Care Home: Copwood Respite Unit

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What the care home does well People spoke highly of the service. Comments included: `I like it here, Copwood Hotel` `Copwood makes me laugh and happy` `She very much enjoys going to Copwood Respite Unit, always wants to know when the next visit is` `Copwood is a nice and friendly place to come for my respite, I enjoy coming` `It is a nice place to visit, and friendly` `I think Copwood Respite Unit is a wonderful place` `The response I get from service users and their families is very positive`. People`s needs are assessed thoroughly before they start to use the service. This means that staff can be told about any specific needs they might have and know what help and support to provide. Staff have very good knowledge on people`s care needs and speak confidently about the care they give. They have very good knowledge of people`s individual support needs and can describe people`s routines well. Most people who use the service or their relatives said the home meets their needs. One said, `The unit has been a godsend to us and as far as we are concerned gives excellent service`. When asked what the service does well, a health professional said, `Responding to individuals needs and recognising individuals strengths and interests`. Menu records showed a wide variety of food is available. The manager said they try to `broaden people`s horizons` by providing different foods such as Indian or Mexican for people to try. People who use the service or their relatives spoke highly of the care and support they receive. Comments included: `They show they care, not only about service users but also their carers` `They know service users very well` `They look after me, bath me, help me to dress, feed me`. People who use the service spoke highly of the staff. Their comments included: `I like being at Copwood, they look after me there` `The staff team has become more consistent` `Great staff`. The manager has worked hard to develop and lead a staff team who feel confident in their ability to deliver a good respite service. Staff said the manager is a good leader, she leads by example and is very supportive and approachable. Staff and people who use the service spoke highly of the manager. Their comments included: `Cathy is wonderful` `Pleasant and professional` `Manager has turned the service around` `Copwood is a nice place to work and Cathy`s input is the reason` `She trains us well and likes us to develop ourselves`. A health professional said, `The manager is very involved with the whole staff team in supporting them`. What has improved since the last inspection? Meetings are held for parents/carers so that they can put forward their views. The manager said that as a result of a suggestion made at one of these meetings, they have introduced a communication sheet that goes home with people who use the service to say how they have been and what activities they have taken part in during their stay. The manager said this is particularly useful for people who do not use verbal communication. In the AQAA, the manager said, `We have increased staffing levels to enable days out to places of interest outside of the local Leeds/Bradford area`. The manager said the service has improved over the last 12 months as they now have well established links and support from district nursing teams and a dietician. She said she was hoping they would be able to provide training to staff on health issues. At our last inspection of the home, we asked them to make some improvements to the way medication was stored. A fridge for storage of medication that needs refrigeration has now been bought and means this medication is stored safely. When we last visited the service we said that improvements were needed to the environment to make it more comfortable for people who use the service. In the AQAA, the manager said, `A table of works were agreed with a surveyor and the Respite Unit was totally refurbished and decorated in February 2008. The environment is more homely with new soft furnishings and surroundings that are attractive. Worn furniture has been replaced throughout the building.` We noticed a number of improvements since our last visit. These included:- Carpets replaced with laminate flooring throughout the building. - A large plasma television that is wall mounted which makes it easier for everyone to see. - New, modern lounge and dining room furniture. -A new fridge freezer with a drinks dispensor that people can help themselves to. -Televisions provided in each bedroom. - Lockable storage provided in each bedroom. At our last visit to the home we said they must have suitable locks on bedroom doors that people could use independently. The manager said they have looked into this and assessed people`s ability to hold and use a key. She said those people that can manage a key, do so, when they visit. She said that those who do not have the ability to do this are assisted by staff to keep their room locked and safe. In the AQAA, the manager told us that she had improved the service by increasing the staffing levels and `Recruited skilled staff to reduce the need to rely on casual and/or agency staff.` This means that people are supported by staff who know them well. The manager is now registered with the CQC which means she is accountable for the day to day running of the service. Food safety practice has improved. Food was being stored correctly and the relevant food safety tests such as testing food temperatures was being carried out. What the care home could do better: Staff said they review the plans every three months. They said they do this by looking through people`s notes and observing for any changes. They do not routinely contact parents or carers to discuss any changes and rely on parents or carers giving them that information. For example, changes in mobility or medication. Some consideration should be given to reviewing people`s needs, including medication, prior to every visit so that any changes are not missed or overlooked. In surveys we received, views on activity available to people at the service were mixed. Some people were happy with what was on offer, others said they would like more, especially activity out in the community. Some consideration should be given to developing the complaints procedure in alternative formats such as easy read or pictorial. This will make it more accessible for people. Last time we visited the service we said they had to have a call system provided so that staff can summon assistance if needed. The manager said she has considered this and due to being such a small home does not think it necessary. There have been no incidents where staff have not been able to summon assistance. She had not completed a risk assessment of this situation. Therefore we require that a risk assessment is completed, supported by a management plan to show what the risks are and why a call system is not needed. Key inspection report Care homes for adults (18-65 years) Name: Address: Copwood Respite Unit 15 Copgrove Road Holmewood Bradford BD4 0DJ     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: Dawn Navesey     Date: 1 2 0 1 2 0 1 0 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 35 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 35 Information about the care home Name of care home: Address: Copwood Respite Unit 15 Copgrove Road Holmewood Bradford BD4 0DJ 01274684511 01274684511 catherine.mageean-ring@bdct.nhs.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Bradford District NHS Trust Name of registered manager (if applicable) Mrs Catherine Alice Mageean-Ring Type of registration: Number of places registered: care home 6 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia learning disability physical disability sensory impairment Additional conditions: Date of last inspection Brief description of the care home Copwood is a Bradford District Care Trust home situated in the Holmewood area of Bradford. The home is registered to provide respite care for up to 6 people with learning disabilities who are over the age of 18. The home is attached to a day centre for people with learning disabilities. It is a single storey building, hence all facilities are provided at ground floor level. The accommodation comprises a lounge/dining area, kitchen/ dining area, two bathrooms, six single bedrooms, and a multi-sensory room. There is also a dedicated office space and a staff sleep in room. Copwood has an enclosed garden and a large car parking area that is located at the front of the Care Homes for Adults (18-65 years) Page 4 of 35 Over 65 0 0 0 0 6 6 6 6 Brief description of the care home adjoining day centre. Local shops and bus routes are within easy access. The fees for the respite service are 8 pounds 76 pence per night stay, no extras are charged for. 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: 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 the people who use this service experience good quality outcomes. The Care Quality Commission (CQC) inspects homes at a frequency determined by how the home has been risk assessed. The inspection process has now become a cycle of activity rather than a series of one-off events. Information is gathered from a variety of sources, one being a site visit. More information about the inspection process can be found on our website www.cqc.org.uk This visit was unannounced and was carried out by one inspector who was at the home from 12-45pm until 6-15pm on the 12th January 2010 and from 2-50pm until 6-20pm on 26th January 2010. The purpose of the inspection was to make sure the home was operating and being Care Homes for Adults (18-65 years) Page 6 of 35 managed for the benefit and well being of the people who use the service. And also to monitor progress on the requirements and recommendations made at the last inspection. Before the inspection evidence about the home was reviewed. This included looking at any reported incidents, accidents and complaints. This information was used to plan the visit. An AQAA (Annual Quality Assurance Assessment) was completed by the home manager before the visit to provide additional information. This was well completed and gave us all the information we asked for. Survey forms were sent out to people using the service, staff and health care professionals. Some of these have been returned and comments made within them have been used within this report. During the visit a number of documents and records were looked at and some areas of the home used by the people staying at the home were visited. Some time was spent with the people who use the service, talking to them and interacting with them. Time was also spent talking to staff and the manager. We have reviewed our practice when making requirements to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. Feedback at the end of the visit was given to the manager. Care Homes for Adults (18-65 years) Page 7 of 35 What the care home does well: People spoke highly of the service. Comments included: I like it here, Copwood Hotel Copwood makes me laugh and happy She very much enjoys going to Copwood Respite Unit, always wants to know when the next visit is Copwood is a nice and friendly place to come for my respite, I enjoy coming It is a nice place to visit, and friendly I think Copwood Respite Unit is a wonderful place The response I get from service users and their families is very positive. Peoples needs are assessed thoroughly before they start to use the service. This means that staff can be told about any specific needs they might have and know what help and support to provide. Staff have very good knowledge on peoples care needs and speak confidently about the care they give. They have very good knowledge of peoples individual support needs and can describe peoples routines well. Most people who use the service or their relatives said the home meets their needs. One said, The unit has been a godsend to us and as far as we are concerned gives excellent service. When asked what the service does well, a health professional said, Responding to individuals needs and recognising individuals strengths and interests. Menu records showed a wide variety of food is available. The manager said they try to broaden peoples horizons by providing different foods such as Indian or Mexican for people to try. People who use the service or their relatives spoke highly of the care and support they receive. Comments included: They show they care, not only about service users but also their carers They know service users very well They look after me, bath me, help me to dress, feed me. People who use the service spoke highly of the staff. Their comments included: I like being at Copwood, they look after me there Care Homes for Adults (18-65 years) Page 8 of 35 The staff team has become more consistent Great staff. The manager has worked hard to develop and lead a staff team who feel confident in their ability to deliver a good respite service. Staff said the manager is a good leader, she leads by example and is very supportive and approachable. Staff and people who use the service spoke highly of the manager. Their comments included: Cathy is wonderful Pleasant and professional Manager has turned the service around Copwood is a nice place to work and Cathys input is the reason She trains us well and likes us to develop ourselves. A health professional said, The manager is very involved with the whole staff team in supporting them. What has improved since the last inspection? Meetings are held for parents/carers so that they can put forward their views. The manager said that as a result of a suggestion made at one of these meetings, they have introduced a communication sheet that goes home with people who use the service to say how they have been and what activities they have taken part in during their stay. The manager said this is particularly useful for people who do not use verbal communication. In the AQAA, the manager said, We have increased staffing levels to enable days out to places of interest outside of the local Leeds/Bradford area. The manager said the service has improved over the last 12 months as they now have well established links and support from district nursing teams and a dietician. She said she was hoping they would be able to provide training to staff on health issues. At our last inspection of the home, we asked them to make some improvements to the way medication was stored. A fridge for storage of medication that needs refrigeration has now been bought and means this medication is stored safely. When we last visited the service we said that improvements were needed to the environment to make it more comfortable for people who use the service. In the AQAA, the manager said, A table of works were agreed with a surveyor and the Respite Unit was totally refurbished and decorated in February 2008. The environment is more homely with new soft furnishings and surroundings that are attractive. Worn furniture has been replaced throughout the building. We noticed a number of improvements since our last visit. These included: Care Homes for Adults (18-65 years) Page 9 of 35 - Carpets replaced with laminate flooring throughout the building. - A large plasma television that is wall mounted which makes it easier for everyone to see. - New, modern lounge and dining room furniture. -A new fridge freezer with a drinks dispensor that people can help themselves to. -Televisions provided in each bedroom. - Lockable storage provided in each bedroom. At our last visit to the home we said they must have suitable locks on bedroom doors that people could use independently. The manager said they have looked into this and assessed peoples ability to hold and use a key. She said those people that can manage a key, do so, when they visit. She said that those who do not have the ability to do this are assisted by staff to keep their room locked and safe. In the AQAA, the manager told us that she had improved the service by increasing the staffing levels and Recruited skilled staff to reduce the need to rely on casual and/or agency staff. This means that people are supported by staff who know them well. The manager is now registered with the CQC which means she is accountable for the day to day running of the service. Food safety practice has improved. Food was being stored correctly and the relevant food safety tests such as testing food temperatures was being carried out. What they could do better: Staff said they review the plans every three months. They said they do this by looking through peoples notes and observing for any changes. They do not routinely contact parents or carers to discuss any changes and rely on parents or carers giving them that information. For example, changes in mobility or medication. Some consideration should be given to reviewing peoples needs, including medication, prior to every visit so that any changes are not missed or overlooked. In surveys we received, views on activity available to people at the service were mixed. Some people were happy with what was on offer, others said they would like more, especially activity out in the community. Some consideration should be given to developing the complaints procedure in alternative formats such as easy read or pictorial. This will make it more accessible for people. Last time we visited the service we said they had to have a call system provided so that staff can summon assistance if needed. The manager said she has considered this and due to being such a small home does not think it necessary. There have been no incidents where staff have not been able to summon assistance. She had not completed a risk assessment of this situation. Therefore we require that a risk assessment is completed, supported by a management plan to show what the risks are Care Homes for Adults (18-65 years) Page 10 of 35 and why a call system is not needed. 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 11 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 12 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. People who use the service and their representatives have the information needed to choose a home that will meet their needs. They are provided with thorough standards of pre-admission assesment which makes sure the service can fully meet peoples needs. Evidence: In the AQAA, the manager said, All service user needs are assessed by the Community Team for Learning Disabilities. All service users have an assessment completed when they first access the Respite Service. We meet with service users and their families and ensure we have accurate details of how the individual would like to be supported. Assign a staff member to work alongside the individual, family/carer and social worker at each stage of the referral process; this is overseen by the Manager. Meet with the individual and their family/carer after an initial six week period to establish what they think of the service and to ensure they are receiving the level of support required. We looked at pre- admission assessments for some people. We saw that peoples Care Homes for Adults (18-65 years) Page 13 of 35 Evidence: needs are assessed thoroughly before they start to use the service. This means that staff can be told about any specific needs they might have and know what help and support to provide. The assessments involve the person using the service, their family and any other professionals involved with their care. For example, community nurses or staff from day centres. This is good practice and means peoples needs are identified well. The manager told us that when planning peoples stays, they try to make sure people who are friends or have similar interests can visit at the same time. For example, she said there are a group of people who use the service who enjoy going out to the theatre so they try to make sure their visits coincide with this. We received surveys from people who use the service, relatives, health professionals. They spoke highly of the service. Comments included: I like it here, Copwood Hotel Copwood makes me laugh and happy She very much enjoys going to Copwood Respite Unit, always wants to know when the next visit is Copwood is a nice and friendly place to come for my respite, I enjoy coming It is a nice place to visit, and friendly I think Copwood Respite Unit is a wonderful place The response I get from service users and their families is very positive. Care Homes for Adults (18-65 years) Page 14 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are encouraged to make decisions about their lives and are involved in planning their care and support. Evidence: In the AQAA, the manager said, We ensure that comprehensive care plans are in place for all service users, they are detailed and reflect individual needs and choices. We meet with service users and their families/carers to ensure they are involved in the creation of the care plan. We ensure all care plans are current and reviewed on a three monthly basis. We looked at care plan and risk assessment records for some people who stay at the home. We found the care plans to be person centred and individual to each person. Care plans and risk management plans had clear and detailed instruction on how the needs of people who use the service are to be met. Staff said they felt the care plans gave them enough detail on meeting peoples needs. They said they were trained and encouraged to make sure they included good levels of detail in peoples plans. Care Homes for Adults (18-65 years) Page 15 of 35 Evidence: They said this meant getting to know people well to find out what they want and need from the service. One staff member said, They are the best and most easy to follow care plans I have ever worked with. Staff said they review the plans every three months as mentioned above. They said they do this by looking through peoples notes and observing for any changes. They do not routinely contact parents or carers to discuss any changes and rely on parents or carers giving them that information. For example, changes in mobility or medication. Some consideration should be given to reviewing peoples needs prior to every visit so that any changes are not missed or overlooked. Staff had very good knowledge on peoples care needs and could speak confidently about the care they give. They had very good knowledge of peoples individual support needs and could describe peoples routines well. There are also good systems in place to make sure staff familiarise themselves with peoples care needs before they come for their respite care. This is especially important for people who do not use the service on a regular basis. Most people who use the service or their relatives said the home meets their needs. One said, The unit has been a godsend to us and as far as we are concerned gives excellent service. Two people said they wished they could have more respite care than they currently get. One person said the service did not meet their needs properly. They said they the service could do better by, having persons dedicated to job and to look after more closely. Staff said they got up to date information on peoples needs. One said, The home is a small 6 bedded unit and has a very home from home feel to it, and also with such a small unit the client can have that one to one that is so important to a lot of people. When asked what the service does well, a health professional said, Responding to individuals needs and recognising individuals strengths and interests. People are encouraged to make choices and decisions about what they do. Staff said they encourage people to make choices in their every day lives such as what to do, what to eat, what to wear and where to go out. We saw people being offerred choices throughout the visit. Staff also responded well to requests for anything from the people staying at the home. We saw people were supported to make choices, using a variety of communication methods such as pointing, touch and facial expression. Staff showed they had a good understanding of how people communicate. The staff and Care Homes for Adults (18-65 years) Page 16 of 35 Evidence: manager are currently working on a pictorial menu which some people may be able to use to increase the way in which they make food choices. There are also a number of information sheets around the home showing some translations of words in Urdu which may be useful when communicating with people who use the service. People who use the service have regular meetings. These are called Service User Forums. At these meetings people can put forward suggestions for activities, menus and trips. They can also discuss issues such as staff changes. Meetings are also held for parents/carers so that they can put forward their views. The manager said that as a result of a suggestion made at one of these meetings, they have introduced a communication sheet that goes home with people who use the service to say how they have been and what activities they have taken part in during their stay. The manager said this is particularly useful for people who do not use verbal communication. Care Homes for Adults (18-65 years) Page 17 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. People who use the service are able to make choices about their lifestyle. Social, educational, cultural and recreational activities meet most peoples expectations. They also benefit from a good, healthy and varied diet. Evidence: In the AQAA, the manager said, Each individual service user has a social assessment which identifies what they particularly enjoy taking part in, and what support/reassurance they may need with the activity. We have increased staffing levels to enable days out to places of interest outside of the local Leeds/Bradford area. We celebrate religious festivals and enjoy traditional food and activities. In surveys we received, views on activity available to people at the service were mixed. When asked what the service does well, a health professional said, meaningful and fun activities. A member of staff said, Service users receive lots of interaction. Care Homes for Adults (18-65 years) Page 18 of 35 Evidence: Someone who uses the service said, Baking and cooking. When asked what the home could do better, a staff member said, Continue to improve to give our clients better leisure and outdoor opportunities and More outings, but staff are working on this. A relative said, Have more things for clients to do. Someone who uses the service said, Going out walking. People who use the service said they can choose what they want to do, through the day, in the evenings and at weekends. One person said, I like going out with everyone. Another said they enjoyed going to the local shops. Staff said that some people like to carry on with their routines they are used to at home such as watching certain television programmes. We saw that people were supported to do this. The manager and staff said that people who use the service continue to go to their day care placements when staying at the home. They said they offer plenty of activity in the home for people, such as art work, baking, beauty sessions, sensory room and relaxing baths, especially in the week when people have been out all day. They also said that some people prefer to relax and just watch television after having been out all day. There was plenty of social interaction between the staff and people who use the service. It was clear that staff and people who use the service get on well. More activity out of the home such as walks, trips to places of interest, shopping, meals out and theatre trips are organised at weekends. One person using the service said they were looking forward to a pantomine trip that had been arranged. The home has also got a staff member who has passed a test to drive the minibus that they loan from the adjacent day centre, which has led to more day trips. Records we looked at showed that generally there is a lot more activity in the house than out and about in the community. Staff said they try to get people out to local shops and on local walks when they can. They said that, in the main, they have enough staff to provide a decent level of activity but it can sometimes depend on the mix and dependancy levels of people who are using the service. We looked at menus at the home. These are planned around peoples likes and dislikes. Staff also make sure that any special dietary requirements such as vegetarian or soft diets are catered for. Halal meat and products are provided for people who need them. One person said they enjoyed the food and staff were good cooks. They also said they could help themselves to drinks and snacks whenever they wanted. Menu records showed a wide variety of food is available. The manager said they try to broaden peoples horizons by providing different foods such as Indian or Mexican for Care Homes for Adults (18-65 years) Page 19 of 35 Evidence: people to try. Care Homes for Adults (18-65 years) Page 20 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. Overall, peoples general healthcare needs are well met and based upon their individual needs. Evidence: In the AQAA, the manager said, We liaise with individual service users and their families to gain information about how they would like to be supported.We audit medication on a regular basis. We support service users with their individual health needs. Any identified concerns are referred to the family and/or appropriate health care professional. The manager also said the service has improved over the last 12 months as they now have well established links and support from district nursing teams and a dietician. She said she was hoping they would be able to provide training to staff on health issues. People who use the service or their relatives spoke highly of the care and support they receive. Comments included: Care Homes for Adults (18-65 years) Page 21 of 35 Evidence: They show they care, not only about service users but also their carers They know service users very well They look after me, bath me, help me to dress, feed me. People who use the service have good plans in place to show how they would like to be supported with their personal care needs. For example, whether they like a bath or shower. They also show the amount of support each person requires and what they can do for themselves. This is good person centred practice. Care plans are also in place for any health needs such as diabetes or epilepsy. Staff had good knowledge of peoples personal support needs. Staff were thoughtful, discreet and respectful of peoples dignity when attending to any needs. People staying at the home looked well cared for and well groomed. Staff were clear on the need to respect peoples privacy and dignity. They also said it was important to maintain peoples independence. They gave good examples of how they do this. Staff said they have received good training in meeting the health needs of people who use the service such as epilepsy management, the administration of Buccal Modazalon, moving and handling and first aid. The manager is currently arranging training in diabetes, meeting nutritional needs and autism. This will mean staff are further equipped to meet peoples needs fully. Some staff have not yet completed training in epilepsy, but have completed first aid training and are aware of peoples epilepsy management plans. The manager is aware they need to complete this training and is currently trying to arrange it. At our last inspection of the home, we asked them to make some improvements to the way medication was stored. A fridge for storage of medication that needs refrigeration has now been bought and means this medication is stored safely. During the visit we observed staff checking medication into the home. It is always done by two staff to reduce the risk of errors occurring. This is good practice. We also checked some medication administration records (MAR) sheets and found them to be in good order. Staff also administer medication in twos and only staff who have been trained to administer medication do so. As mentioned in the Individual Needs and Choices section of this report, care plans are reveiwed every three months, this includes medication. However, as also mentioned, changes in medication rely on parents/carers informally informing staff or staff noticing any changes when they book Care Homes for Adults (18-65 years) Page 22 of 35 Evidence: the medication in. Some consideration should be given to reviewing peoples medication needs prior to every visit so that any changes are not missed or overlooked. Care Homes for Adults (18-65 years) Page 23 of 35 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are able to express their concerns and are protected from abuse. Evidence: In the AQAA, the manager said, We have a Complaints policy which is followed. Adult Protection Guidelines are used within our everyday practice. All staff have received training in Adult Protection Procedures. We meet with service users, their families or carers to address their concerns and provide a timely response. A clear record of concerns /complaints is held by the manager along with a copy of the response made to the individual who raised the concern/complaint. In surveys returned to us most people said they knew how to make a complaint or raise concerns. We looked at complaints records in the home and saw that complaints have been recorded and investigated properly. The complaints procedure is readily available and displayed in the home. This has not been produced in any alternative format such as easy read or pictorial. Some consideration should be given to developing this to make it more accessible for people. There has been one safeguarding issue within the home in the last year. This has been dealt with properly, with appropriate action being taken. The manager and staff team Care Homes for Adults (18-65 years) Page 24 of 35 Evidence: are aware of how to report safeguarding issues, which means people are protected well. Records showed that staff have received training in safeguarding adults. They were able to say what action they would take if they suspected abuse or had an allegation of abuse made to them. They were also able to describe the different types of abuse. They were familiar with the whistle blowing procedure and said they would have no hesitation in using it if they thought they needed to raise concerns outside of the home or organisation. Records are kept of the finances of people who use the service and their monies are kept safe. Care Homes for Adults (18-65 years) Page 25 of 35 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Overall, the environment is homely, comfortable and safe for people who use the service. Evidence: When we last visited the service we said that improvements were needed to the environment to make it more comfortable for people who use the service. In the AQAA, the manager said, A table of works were agreed with a surveyor and the Respite Unit was totally refurbished and decorated in February 2008. The environment is more homely with new soft furnishings and surroundings that are attractive. Worn furniture has been replaced throughout the building. We had a look round the home. Communal areas, bathrooms and bedrooms were visited. The home looked clean, fairly homely and well maintained. There was original art work from people who use the service on the walls and around the home, which gave the home a particularly homely feel. People who use the service said it was always clean and fresh. We noticed a number of improvements since our last visit. These included: - Carpets replaced with laminate flooring throughout the building. Care Homes for Adults (18-65 years) Page 26 of 35 Evidence: - A large plasma television that is wall mounted which makes it easier for everyone to see. - New, modern lounge and dining room furniture. -A new fridge freezer with a drinks dispensor that people can help themselves to. -Televisions provided in each bedroom. - Lockable storage provided in each bedroom. However, some signage in the home is a bit clinical and detracts from the homely feel that has been created. Staff said they did not know why the signs were needed as they were well aware of the instructions on them, for example to put used tissues in the bin or how to wash their hands. The manager removed some of these at the time of the visit. The home is fully accessible to anyone using a wheelchair. There is specialist equipment such as tracking hoists and hi-lo beds and baths which means they can meet peoples diverse needs. There is also a multi- sensory room, that is well equipped to meet peoples needs. People who use the service have full access to the kitchen and are encouraged to get involved in food preparation or help themselves to snacks and drinks when they want. At our last visit to the home we said they must have suitable locks on bedroom doors that people could use independently. The manager said they have looked into this and assessed peoples ability to hold and use a key. She said those people that can manage a key, do so, when they visit. She said that those who do not have the ability to do this are assisted by staff to keep their room locked and safe. She also said that in her opinion, the people who cannot manage a key would not be able to manage any other system such as a swipe card. She agreed to keep this under review for the future though. Clinical waste is properly managed. Staff have received training in infection control as part of their induction and were able to say what other infection control measures are in place. Hand washing and hand drying facilities were available in all areas of the home. Liquid soap or paper towels were available. This ensures good hygiene practice. Care Homes for Adults (18-65 years) Page 27 of 35 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are trained skilled and in sufficient numbers to support people who use the service. Evidence: People who use the service spoke highly of the staff. Their comments included: I like being at Copwood, they look after me there The staff team has become more consistent Great staff. In the AQAA, the manager told us that she had improved the service by increasing the staffing levels and Recruited skilled staff to reduce the need to rely on casual and/or agency staff. This means that people are supported by staff who know them well. We looked at rotas. They showed that there are sufficient staff and that they work flexibly to meet the needs of the people who use the service. All the staff we spoke to said they felt they had enough staff to meet peoples needs properly. The manager also works flexibly to meet the needs of the service. In the AQAA, she said, The Care Homes for Adults (18-65 years) Page 28 of 35 Evidence: Manager works flexibly to ensure she has a working knowledge of the needs of the individuals who access the service and to monitor the standard of care delivered to the service users. We looked at recruitment records These showed that recruitment is properly managed by the home; interviews are held, references and CRB (Criminal Record Bureau) checks are obtained before staff start work and checks are made to make sure staff are eligible for work. However, the records, such as references for people who have been employed a number of years ago are not held at the home and could not be checked. The manager said she was in the process of trying to obtain these from the head office to get all staffs files up to date. Staff said their induction at the service had been good and prepared them well for their job. In the AQAA, the manager said, All staff complete the Learning Disability Induction Award as part of their induction. All staff shadow (work alongside) an existing member of the team for a two week period to ensure they are inducted into all practises well and have met a number of service users and are able to begin to develop a positive supporting relationship with them. Staff said all their training was good and that any updates they needed were always provided. They were aware of new training course such as autism, that are being planned for them. Records showed that staffs essential training such as moving and handling, first aid, food hygiene and safeguarding adults was up to date. The manager has a training plan in place which clearly shows who has done what training and when any updates are due. Staff complete an annual appraisal with their manager to identify any training needs or special interests they may have. The manager also said, We have organised specialist training packages to address the specific support needs of individual service users. Over half of the staff team have completed an NVQ (National Vocational Qualification) in care at level 2 or above. This means they are qualified to carry out their job. We looked at staffs supervision records and saw that regular one to one sessions are provided for staff to discuss their roles. Staff said they were happy with the support they get. One said, Good support, regular supervision. Care Homes for Adults (18-65 years) Page 29 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 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 well managed, the interests of the people who use the service are seen as important to the manager and staff and are properly safeguarded. Evidence: The manager has worked hard to develop and lead a staff team who feel confident in their ability to deliver a good respite service. Staff said the manager is a good leader, she leads by example and is very supportive and approachable. Staff and most people who use the service spoke highly of the manager. Their comments included: Cathy is wonderful Pleasant and professional Manager has turned the service around Copwood is a nice place to work and Cathys input is the reason Care Homes for Adults (18-65 years) Page 30 of 35 Evidence: She trains us well and likes us to develop ourselves. A health professional said, The manager is very involved with the whole staff team in supporting them. One person was dissatisfied with the amount of respite care they received and felt the manager had not addressed this with them properly. The manager has many years experience working in management and care services for people with learning disabilities. She has completed the Registered Managers Award and NVQ 4 in care management, making her suitably qualified to manage the home. She is also now registered with the CQC which means she is accountable for the day to day running of the service. The manager and some staff have completed training in the Mental Capacity Act and Deprivation of Liberty Safeguards which has given them a better understanding of the rights of people who use the service, their liberty and decision making processes. Records we looked at showed that regular health and safety checks are carried out. In the AQAA, the manager said relevant policies and procedures were in place, and reviewed. She also said equipment has been serviced or tested as recommended by the manufacturer or regulatory body. She also said relevant health and safety policies and procedures were in place, and reviewed. Food safety practice has improved. Food was being stored correctly and the relevant food safety tests such as testing food temperatures was being carried out. Last time we visited the service we said they had to have a call system provided so that staff can summon assistance if needed. The manager said she has considered this and due to being such a small home does not think it necessary. There have been no incidents where staff have not been able to summon assistance. She had not completed a risk assessment of this situation. Therefore we require that a risk assessment is completed, supported by a management plan to show what the risks are and why a call system is not needed. Accident records are completed, followed up and monitored for any patterns trends or ways of avoiding future accidents. A senior manager from the organisation visits the home monthly and conducts monthly provider reports with requirements for improvement. Staff said they speak with people who use the service and staff during these visits as part of their Care Homes for Adults (18-65 years) Page 31 of 35 Evidence: monitoring of the service. The organisation seeks the views of people who use the service or their relatives by sending out a questionnaire so that they can get feedback on how people think the service can improve. We looked at some of these that had been returned. They were overall very positive about the service received. Care Homes for Adults (18-65 years) Page 32 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 33 of 35 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation 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 42 13 Risk assessments must be carried out to show how staff summon help in an emergency. This is to ensure everyones safety. 28/02/2010 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 22 Some consideration should be given to developing the complaints procedure in alternative formats such as easy read or pictorial. This will make it more accessible for people. Care Homes for Adults (18-65 years) Page 34 of 35 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. 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