Care Home: Coombe Road (82)

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What the care home does well All the written and verbal feedback we received from the services major stakeholders, which included the people who live at 82, Coombe Road, their relatives, and staff who work there was very positive. Typical comments included, `i like living here...its my home`, `as parents we our so grateful to the staff for improving the quality of our loved ones life`, and `the manager and all his staff are always most helpful`. Michael Luganda has been in operational day to day control of 82, Coombe Road for 7 years and this continuity of provision has ensured the people who use the service have benefited from living in a home that has been consistently well run by a suitably competent and experienced manager. All the staff we observed during our visit interacted with all the people who use the service in a very kind, respectful and professional manner at all time. The manager and staff met all demonstrated a good understanding of the needs, wishes, and preferences of the people they supported. It was evident from comments made by the manager and staff that they know how to appropriately deal with behaviours that challenge and would only resort to using approved physical intervention techniques or `as required` psychotropic medication in exceptional circumstances. Staff are well trained and supported by their managers to perform their duties of care. There are also more than enough staff on duty at all times to meet the needs of the people who use the service. We were particularly impressed with the managers flexible approach to planning the duty rosters which ensures additional staff are always on shift to cover peak periods of activity. This ensures there are always `extra` staff available to take the people who use the service out into the wider community on various day trips and social events. The service has a `can do` attitude when it comes to supporting the people who use it to take `responsible` risks to enable them to develop their independent living skills. Staff were observed actively encouraging people to do more for themselves by washing up, making hot drinks and going shopping. The service has developed some excellent quality assurance systems, which enable all the people who use the service and their representatives to express their views and influence how the home operates. Finally, the atmosphere in the home doing the course of this visit remained extremely relaxed and congenial. What has improved since the last inspection? The one outstanding requirement identified in the services last report has been addressed. During a tour of the premises we noticed the work to turn a first floor room into a sensory room has been completed. The new sensory room was well equipped and fit for its new purpose. As recommended in the last report a new carpet has been fitted in the main lounge.The home has also been suitably adapted to make it more wheelchair accessible. A ramp has been installed in the rear garden to improve access to the services car park and certain doors on the ground floor fitted with automatic fire release mechanisms which enables them to be propped open during the day . Care plans have also been improved in the last 12 monhts. They are now far more accessible to the people who use the service and staff, thus ensuring all the relevant parties have all the information they require to meet the needs and wishes of the servcie users. The service has managed to develop some excellent tools to enable the people who use it to be consulted on and participate in all aspects of life in their home. This includes new menus, which are now available in photo form, thus enabling all the people who use the servcie to have far greater opportunity to choose what they eat at mealtimes. The people who use the service are also actively encouraged to join in monthly staff meetings and one to one sessions with their designated keyworker. The manager has introduced new shift plans for staff to follow when they are duty. All the staff met agreed these new `aide memoirs` helped them remember their daily routines and tasks, especially those relating to health and safety checks. What the care home could do better: All the positive comments made above notwithstanding the manager openly concedes the service is far from `perfect`. We have made a list of all the areas of practise we believe the servcie could be doing better in: Care plans should contain up to date risk assessments that make it clear all the people who use the service were consulted about whether or not they wished to take greater responsibility for looking after their own medication and finances, and if so, whether they were capable of doing it safely. Any restrictions placed on service users freedom of choice or movement must be assessed and recorded in their care plan. This will ensure service users rights to make informed decisions and to go where they choose in their own home are not restricted unnecessarily. Guidance for staff to follow when using approved physical intervention techniques to deal with certain incidents of challenging behaviour should be reviewed at least annually with all the relevant parties, including the service users professional representatives. This will minimise the risk of service users suffering abuse through the unnecessarily use of excessive force to manage behaviours that challenge. The providers should consider establishing a time specifc action plan to replace the rather worn out carpet in the entrance hall. The providers should also consider assessing the continued suitability of all the homes exterior wooden window frames and sills, which from a distance appear to have seen better days.The manager should be mindful of the ethnic imbalance which current exists between his staff team and the pople who use the service when he next recruits new staff. Finally, the provider should establish a time specific action plan setting out how they intend to ensure sufficient numbers of its current staff team achieve an NVQ in care (Level 2 or above). This will ensure all the homes staff have the necessary knowledge and skills to meet the service users needs. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Coombe Road (82) 82 Coombe Road Croydon Surrey CR0 5RA     The quality rating for this care home is:   three star excellent 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: Lee Willis     Date: 3 0 0 7 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 35 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 35 Information about the care home Name of care home: Address: Coombe Road (82) 82 Coombe Road Croydon Surrey CR0 5RA 02086818078 02086818078 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) : Milbury Care Services Ltd care home 8 Number of places (if applicable): Under 65 Over 65 0 learning disability Additional conditions: 8 The maximum number of service users who can be accommodated is: 8 The registered person may provide the following category of service only: Care Home Only (CRH - PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Learning disability - Code LD Date of last inspection Brief description of the care home 82 Coombe Road is owned by Voyage and is registered with the Commission to provide personal care and support for up to eight generally middle aged (i.e. aged 40 to 65) adults with learning disabilities. Michael Luganda, who has been the registered manager of the service since November 2003, remains in operational day-to-day control. This detached Victorian property is set back from a main road in a residential suburb to the South east of Croydon and is opposite a large park. Local trams and buses stop right outside the home and central Croydon with its wide variety of shops, banks, restaurants, and other leisure facilities is no more than a ten minute ride away. The property is built over three stories and comprises of eight single occupancy bedrooms; a main lounge; separate dinning area with a conservatory attached, new sensory room, large kitchen, laundry room, top floor office, and staff sleep-in room. Care Homes for Adults (18-65 years) Page 4 of 35 Brief description of the care home The garden at the rear of the property is mainly laid to lawn and is well maintained. The providers ensure people who live at the home are given a guide and a contract, which contains information about what services, and facilities are offered, and what people can expect to pay for them. Care Homes for Adults (18-65 years) Page 5 of 35 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The quality of life the people who live at 82, Coombe Road has continued to improve in recent years. We have therefore decided to increase its star rating from two to three making it an excellent performing service. From all the available evidence gathered during this Key inspection it was evident the home now has a substantial number of strengths, as well as a sustained track record of delivering good performance and managing improvement. Where areas for improvement have emerged the service continues to recognise and manage them well. We spent 4 hours at the home during our afternoon visit. In this time we met four people who use the service, the registered manager, and three support workers. We also looked at various records and documents, including the care and health action Care Homes for Adults (18-65 years) Page 6 of 35 plans for two people who currently use the service. The remainder of the visit was spent touring the premises. Four of our satisfaction surveys were returned to us. These had all been completed with support from their keyworker or a relative by the people who use the service. The manager also completed and returned our Annual Quality Assurance Assessment (AQAA) form when we asked for it. The self-assessment (AQAA) tells us what the manager believes the service does well, how it has been improved in the past year, and what they could do better. What the care home does well: What has improved since the last inspection? The one outstanding requirement identified in the services last report has been addressed. During a tour of the premises we noticed the work to turn a first floor room into a sensory room has been completed. The new sensory room was well equipped and fit for its new purpose. As recommended in the last report a new carpet has been fitted in the main lounge. Care Homes for Adults (18-65 years) Page 8 of 35 The home has also been suitably adapted to make it more wheelchair accessible. A ramp has been installed in the rear garden to improve access to the services car park and certain doors on the ground floor fitted with automatic fire release mechanisms which enables them to be propped open during the day . Care plans have also been improved in the last 12 monhts. They are now far more accessible to the people who use the service and staff, thus ensuring all the relevant parties have all the information they require to meet the needs and wishes of the servcie users. The service has managed to develop some excellent tools to enable the people who use it to be consulted on and participate in all aspects of life in their home. This includes new menus, which are now available in photo form, thus enabling all the people who use the servcie to have far greater opportunity to choose what they eat at mealtimes. The people who use the service are also actively encouraged to join in monthly staff meetings and one to one sessions with their designated keyworker. The manager has introduced new shift plans for staff to follow when they are duty. All the staff met agreed these new aide memoirs helped them remember their daily routines and tasks, especially those relating to health and safety checks. What they could do better: All the positive comments made above notwithstanding the manager openly concedes the service is far from perfect. We have made a list of all the areas of practise we believe the servcie could be doing better in: Care plans should contain up to date risk assessments that make it clear all the people who use the service were consulted about whether or not they wished to take greater responsibility for looking after their own medication and finances, and if so, whether they were capable of doing it safely. Any restrictions placed on service users freedom of choice or movement must be assessed and recorded in their care plan. This will ensure service users rights to make informed decisions and to go where they choose in their own home are not restricted unnecessarily. Guidance for staff to follow when using approved physical intervention techniques to deal with certain incidents of challenging behaviour should be reviewed at least annually with all the relevant parties, including the service users professional representatives. This will minimise the risk of service users suffering abuse through the unnecessarily use of excessive force to manage behaviours that challenge. The providers should consider establishing a time specifc action plan to replace the rather worn out carpet in the entrance hall. The providers should also consider assessing the continued suitability of all the homes exterior wooden window frames and sills, which from a distance appear to have seen better days. Care Homes for Adults (18-65 years) Page 9 of 35 The manager should be mindful of the ethnic imbalance which current exists between his staff team and the pople who use the service when he next recruits new staff. Finally, the provider should establish a time specific action plan setting out how they intend to ensure sufficient numbers of its current staff team achieve an NVQ in care (Level 2 or above). This will ensure all the homes staff have the necessary knowledge and skills to meet the service users needs. 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 10 of 35 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 11 of 35 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The services Statement of Purpose and Guide are available in easy to read formats that enable the people who use the servcie and their representatives to determine what facilities and services the home offers and whether or not the place is right for them. The services admissions procedures reflect best practice and the manager demonstrated a good understanding of thee implementation. Evidence: As stated in the services AQAA the manager was able to produce easy to read versions of homes Statement of Purpose and Guide on request. These documents were written in plain language and illustrated with a variety of pictures, symbols and photographs to enable the pople who use the servcie to have access to their contents. 100 of the people who use the service who completed our surveys with support from either their relatives or staff told us they were asked if they wanted to move into 82, Care Homes for Adults (18-65 years) Page 12 of 35 Evidence: Coombe Road, and they and their representatives got enough information about the home before they moved in so they could decide if it was the right place for them or their loved one. AQAA tells us that all six of the people who currently use the service have access to a copy of the homes latest CQC (formerly the CSCI) report and have a copy of their agreement with their funding authority. The manager also wrote in the AQAA that no placements have broken down or any new service users admitted in the past 12 months. The manager demonstrated a good understanding of what constituted best practice regarding new admissions and assured us he would not accept any new referrals if he did not think the new servcie user was compatible with the existing servcie user group and/or his staff team were capable of meeting their needs effectively. Care Homes for Adults (18-65 years) Page 13 of 35 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans have been improved to make them more accessible to the poeple who use the service and staff, thus ensuring all the relevant parties have all the information they require to meet the needs and wishes of the servcie users. The servcie has developed excellent arrangements to enable the people who use it to be consulted on, and participate in, all aspects of life in their home. The service has a can do attitude when it comes to supporting the people who use it to take responsible risks as part of a structured programme to promote independent living skills. However, the way staff record the outcome of assessments carried out to determine whether or not people are willing and capable of taking greater responsibility for certain more aspects of their lifes needs to be improved. Evidence: We looked at half the care plans that had been developed for the pople who use the Care Homes for Adults (18-65 years) Page 14 of 35 Evidence: servcie. They were all person centred and set out in great detail how these individuals current personal, social, and health care needs were being met through positive interventions, and what their unique strengths and preferences were. We thought information about individuals specialist communication needs and preferred methods of communication was particularly good, which enable staff to have a good understanding of how to interact with the people they supported. All the staff met told us they thought this relatively new care plan format was a much better working tool and generally easier to use than previous plans. The new care plan format is also written in plain language and illustrated with various pictures, symbols, and photographs to enable it to be understood by the people for whom they have been developed. The manager told us all the pople who use the servcie were actively encouraged by their designated keyworkers to get involved in the process of creating these new care plans. The service is commended for using positive non-restrictive interventions, which have been successfully implemented to prevent one service user in particularly challenging the servcie and continually harming themselves. All the feedback we received from relatives about the progress the service had made to improve this individuals quality of life was extremely positive. A relative who returned one of our surveys wrote - we as parents have seen an enormous difference in our loved ones life thanks to this home. Documentary evidence was produced on request that showed us care plans are being reviewed at least bi-annually and up dated accordingly to reflect any changes in need or circumstances. The manager told us anyone who is subject to the Care Programme Approach to care planning have their placements reviewed at more regular intervals which involves all the relevant mental health professionals. As stated in the AQAA a servcie user we spoke with at length confirmed that had a designated keyworker which they had helped choose. This individual also told us they regularly meet with their keyworker and the manager was able to produce documentary evidence on request that showed us one to one meetings with keyworkers were being held on a monthly basis. During a tour of the premises we noted an information board in a communal area which was full of useful information about activities, leisure facilities, and social events that were happening in the local community. Since he last inspection the service has developed photographic menus to enable the pople who use the service to have more informed choices about the meals they eat. We were impressed with these new menus we sampled at random. A person who uses Care Homes for Adults (18-65 years) Page 15 of 35 Evidence: the service told us they liked the pictures on the new menus. A wide variety of risk assessments were contained in the care plans examined in depth, which covered most aspects of these particular individuals personal, social, and health care needs. It was also evident from the comments made by the manager and other staff met that the servcie was committed to supporting the people who use the service to take responsible risks and to do as much for themselves as they were willing and capable of doing. For example, we observed several people who use the service being actively encouraged and supported by staff to engage in various household chores, including washing up, making hot drinks, and sorting out that days post. One service user spoken with at length told us they regularly go food shopping with staff as they knew what they liked to eat. However, all the positive points made above about the services can do attitude regarding supporting the people who use the servcie to develop their independent living skills and not restricting their freedom of choice and movement unnecessarily, recorded assessments of the risks associated with these activities were not always contained in the relevant care plan. For example, all care plans should contain up to date risk assessments that enable anyone authorised to inspect them to determine whether or not the pople who use the service were firstly willing, and then capable, of looking after their own medication and/or finances. Care Homes for Adults (18-65 years) Page 16 of 35 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The social, leisure, and recreational activities the people who use the service have the chance to participate in each day, both at home and in the wider community, remains varied and stimulating. Dietary needs and preferences are well catered for ensuring the people who use the service are provided with daily variation and choice. Evidence: As required in the services last two inspection reports the manager told us that as stated in the AQAA work on the new sensory room was now complete. During a tour of the premises we viewed the new sensory room, which was well equipped and fit for its purpose. Care Homes for Adults (18-65 years) Page 17 of 35 Evidence: 50 of the people who use the service who returned our surveys with support from their relatives or staff said they could always make decisions about what they did each day, while the rest wrote this was usually or only sometimes the case. Nonetheless, 100 ticked yes in response to the question - can you do what you want to do during the day, evenings, and weekends. As stated in the AQAA we found evidence to support the managers claim that as a result of listening to the people who use the service new furniture and plants have been put in the garden and weekly menus have been revised to include pictures to enable the people who use the service to have more choice. As previously mentioned in this report the staff were observed actively encouraging and supporting the people who use the service engage in a number of household chores, as well as leisure activities. We spoke to one person who uses the servcie who was busy making bead necklaces, which they told us they enjoyed doing. This individual also told us they were learning to cook at college and that sometimes they made their own meals at home. During a tour of the premises we observed another service user enjoying the swing in the garden , which was one of their hobbies we identified from their care plan. Care plans contained detailed information about each service users social interests and hobbies, and staff maintain up to date records of all the social activities people who use the servcie choose to engage in each day. It was evident from activity records sampled at random that the people who use the servcie are offered a relatively good balance of in-house and community based activities to participate in each day, which includes attending local colleges and day centres, eating out, day trips, walks in the local park, accessing public transport, home visits by a aromatherapist, and regular music mornings. The manager told us all the people who use the servcie have been away on holiday with staff in the past year. The manager confirmed that as stated in the AQAA there are no limitations on responsible visiting times for the relatives and friends of the people who use the service. The manager told us service users relatives are always invite to attend their loved ones Birthday parties and other social events organised at the home. The manager also told us it is the responsibility of each service users keyworker to keep relatives informed about all the significant events that occur in their loved ones life. The lunch time meal served o the day of this inspection smelt and looked very appetising, and could be identified in a photograph on that weeks menu. Care plans contain detailed information about each service users food and drink preferences, as well as their dislikes. It was also evident from information contained in care plans Care Homes for Adults (18-65 years) Page 18 of 35 Evidence: being case tracked that where appropriate advice had been sought from the relevant professionals to encourage healthy eating. It was positively noted that a record of the food actually consumed by the pope who use the servcie also reflected their diverse cultural tastes. For example, we noted that Caribbean style cuisine was often prepared by staff, which reflected the cultural heritage of one person who uses the servcie. One person who uses the servcie told us they liked the meals served and sometimes they went food shopping with staff. Care Homes for Adults (18-65 years) Page 19 of 35 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Suitably robust arrangements are in place to ensure the people who use the service receive personal support in the way they prefer and require, and that their unique physical and emotional health care needs are continually recognised and met. Policies and procedures for handling medication are sufficiently robust to keep the people who use the service safe and free from abuse through the inappropriate use of medication as a chemical restraint. Evidence: All the people who use the service we met were dressed in well maintained clothes that were age appropriate. One person who uses the service told us they go clothing shopping with their keyworker. The manager confirmed that as stated in the AQAA the home offers same sex personal care where this is appropriate. Staff maintain detailed records of the outcome of all the appointments the people who use the service have with health care professionals, which showed us the servcie Care Homes for Adults (18-65 years) Page 20 of 35 Evidence: routinely seeks input from all the relevant health care professionals. Staff maintain monthly weight charts for service users who are on a professionally agreed programme to control their weight, which is constantly monitored and reviewed. The manager confirmed that no major accidents involving the people who use the servcie have occurred in the past. The manager was aware that we should be notified immediately about the occurrence of any significant incident or event which adversely affects the health or well being of the people who use the service. The manager confirmed that as stated in the AQAA the home does not currently stock any Controlled Drugs on behalf of the people who live there, and that there have been no serious incidents involving the handling of medication within the past 12 monhts. No recording errors were noted on medication administration sheets sampled between the monhts of May and July 2009. All the medication held by the home on behalf of the service users is securely stored away in a locked cabinet in the office. The manager told us that in addition to staff staff always checking medication every time it is dispensed, he carries out spot checks on all the staffs medication handling practises at regular intervals. Protocols for the use of as required behavioural modification medication was made available upon request. records maintained by staff indicated that this type of medication had been used sparingly in the past year and staff met confirmed that it should only be used as a last resort when all other strategies to deescalate a challenging incidetn had failed. It was positive note that when as required medication had been sued staff always stated clearly on the back of the relevant MAR sheet their rationale for deciding to administer it at that time. Administration records kept regarding the use of as required medication reflected current stocks held in the home. Care Homes for Adults (18-65 years) Page 21 of 35 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The homes arrangements for dealing with concerns and complaints are sufficiently robust to ensure the representatives of the people who use the service feel their views will be listened to and acted upon. In the main the people who use the service are protected from abuse and neglect because staff understand what constituted best practise regarding safeguarding. However, the way the service records and reviews it decisions to limit service users freedom of choice and/or movement when its considered to be in their best interests needs to be improved. Evidence: 100 of the people who use the service with support from either staff or their relatives told us they knew who to speak to if they were not happy and how to make a complaint. An easy read version of the services complaints procedures were produced on request. As stated by the manager in the services AQAA we noted that no complaints about the homes operation have been made in the past year. The manager told us the service takes all complaints seriously and would always investigate them. Similarly, the manager confirmed that as stated in the AQAA no allegations of abuse have been made within the service in the past year and no staff referred for possible including on the Protection Of Vulnerable Adult (POVA) register. Two staff met Care Homes for Adults (18-65 years) Page 22 of 35 Evidence: demonstrated a good understanding of what constituted abuse and who they should notify if they suspected or witnessed abuse at the home. The manager told us all his current staff team had received safeguarding training. The manager told us that none of the staff have been required to use their Non Violent Crisis Intervention (NV CI) training to deal with incidents of challenging behaviour for over two years. Staff met confirmed professionally approved physical intervention techniques should only ever be used as a last resort to deal with incidents of challenging behaviour and that their NVCI was refreshed on an annual basis in line with best practise guidelines. The relevant care plan contained specific guidance for staff to follow when using NVCI approved physical intervention techniques when dealing with certain types of aggression. However, this risk management strategy had not been reviewed since March 2008 and lacked the agreement of all the relevant professionals. During a tour of the premises we noted a bathroom and toilet on the first floor remained locked. The manager told us this was done to prevent one servcie user harming themselves and was not unnecessarily restrictive because the only other service user who frequently used this toilet was able to access it without staff support. We observed the aforementioned servcie user accessing this toilet without staff support during our visit. The restriction appears to have been made in the servcie users best interests and it not unnecessarily restrictive, although the manager did concede that no risk assessments regarding its implementation had been carried out. Care Homes for Adults (18-65 years) Page 23 of 35 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The services interior decor, fittings and soft furnishings ensures the people who use the service live in a very homely and comfortable environment. The recent adaptations made to the homes interior and garden ensure it is far more accessible for people with mobility needs. The homes arrangements for controlling infection are sufficiently robust to ensure the people who use the service also live in a very clean and safe environment. Evidence: During a tour of the premises we were able to confirm that as stated in the services AQAA bedrooms have been redecorated, and some soft furnishings replaced as a result of listing to the people who live at 82, Coombe Road. Since the last inspection new carpets have been fitted in the lounge as recommended. We agree with the manager that the carpet in the hallway will need to be replaced sooner rather than later and assessment carried out on the continued suitability of the homes exterior wooden window frames and sills, which appear to have seen better Care Homes for Adults (18-65 years) Page 24 of 35 Evidence: days. The gardens at both the front and rear of the property remain well maintained. The service is commended for all the adaptations it has made to the home to make it far more wheelchair friendly.Since the last inspection a new ramp has been installed in the rear garden to enable wheelchair users to access the homes car park and fire release mechanisms fitted to a bedroom and toilet door on the ground floor to enable a service user who sometimes uses a wheelchair to access these areas without staff support. All the written feedback we received said the home is always kept fresh and clean. The home looked spotless during our tour of the premises. The AQAA tell us that the service has an action plan to deliver best practise in the preventing and control of infection and that all 13 of the homes permanent support worker team have received training in this essential area of practise. Certificates of attendance of an approved infection control course were produced on request. All the toilets viewed during this visit were well stocked with toilet tissue and soap. Care Homes for Adults (18-65 years) Page 25 of 35 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who use the service are kept safe and appropriately supported because the manager ensures that more than enough suitably experienced and qualified staff are on duty at all times. The servcie is also commended for having such a flexible approach to planning the duty rosters to meet the servcie users social needs. The needs and wishes of the people who use the servcie are also met because staff get the right training, supervision and support they require to perform their duties. Evidence: The feedback we received from people who returned our surveys regarding staff was in the main very positive. 100 percent of the written responses we received from the pople who use the service was staff always treated you well and usually listened and acted upon what you and or your loved one told them. All the support workers who were on duty during this site visit were observed interacting with the service users in very caring and respectful manner throughout this visit. The manager told us that a minimum of three support workers are always on duty throughout the day, with an additional fourth person frequently employed to cover peak periods of activity and pre-planned social outings and events. Duty rosters Care Homes for Adults (18-65 years) Page 26 of 35 Evidence: sampled at random confirmed that the servcie has a very flexible approach to planning shifts and that a fourth person routinely workers during the day to ensure servcie users social wishes are met. On arrival we noted three supports workers were all on duty, which did not include the registered manager who was also working that morning. This positive comments made above notwithstanding about staffing ratios information contained in the AQAA revealed that the ethnically diverse mix of the current staff team was not particularly reflective of that of the servcie users. We recommend the manager is mindful of this ethnic imbalance we he next recruits new staff. As stated by the manager in the AQAA we were provided with documentary evidence on request that showed us all three of the homes most recently recruited members of staff who had started work in the home in the last 12 monhts have had satisfactory preemployment checks carried out on them. The manager told us all the people who use the servcie are encouraged to meet prospective new staff as part of the recruitment process to ascertain how they interact with one another. The manager told us two out of three of the services most recent recruits had successfully completed their induction and the third was in the process of finishing theres. The manager told us the homes induction was very thorough and covered service users needs, their roles and responsibilities as support workers and health and safety. The manager confirmed during this inspection that as stated in the services AQAA less than 50 percent of the homes permanent staff team had still yet to achieve a National Vocational Qualification in care (Level 2 or above), contrary to National Minimum training Standards for support workers. We recommend the provider establishes a time specific action plan setting out how they intend to address this major shortfall in their staffs basic training. This comment notwithstanding as stated by the manager in the AQAA enough evidence was gathered during this inspection for us to see that staff have the necessary knowledge and skills to meet the needs of all the people who currently use the service. All the written and verbal feedback provided by staff about the training they had received told us it was relevant to their role as support workers. The area manager had carried out a thorough assessment of the staff teams training strengths and needs, which revealed very few gaps in peoples knowledge and skills. The manager told us all his staff team have received up to date training in fire safety, first aid, moving and handling, food hygiene, infection control, health and safety, medication, equality and diversity, safeguarding adults, managing challenging behaviours, and Care Homes for Adults (18-65 years) Page 27 of 35 Evidence: physical intervention techniques. In addition to these mandatory courses sufficient numbers of staff have also received training in working with people with autism, and epilepsy. We sampled three staff files at random which each revealed these individual had received at least three formal recorded supervision sessions with the manager in the past 6 monhts in line with best practise guidelines. The manager also told us he had appraised the performance of two thirds of his staff team over the past year and hoped to complete the task within the next 3 monhts. The servcie is commended for exceeding National Minimum Standards by arranging for four joint meetings to be held between staff and service users in the past 6 monhts. Care Homes for Adults (18-65 years) Page 28 of 35 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who use the service continue to benefit from living in a home that continues to be extremely well run by a very experienced and competent manager. The service has developed some excellent quality assurance system which enable all the people who use the service and their representatives to express their views and influence how the home is run and continues to develop. Health and safety arrangements are sufficiently robust to safeguard the welfare of the people who use the service, their guests, and staff. Evidence: Michael Luganda has been managing 82, Coombe Road for seven years. All the written and verbal feedback we received from the people who use the servcie and staff about the managers leadership style was extremely ;positive. typical comments included Michaels a great manager - hes very consistent ... you know where you stand with him. Care Homes for Adults (18-65 years) Page 29 of 35 Evidence: Since the last inspection the manager has introduced new shift plans to ensure staff know exactly what their responsibilities each time they are duty. Staff met told us the new shift plans were working well and helped minimise the risk of people doing certain tasks, such as weekly health and safety checks. The manager told he feels he gets all the support he needs from his area manager, who is always on hand to offer him advice. The manager was able to produce the services last four Regulation 26 reports which had been carried out every month by a senior representative from Voyage. The results of these internal quality assurance reports were in the main very positive and the manager told us he always uses them to identify new ways of improving the service. The manager was able to provide us with a copy of the homes annual quality assurance report which was based on the results of all the feedback the servcie had obtained from the people who live at 82, Coombe road and their representatives. Finally, the service sent us their annual quality assurance assessment (AQAA) when we asked for it. The assessment was very clear and gave us all the information we asked for. The homes fire records revealed that the fire alarm system continues to be tested on a weekly basis and fire drills undertaken at regular intervals in line with best practise fire safety guidelines. During a tour of the premises it was noted that none of the homes fire resistant doors were being inappropriately wedged open to prevent there automatic closure in the event of a fire. The temperature of hot water emanating from a bath on the first floor was found to be below a safe level when we tested in at midday. Staff also maintain various weekly and monthly checks they carry out on the homes health and safety equipment. All the items of food we fond in the kitchen during our tour of the premises were correctly stored and labelled in line with basic food hygiene and environmental standards. The manager stated in the services AQAA that the homes electrical circuits; fire detection and alarms; fire fighting equipment; emergency lighting; water heating system; and gas appliances - have all been serviced or tested as recommended by the manufacturer or their regulatory body. All the home portable electrical appliances were last tested in June 2009. The manager also wrote in the AQAA that written Care Homes for Adults (18-65 years) Page 30 of 35 Evidence: assessments on Chemicals and Substances hazardous to Health (COSHH) are in place and routinely reviewed. Care Homes for Adults (18-65 years) Page 31 of 35 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 32 of 35 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation 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 23 17 Any restrictions placed on service users freedom of choice or movement must be assessed and recorded in their care plan. This will ensure service users rights to make informed decisions and go whee they choose in their own home are not restricted unnecessarily. 01/10/2009 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 9 Care plans should contain up to date risk assessments that make it clear all the pople who use the service were consulted about whether or not they wished to take greater responsibility for looking after their own medication and finances, and if so, whether they were capable of doing it safely. Guidance for staff to follow when using approved physical intervention techniques to deal with certain incidents of challenging behaviour should be reviewed at least annually 2 23 Care Homes for Adults (18-65 years) Page 33 of 35 with all the relevant parties, including the service users professional representatives. This will minimise the risk of service users suffering abuse through the unnecessarily use of excessive force to manage behaviours that challenge 3 24 The providers should consider establishing a time specifc action plan to replace the rather worn out carpet in the entrance hall. The providers should consider assessing the continued suitability of all the homes exterior wooden window frames and sills, which from a distance appear to have seen better days, and take appropriate action where necessary. The manager should be mindful of the ethnic imbalance which current exists between his staff team and the pople who use the service when he next recruits new staff. The provider should establish a time specific action plan setting out how they intend to ensure sufficient numbers of its staff team achieve an NVQ in care (Level 2 or above). This will ensure all the homes staff have the necessary knowledge and skills to meet the servcie users needs. 4 24 5 33 6 35 Care Homes for Adults (18-65 years) Page 34 of 35 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. 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