Care Home: Conifers

What the care home does well The admission procedure ensures that people would have a thorough assessment of their needs and aspirations before they move in. Social, leisure and employment opportunities for people to engage in are well managed, age appropriate and provide the people with daily variety and stimulation. Quality in this outcome area is excellent. The arrangements for health care needs of people are good and they receive personal support in the way they prefer. There is a complaints procedure in a format that people can understand. There are suitable vulnerable adult protection and abuse prevention measures in place. There is a small well established staff team that have worked together for a number of years, this has benefited people who use the service providing stability and consistency while dealing with their individual needs What has improved since the last inspection? The services recruitment practice has been improved. Staff training has improved. Person centred plans have improved. What the care home could do better: The service could do more to make sure that people have appropriate risk assessments and risk management strategies in place so that they can be protected fom harm. The bolt on the door leading to the back garden needs to be replaced. The statement of purpose could be reviewed. We would like to thank the people who use the service and the registered provider for their support in the inspection process. Key inspection report Care homes for adults (18-65 years) Name: Address: Conifers 44 Broad Green Avenue West Croydon Surrey CR0 2ST     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: James OHara     Date: 2 7 0 4 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 25 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 25 Information about the care home Name of care home: Address: Conifers 44 Broad Green Avenue West Croydon Surrey CR0 2ST 02086650237 02086832329 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mrs Yvonne Wilson,Mr Milton Anthony Wilson care home 6 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: A variation has been granted to allow one specified resident over the age of 65 to be admitted. Date of last inspection Brief description of the care home Conifers is located in a quiet avenue off a busy thoroughfare close to the centre of Croydon. There is access to local buses and trains, facilities and amenities are all easily accessible. Conifers has been registered to provide support to six people with learning disabilities. Conifers comprises of four floors with the living room, kitchen and laundry in the basement, two bedrooms and a bathroom with access to the back garden on the ground floor, two bedrooms and a bathroom on the second floor and two bedrooms a shower room and a toilet on the top floor. Most people who use the service have done so since it opened and all know each other very well. The registered provider is also the registered manager and owns the property. The current fee charged at Conifers is £520.00 per week. 6 Over 65 0 Care Homes for Adults (18-65 years) Page 4 of 25 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 2 star. This means people who use this service experience good quality outcomes. This key unannounced site visit was carried out over three hours between 9.30 am and 12.30 pm. Methods of inspection included a tour of the premises, observation of contact between staff and people who use the service and discussion with three people who use the service and the registered provider. Records examined included care plans, person centred plans, needs assessments, risk assessments, complaints, adult protection, staffing training, personnel, supervision, medication and health and safety. Requirements and recommendations from the previous inspection were also discussed with the registered provider. The registered provider also completed an annual quality assurance assessment. The annual quality assurance assessment is a self assessment that focuses on how well Care Homes for Adults (18-65 years) Page 5 of 25 outcomes are being met for people using the service. It also gave us some numerical information about the service. Care Homes for Adults (18-65 years) Page 6 of 25 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 7 of 25 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 8 of 25 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. The services admission procedure ensures that people would have a thorough assessment of their needs and aspirations before they move in. Evidence: The service has a statement of purpose and a service user guide. The statement of purpose was last reviewed in 2005. It is recommended that the statement of purpose is reviewed. One person sadly passed away in November 2008. People we spoke to told us that this person was greatly missed however they all attended the funeral and were able to say their goodbyes. The service has an admissions policy that states that people wishing to use the service must have a full assessment from the care management team, full physical and psychological assessments and involvement from family and advocates. One new person moved in on the Friday prior to this site visit. This person has moved Care Homes for Adults (18-65 years) Page 9 of 25 Evidence: in on an emergency short term basis. The registered provider visited this person at their home and carried out an assessment. The registered provider has drawn up a care plan using information provided by the persons care manager, the person and their family. The care manager told us on the telephone that they were forwarding an assessment of the persons needs to the service. Care Homes for Adults (18-65 years) Page 10 of 25 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. People who use the service have care plans and person centred plans that include information on their needs and personal goals. The service could do more to make sure that people have appropriate risk assessments and risk management strategies in place so that they can be protected fom harm. Evidence: Four peoples files were examined, all had had their placement reviewed in the last year by their care managers from the placing authority. We looked at person centred plans for three people, these plans included detailed information on peoples needs and wishes under the headings, what I like people to know about me, who is important to me, what happened at my last review, education, training and employment, what I need help with, my health care needs, who helps me with these, my money and what I would like to do in the future. These plans had been agreed and signed by the people concerned and kept under regular review. Care Homes for Adults (18-65 years) Page 11 of 25 Evidence: A requirement was set at the last key inspection that the registered manager must make sure that appropriate risk assessments and risk management strategies are set in place in order to protect the health and welfare of people who use the service. Risk assessments have been carried out and these have been kept under regular review, some risk assessments have been completed identifying the risk to the individual and how the risk is managed by the service however some risk assessments need to include more detail on the risk to the individual and how the risk is managed. This requirement has been partially met. Care Homes for Adults (18-65 years) Page 12 of 25 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Social, leisure and employment opportunities for people to engage in both inside Conifers and in the wider community are well managed, age appropriate, and provide people with daily variety and stimulation. Evidence: People are encouraged to follow their own interests and hobbies. One person has an interest in trains and has a large model railway in their bedroom, this person also attends a local model railway club and is a keen train spotter. The registered provider told us that people went on holiday to Butlins last year and planned to go there again this year. One person told us they went to Paris earlier this year and was going to Germany in August this year on their birthday. Some people attend day services, college and clubs. Some people go to Church on Care Homes for Adults (18-65 years) Page 13 of 25 Evidence: Sundays. On day of the site visit one person was going to a new college course on IT. One person had recently enrolled in a drama group and acted in a play. Some people attend the local library, ten pin bowling, Mencap Monday Club, walking groups and go to car boot sales. The new person is being supported by staff to work at Asda and go to the physical and able bodied club on Tuesday evenings. All of the people who use the service have contact with their friends and or family. Some people are visited by their family and friends and some people visit and stay with family or friends at weekends or at holiday times. People are involved in menu planning. A varied menu is on offer, which is sufficiently nutritious and takes individual tastes into account, there is also an opportunity for choice with an added menu running concurrently. The registered provider told us that people help with shopping and preparing meals. We spoke to three people who use the service, one person told us that they had recently stopped working at a bus company but they had more time now to do the things they wanted to. They told us that they enjoyed the holiday last year and were looking forward to going to Germany. Another person told us that they were well supported by staff and able to do the things they liked and another person told us they were looking forward to their new college course. Care Homes for Adults (18-65 years) Page 14 of 25 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. The arrangements for health care needs of people who use the service are good and they receive personal support in the way they prefer. Evidence: All of the people who use the service are registered with a local General Practitioner. Health care needs including optical, chiropody and dental health are recorded in appointment monitoring forms located in their files. The registered provider produced evidence that peoples medication is regularly reviewed by their General Practitioners. One person has epilepsy. There are appropriate guidelines and records are in place should they have a seizure. One person has diabetes, the registered provider told us that this person condition is monitored and is diet controlled. Medication is stored in a locked cabinet in the office. None of the people who use the service administer their own medication. Medication administration records were checked on the day of the inspection and were up to date and accurate. The service has the support of a pharmacist for advice and support. Care Homes for Adults (18-65 years) Page 15 of 25 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. There is an appropriate complaints procedure in a format that people who use the service can understand. The service has suitable vulnerable adult protection and abuse prevention measures in place so that people are so far as reasonably practicable protected from abuse. Evidence: There is a clear complaints policy in place that people who use the service can understand, this is included in the service users guide and conspicuously displayed in the hallway. The registered provider told us that there had been no complaints received about the service since the last key inspection. People who use the service attend regular residents meetings, minutes of these meetings indicate that people are encouraged to discuss issues important to them and about how the service is meeting their needs. Any general concerns or complaints that people have could be raised at the meeting. The service has a copy of Croydon Councils Safeguarding Adults procedures in place and all staff has attended Safeguarding Adults training. Care Homes for Adults (18-65 years) Page 16 of 25 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. In general peoples bedrooms were in good decorative order and had appropriate furnishing. The service was clean and free from offensive odours throughout. Evidence: Conifers comprises of four floors with the living room, kitchen and laundry in the basement, two bedrooms and a bathroom with access to the back garden on the ground floor, two bedrooms and a bathroom on the second floor and two bedrooms a shower room and a toilet on the top floor. Bedrooms are of good size and sufficient to meet peoples individual needs and lifestyles. Bedrooms have been decorated to their own personal choices. During a tour of the premises it was observed that the bolt on the back door leading to the garden was broken. The bolt had been used to keep the door locked but it was very difficult to open. The registered provider agreed that this would be dangerous in the event of a fire as the door would be a means of escape. The registered provider must make sure that the bolt on the door leading to the back garden is replaced. On the day of the inspection the premises was clean and hygienic and free from offensive odours throughout. Care Homes for Adults (18-65 years) Page 17 of 25 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. Staff receive regular supervision and training so as to ensure that people benefit from having a consistent approach to their needs. People can be confident that they can be supported and protected because the services recruitment practice has been improved. Evidence: People are supported by the registered provider who also manages the service, three full time and one part time staff. Two members of staff hold National Vocational Qualifications at level two or above. All staff has attended training on food hygiene, first aid, moving and handling, health and safety, medication and fire safety. The registered provider produced evidence that staff are due to attend refresher training on moving and handling, fire awarness, medication and first aid in May 2009. At the last key inspection the registered provider had not obtained proof of identification or a statement as to the persons mental and physical health for a new member of staff. A requirement was set that the registered manager must make sure that staff files include all of the details as stated in Schedule 2 of the Care Homes Care Homes for Adults (18-65 years) Page 18 of 25 Evidence: Regulations. The registered provider has since obtained proof of identification and a statement as to the persons mental and physical health for this member of staff. All members of staff receive regular supervision and have an annual appraisal. Staff training needs are identified at appraisals. Staff meetings take place on a regular monthly basis. Care Homes for Adults (18-65 years) Page 19 of 25 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. People can be sure that their needs are met and wishes are taken into consideration because the service is well managed, the management approach is open, positive and inclusive. People can be sure that hey are protected from harm because good health and safety arrangements are in place. Evidence: The registered provider has worked at the service since it opened in 1996 and has completed the Registered Managers Award and holds a City and Guilds Qualification in the Advanced Management in Care and a BTEC Award for working with people with learning disabilities. The service is well managed and has an open, positive and inclusive atmosphere. The registered provider produced the services quality assurance system. This consisted of relatives and advocates and people who use the service questionnaires, a quality assurance audit and monthly management audits. Care Homes for Adults (18-65 years) Page 20 of 25 Evidence: One relative commented in a survey that the residents are encouraged to live as full a life as possible, another relative commented there is a good family feeling about the home and another commented Conifers is one of the best residential homes. A person living at the service commented I like it here very much. The fire alarms call points are tested by staff on a regular weekly basis and all staff has attended training on fire safety. The registered provider told us in the Annual Quality Assurance Assessment that the premises electrical circuts, portable appliances, fire alarm system, fire fighting equipment and gas appliances had been tested as recommended by the manufacturer or other regulatory body. Care Homes for Adults (18-65 years) Page 21 of 25 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 9 12 (1, 2 and 3). The registered manager 30/06/2007 must make sure that appropriate risk assessments and risk management strategies are set in place in order to protect the health and welfare of people who use the service. Care Homes for Adults (18-65 years) Page 22 of 25 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 13 The registered manager must make sure that appropriate risk assessments and risk management strategies are set in place. This previous requirement has been partially met. In order to protect the health and welfare of people who use the service. 26/06/2009 2 23 The registered provider must make sure that the bolt on the door leading to the back garden is replaced. To provide a clear means of escape to people who use the service and staff in the event of a fire. 28/05/2009 Care Homes for Adults (18-65 years) Page 23 of 25 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 It is recommended that the statement of purpose is reviewed. Care Homes for Adults (18-65 years) Page 24 of 25 Helpline: 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. Care Homes for Adults (18-65 years) Page 25 of 25 - 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!