Care Home: Creek Road (79)

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What the care home does well The organisation applied for de-registration, but withdrew their application to ensure that all relevant issues were resolved prior to de-registration. The reason for withdrawal was to prepare users of the service to improve their budgeting and daily living skills and to provide reassurance to families that the de-registration would enable users to further develop their independence. Detailed consultation was organised regularly with users and their families. Social services are also heavily involved in preparation for transition. All users are out of the house in weekday morning hours, attending colleges or working. One of the users proudly stated: "I have now got a second job. I get paid for it." The environment was significantly improved as a part of preparation for independent living. Care plans were updated and were rewritten with the involvement of users to ensure that these individual documents belong to users and that they are fully in control of these. Additional risk assessments were carried out at the time of the review. Staffing situation changed and the new manager was about to start. She has extensive knowledge of supported living principles. Staff were now made permanent and allocated to this scheme exclusively. All service users were looking forward to the transition, but with visible anticipatory anxiety that only encouraged them to progress further. What has improved since the last inspection? The four ladies living in the home have made huge progress towards independence. They have not only learnt new skills, but have increased the level of their personal responsibility for their lives. One of them started working at a second job which was paid, and was proud of her achievements. They have changed the rooms internally to accommodate better new conditions and newer lifestyle. One of them used her room a lot, but since moving downstairs, she also started spending more time in communal areas and sharing life with others. Although the acting manager was still in the home at the time of the site visit, she explained that the new manager had been recruited. The new manager that was about to start work in the scheme was experienced in supported living principles. Three permanent, designated staff, that were working in the scheme at the time of the site visit were allocated to stay to work in the project even when it becomes a supported living scheme. The plan included the same amount of staff support initially, when the transition goes through. New kitchen utilities were purchased with the intention to improve users` independence and to allow sufficient time for them to learn to safely use them. A slow cooker, new toaster and similar facilities were slowly introduced into everyday life in the home. Double glazing was installed throughout making the home safer, easier to heat and generally more pleasant. The carpet addressed on previous inspections was replaced, making the home much more homely, as well as new curtains. The process to store the homes` and supportive documents and leaflets into newspaper racks and into the cupboards started, thus making the home look more like an ordinary house, rather than a special project. Advocates were now engaged to ensure that users` voices were heard and listened toand supported users to address any potential anxieties they might have. What the care home could do better: At this point there was nothing to require formally, as the home, staff and users were slowly moving towards its` new status - a supported living home. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Creek Road (79) Creek Road (79) March Cambridgeshire PE15 8RE     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Dragan Cvejic     Date: 0 2 0 4 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 28 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 03000 616161 (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 28 Information about the care home Name of care home: Address: Creek Road (79) Creek Road (79) March Cambridgeshire PE15 8RE 01354654575 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) : Conquest Care Homes (Peterborough) Limited care home 4 Number of places (if applicable): Under 65 Over 65 0 learning disability Additional conditions: Date of last inspection Brief description of the care home 4 79 Creek Road provides accommodation and support to four adults with mild to moderate learning disabilities. All those living in the home are female as are the support staff. The home is in an ordinary house in a residential area of March close to local amenities. Each bedroom is for single occupancy and each has a washbasin. Service users share the bathroom facilities, the lounge, and the kitchen and dining area. To the front of the building is a parking area; to the rear is an enclosed garden. The home is provided by Conquest Care Homes which is a trading subsidiary of Craegmoor Healthcare Ltd. Care Homes for Adults (18-65 years) Page 4 of 28 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. We followed the home since the last inspection through regular contacts. We carried out an Annual Service Review on 05/02/2008 that confirmed consistency of quality of care. The organisation planned to de-register the service and to change it to a supported living scheme. This would allow the ladies that live in the home to extend their independence and to gain greater control of operation of the scheme. The service sent their AQAA, Annual Quality Asurance Assessment with information about their own assessment of the service. We checked 2 users files, 2 staf files, Care Homes for Adults (18-65 years) Page 5 of 28 toured the home and checked medication records, money records and daily records. We spoke to all ladies living there, to one of the visiting parents and to staff. The manager explained the plans for the final preparation to de-register the scheme on their transition to a supported living project. What the care home does well: What has improved since the last inspection? The four ladies living in the home have made huge progress towards independence. They have not only learnt new skills, but have increased the level of their personal responsibility for their lives. One of them started working at a second job which was paid, and was proud of her achievements. They have changed the rooms internally to accommodate better new conditions and newer lifestyle. One of them used her room a lot, but since moving downstairs, she also started spending more time in communal areas and sharing life with others. Although the acting manager was still in the home at the time of the site visit, she explained that the new manager had been recruited. The new manager that was about to start work in the scheme was experienced in supported living principles. Three permanent, designated staff, that were working in the scheme at the time of the site visit were allocated to stay to work in the project even when it becomes a supported living scheme. The plan included the same amount of staff support initially, when the transition goes through. New kitchen utilities were purchased with the intention to improve users independence and to allow sufficient time for them to learn to safely use them. A slow cooker, new toaster and similar facilities were slowly introduced into everyday life in the home. Double glazing was installed throughout making the home safer, easier to heat and generally more pleasant. The carpet addressed on previous inspections was replaced, making the home much more homely, as well as new curtains. The process to store the homes and supportive documents and leaflets into newspaper racks and into the cupboards started, thus making the home look more like an ordinary house, rather than a special project. Advocates were now engaged to ensure that users voices were heard and listened to Care Homes for Adults (18-65 years) Page 7 of 28 and supported users to address any potential anxieties they might have. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –03000 616161. Care Homes for Adults (18-65 years) Page 8 of 28 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 9 of 28 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 recently reviewed statement of purpose was sufficient to provide updated information about the home. Evidence: In the preparation to de-register the scheme and to transfer it to a supported living project, the home updated their statement of purpose and service users guide. This document was still in the hallway at the time of the site visit, but the acting manager and users of the service agreed for it to be located in a newspaper rack together with some other homes documents, thus preparing for the transition. The checked files contained admission information from the past, as all users, all four ladies, were living in the home for a number of years and there were no current or potential near future vacancies. All four ladies stated that the home met their needs. Checked files confirmed their statement. A visitor, mother of one of the users also added: Yes, they are very good, they fully meet my daughters needs. The acting manager was preparing users to fully understand new proposed contracts Care Homes for Adults (18-65 years) Page 10 of 28 Evidence: tenancy aggreements - as they would be different to the current contracts. Families were also involved in negotiation about conditions explained in a proposed documents. The acting manager stated in their AQAA, a self assessment: We want to develop Craegmoor Healthcare Your Voice project. This has been set up by the company to encourage service users to have a voice in the way the services are, and involve them with the future developments. Care Homes for Adults (18-65 years) Page 11 of 28 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. Service users were respected as individuals and appreciated the fact that they could express their wishes and choices. The level of individuality exceeded the minimum standards in the third consecutive year. Evidence: The home was informing us throughout the year of their plans and actions related to transfer to the supported living. The manager reported in AQAA: Consultation with service users, their families and other stakeholders took part throughout last year to de-register the home and reprovide as Supported Living scheme. Further support was given in written formats suitable to the persons needs. Two checked files confirmed that the home kept records of these consultaions. The needs were re-written in a slightly changed format of care plans, that accommodated much better involvement of service users and still clearly explained their needs and how they should be met. These new plans were kept as an addition to the current care Care Homes for Adults (18-65 years) Page 12 of 28 Evidence: plans that addressed their goals while still in a registered scheme. Users of the service made huge progress in decision making. They are now involved in all decisions about their daily routine, about their finances, and are involved in the advocacy service. One user attends Your Voice Forum and represents the Creek Road project. During the site vist, one of the users talked in length about her wish to move to completely independent accommodation. The manager addressed this in their AQAA confirming that the home supported the user: One lady expressed a wish that in the future she may wish to move, so we will continue to work towards developing skills she will need to achieve this. Care Homes for Adults (18-65 years) Page 13 of 28 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. Service users created their lifestyle as they preferred and were supported by staff to carry out their planned activities. They were in charge of their own home. Evidence: All service users made significant progress in developing their independent living skills. They have swapped over their bedrooms, so that the location of the bedrooms allowed them to adjust daily life as they wanted. All four ladies were spending weekdays out of the house, at their places of education or work. One of them recently started a new job and proudly stated: I now have a second job. I get paid for it. One of the users attends Your Voice Forum, a project where users of the services express their voices directly through the organised, formal forum. The AQAA, a self assessment from the home described this progress: We have Care Homes for Adults (18-65 years) Page 14 of 28 Evidence: supported one lady into active paid employment. Two ladies are involved in voluntary work. This offers them further opportunity to integrate with people in the local community. Three ladies will use Easter break to visit their families, whilst the remaining lady asked to have her boyfriend in during these days. Staff supported this, by preparing risk assessments, a mini care plan for the visitor, and ensured this would be a nice experience for this user of the service. A variety of community leisure facilities were used by the users, they were regular users of the swimming, Mencap discos and sport days. The ladies were taking over complete control of the running the home. They now do their shopping in pairs, whereby the two more confident ones support and guide the other two. The ladies were taking care of cooking, cleaning and other normal household chores. All ladies wanted their rota for these tasks to stay on board, to remind them in a sensitive and not intrusive way what they agreed to do on their house meetings. Care Homes for Adults (18-65 years) Page 15 of 28 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. Service users general health was good and they only needed support to deal with their healthcare and to maintain good health. The medication process was also appropriate, ensuring protection for service users. Evidence: The person centred care plans contained all necessary details about the healthcare needs and users initiative to maintain in good health. The service had a very good connection with the local GP. Community psychiatric nurse visits the home regularly and leaves the written feedback that contributes to good health records kept in files, as seen in two checked files. The ladies were almost fully independent in choosing their clothes to reflect their personality. In terms of personal care from staff, there was very little physical intervention needed, but the encouragement and support as identified in care plans ensured the users received both care and support as they needed. Visible staff efforts to ensure smooth transition to supported living resulted in regular reviews that included external professionals and care co-ordinators for each individual. Medication process was safe and encouragement for users to become self medicated Care Homes for Adults (18-65 years) Page 16 of 28 Evidence: was closely monitored and evaluated, to ensure the full safety of the ladies, once they become a part of the supported living programme. Care Homes for Adults (18-65 years) Page 17 of 28 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 home had the measures in place to protect service users from potential abuse and users felt safe and protected. Evidence: The home has not received any formal complaints. There were no complaints addressed to us, the regulators either. However, clear procedure, open and transparent management and quick reactions when needed, ensured that users, their relatives or anyone else involved in care could voice their concerns. This happened during the meetings with relatives about the transfer to supported living. The responses to the concerns raised were carefully listened to and all appropriate actions were undertaken, thus preventing any of the issues arising to the complaint level. The home ensured protection of service users both internlly and externally. When the user reported her suspicions regarding an external person on her way to college, the home undertook all possible action to ensure her safety and still to respect her individuality and personality. All staff were properly checked before starting work with the users, their references were checked as well as CRB (Criminal Records disclosure). The home also properly addressed and involved external professionals to deal with potential agitation that users could express. This action minimised conflicts between users and created a friendly and respectful atmosphere in the home. Care Homes for Adults (18-65 years) Page 18 of 28 Care Homes for Adults (18-65 years) Page 19 of 28 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. Significant improvements to the environment with the involvement of users of the service made the home much more homely, much closer to an ordinary house and a much more pleasant place for users to live in. Evidence: The preparation for transfer to supported living was very visible in the area of the environment. New double glazing, new kitchen appliances, new carpets, curtains and some furniture, as well as the organisation of the house whereby some document were stored in cupboards, notice boards were domesticated, as leaflets were stored in accessible cupboards, made the home real home for the users. One of them stated: This is now real home. The other lady showed her room with her hamster in and stated: I look after him, I clean the cage. I clean my room and keep it tidy. The entire home was brighter and warmer and users independence could be much more easily seen while they walked through the house during the site visit. New appliances in the kitchen , toaster, slow cooker and others, as well as individually lockable kitchen units prepared users for more independent life and improved infection control measures both for the current use and for the future. The home was inspected by Environmental Health and there were no concerns. Care Homes for Adults (18-65 years) Page 20 of 28 Evidence: Some re-wiring was also carried out, reducing the fire risk. Care Homes for Adults (18-65 years) Page 21 of 28 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. A stable staff team created since the last inspection ensured that all users needs were appropriately met and that the transition to supported living could proceed so that no distress is caused to users of the service. Evidence: Since the last inspection, the home employed sufficient staff to ensure the cover for holidays and sickness can be arranged by the permanent staff members. Staffing roles were clear and staff knew their current duties as well as what is expected from the once the scheme transfers to supported living. Staff files checked showed that all checks prior to staff employment were carried out to ensure better protection of service users. Staff spoken to during the site visit confirmed that they were very well supported, through supervisions, training and by regular contact with the acting manager. Staff knew users very well and knew all their needs, aspirations and likes and dislikes. The certificates of training were in files, still held in the home, but the manager explained that once the project transfers to supported living, the staff files will be kept in the head office. The organisation employed a new manager for the scheme that was going through regular checks at the time of the site visit. The new person would be solely responsible Care Homes for Adults (18-65 years) Page 22 of 28 Evidence: for this project. She has wide experience in supported living and would be able to support users during transition and afterwards. The other staff members have been working in this project for a long period and have developed a trustworthy relationship with users, making them more comfortable and reassuring regarding the forthcoming transition. The acting manager reported in AQAA that two staff members held NVQ qualifications and that all staff attended all mandatory refresher training. Training records checked confirmed that. Supervision records showed that the senior care worker provided regular supervision to the rest of the team, while the acting manager supervised her. Care Homes for Adults (18-65 years) Page 23 of 28 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. Safe working practices, staffs knowledge of service users and the regular quality assurance reviews now introduced, all contributed to the safety and welfare of service users and their satisfaction with services and provisions, currently and for the future. Evidence: The project was managed by the acting manager approximately since the last inspection when the previous manager retired. The acting manager was a registered manager for another, bigger scheme, but did share management responsibilities and spent approximately 2-3 days per week in this scheme. This accommodated progress made in a small scheme like this, without a larger impact on service users. This was assessed in last years Annual Service Review. The impact was seen since then, through regular reporting and especially at the site visit, when all service users comfortably and trustingly interacted with the acting manager. The plan for the new manager was another positive management decision, to ensure full and focused support during the transition and the first period after the transfer to supporting people. Care Homes for Adults (18-65 years) Page 24 of 28 Evidence: The organisation recently employed a Speciallist Quality Advisor that impacted on the quality of the quality assurance review processes. The review for this service was currently on-going and the questionnaires were already distributed. The acting manager was in the process of reviewing policies and procedures in relation to transfer, to ensure that all procedures would be prepared at the time of deregistration and transfer to supporting living. Safe working practices were maintained and all staff attended refresher courses for all mandatory subjects. The other checks on the house, that included ellectrical, gas checks, equipment checks etc were either completed or planned as a part of the preparation for the transition to a supporting people scheme and ensuring service users were minimally affected. Care Homes for Adults (18-65 years) Page 25 of 28 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 26 of 28 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 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 Care Homes for Adults (18-65 years) Page 27 of 28 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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