionally if high risk issues were raised before this time then a review would be held before this twelve month period. The staff surveys returned to us indicated they are given information about the needs of the people they support regularly. One survey noted We are kept well informed about any new information concerning the people we support. Another staff survey noted We are fully informed about all the people we are supporting. Residents who returned surveys to us said they are very happy with the support they receive. One said I like the staff, they are always kind and everything is fine. Another said I get on well with my key worker who helps me with lots of things I like to do. Information about residents is handled and stored securely in order to maintain their confidentiality. Conifers DS0000017958.V377022.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): This is what people staying in this care home experience: 12, 13, 15, 16 and 17 People using the 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 being encouraged to do more things that interest them like going to college or leisure activities. EVIDENCE: The manager told us in the Annual Quality Assurance Assessment that all people have equal access to activities that are available locally, such as, the local library, cinema, shops, pub, restaurants, parks, swimming, bowling and trips out in mini bus. We saw and discussed with the manager how people are involved in some of the domestic tasks. He told us that people were supported to clean and tidy Conifers DS0000017958.V377022.R01.S.doc Version 5.2 Page 13 their bedrooms and to carry out some laundry tasks. Two residents enjoyed gardening and were encouraged to use these skills alongside staff support. Staff supported residents to eat a healthy and well balanced diet and to monitor weight on a regular basis. The staff at the home cook all meals for people. Information showed us that they held the relevant qualifications need for this role such as, food hygiene and infection control. Kitchen equipment and regular checks were all in order. There was a four week menu in place that showed us that the likes of residents that were recorded in their information were reflected in the meals provided and that they had a varied and good quality of diet. Conifers DS0000017958.V377022.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 People using the 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 experience good support in managing their health and personal care needs. EVIDENCE: The manager told us in the Annual Quality Assurance Assessment that the health and personal care needs of residents are met and that staff are trained to administer medicines safely. When we visited the home we looked at all of the peoples care plans and how the personal and health care needs of the residents were assessed and how residents were supported. Within this it described the person and the things they like and dislike. There was information recorded about how the person wished to be supported to maintain personal care and hygiene. We looked at how staff supported residents with their healthcare needs. Each person Conifers DS0000017958.V377022.R01.S.doc Version 5.2 Page 15 had a health action plan, which described their needs and how staff were to assist and support them. We saw that staff supported residents to attend appointments to monitor their general health and welfare. They showed us that all people had good access to medical professionals and facilities such as, GP, consultants, psychology, dentist, opticians, chiropody, occupational health and other specialist services. All people looked well cared for and at ease within the with the staff on duty. Resident surveys returned to us indicated they feel their privacy and dignity is always respected by the support staff. Staff working in the home received training and information so that they handled and administered medicines to residents in a safe way. Where residents were capable of safely handling medicines they were fully supported to do this. Conifers DS0000017958.V377022.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 People using the 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 to make their views known if they are unhappy about anything. EVIDENCE: The manager told us in the Annual Quality Assurance Assessment that we listen to our residents views and act upon them at all times. We communicate well with outside agencies to minimise any possibilities of complaints We saw that there are policies and procedures available to staff so they are clear on their responsibilities and know how to work safely. We saw that staff have completed training on how to ensure service users are protected from abuse, neglect and self harm. During discussion the manager demonstrated an understanding of the different types of abuse and that he knows how to deal with allegations of abuse correctly. A copy of the Essex adult protection procedure is in place to support him with this. We saw that a whistle blowing procedure is available to staff so they can raise concerns anonymously. No allegations of abuse have been made about this service. One of the staff surveys returned to us noted I found my most recent training on safeguarding vulnerable adults very good as it related to peoples needs. Conifers DS0000017958.V377022.R01.S.doc Version 5.2 Page 17 A complaint procedure is in place so that residents and their relatives know what to do if they are unhappy about the quality of the support they receive. No complaints regarding this service have been received since the last key inspection. Conifers DS0000017958.V377022.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 People using the 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 comfortable, clean and homely environment that has been improved over the last year. EVIDENCE: The manager told us in the Annual Quality Assurance Assessment that the home is kept clean and free from odours. Walking around the home we saw that it was clean, with no odours and safe. Some of the fixtures and fittings were tired and in need of replacing and some of the décor needed upgrading. There was no maintenance plan in place. We discussed with the manager the need to have an action plan that addresses general maintenance issue so that the up keep of the service as a whole is gradually addressed and put into place. This will reassure the people who live there that these things will be achieved and completed at some point. Conifers DS0000017958.V377022.R01.S.doc Version 5.2 Page 19 Conifers DS0000017958.V377022.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35 People using the 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 staff group who are qualified, experienced and available to support people when they need it. EVIDENCE: The manager told us in the Annual Quality Assurance Assessment that all staff have worked at the Conifers for a number of years. When we visited the home we looked at staffing levels and found that staff had been in post a number of years and that each shift is covered by permanent staff. We saw by looking through eight staff files that the manager ensures that all staff are supervised appropriately and have regular meeting held. This means the residents receive good support to enable them to live their lives in the way they prefer. Conifers DS0000017958.V377022.R01.S.doc Version 5.2 Page 21 According to the AQAA most of the staff are qualified to National Vocational Qualification level 2 or above in care. (a recognised qualification for staff involved in the care profession) We saw this to be the case when looking at staff documentation. Files showed us that staff are provided with induction training when they are first employed. (So they are clear on their responsibilities and know what is expected of them) We saw that thorough recruitment and selection procedures are in place and that the necessary checks are carried out before staff are employed. (to ensure they are suitably qualified and competent) The staff who returned surveys to us said they enjoy their work and feel well supported in their role. They said the manager is very supportive and available for advice when needed. Conifers DS0000017958.V377022.R01.S.doc Version 5.2 Page 22 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is run in peoples best interests ensuring that their health and safety is protected. EVIDENCE: The manager told us in the Annual Quality Assurance Assessment that the manager is a trained nurse [ E.N(MS) ] and gained NVQ4 in management and has over 30 years experience with people with learning disabilities. The registered manager has been in post for many years, has achieved much and holds a wealth of experience and knowledge of the current resident group and this goes towards securing the health, safety and welfare of all people. It Conifers DS0000017958.V377022.R01.S.doc Version 5.2 Page 23 also provides consistency of care and supports staff to maintain the quality of care given to all people. We looked at the homes quality assurance system which took into account the views of people who use the service, their families, staff and others involved in their care and support. We saw that questionnaires were sent to people who use the service and others involved in their care. We could see that these results were collated by the manager and that informed the homes action plan. When we visited the home we saw that there were risk assessments in place to identify where each person may be vulnerable such as in managing money. Staff supported residents to access money from their bank accounts and kept good records where monies were held for safekeeping on residents’ behalf. We looked at the arrangements for ensuring that the home was maintained safely. We saw that regular checks were carried out on equipment such as hot water and heating systems, fire alarms and fire fighting equipment, gas and electrical installations and equipment. All equipment was well maintained and repaired as required. Conifers DS0000017958.V377022.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 X Version 5.2 Page 25 Conifers DS0000017958.V377022.R01.S.doc Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA24 Regulation 23 Requirement The registered person shall make sure the premises are fit for purpose and are appropriate to the needs of the residents. This is because many of the communal areas and some residents bedrooms need repainting, repairing and redecoration. Timescale for action 31/12/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Conifers DS0000017958.V377022.R01.S.doc Version 5.2 Page 26 Care Quality Commission Care Quality Commission Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 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) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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