Care Home: Delbrook House

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What the care home does well The home is small and when full can only accommodate four (4) people, because of this it can provide, for those who need this, a close intimate homely environment. The home is well maintained and clean and all areas are welcoming. The owners make sure that all the staff have had the proper employment checks in place before they start working at the home and this makes sure the people who live there are safe. The owners also make sure the staff are trained to look after people with a learning difficulty.Delbrook HouseDS0000072899.V375182.R01.S.docVersion 5.2The owners make sure that people can stay at the home before they move on a trial basis and provides them with lots of information about the home before they decide to move in. This makes sure that the person has made the right choice and does not feel rushed into moving in to the home. What has improved since the last inspection? This is the first inspection of this service. What the care home could do better: The home needs to keep lots of information about the people who live there so that the staff can care for them properly. The owners need to make sure that the people who live at the home are involved and consulted so they know that information is kept about them. This will make sure they know it is right and have say in how they would like to be cared for. The owners of the home need to make sure that there is plenty of information about the peoples health needs so that they can be looked after properly and their health can be monitored by health care professional like doctors and nurses. Key inspection report CARE HOME ADULTS 18-65 Delbrook House 21-23 Marlborough Avenue Princes Avenue Hull North Humberside HU5 3JP Lead Inspector George Skinn Key Unannounced Inspection 13th May 2009 09:00 Delbrook House DS0000072899.V375182.R01.S.doc Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care home adults 18-65 can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Delbrook House DS0000072899.V375182.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Delbrook House DS0000072899.V375182.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Delbrook House Address 21-23 Marlborough Avenue Princes Avenue Hull North Humberside HU5 3JP 01482 343463 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Stephen John Welburn Rosemary Kay Rosemary Kay Care Home 4 Category(ies) of Learning disability (4) registration, with number of places Delbrook House DS0000072899.V375182.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home only Code PC To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: 2. Physical disability - Code PD, maximum number of places, 4 The maximum number of users who can be accommodated is 4 Date of last inspection Not applicable first inspection Brief Description of the Service: Delbrook house is two old Edwardian houses knocked together. The home has been modified inside to meet the needs people who live at the home. It is located in Avenues areas of Hull and is well situated for public transport into the city centre. There are plenty of local amenities for people to use; these include pubs, restaurants, a library and an adult education centre, there is also a park nearby. The home has of four (4) bedrooms one is one the ground floor and has an ensuite shower. The bedrooms are nicely decorated, clean and tidy. The furniture is a mixture of old and new pine furniture. The people who live at the home have a choice of two lounges. The main lounge on the ground floor is large and contains a TV and plenty of seating; there is one the first floor which is quieter. The home has a large dinning room and this would easily seat four (4) people. There are plenty of toilets for people to use and there is a bathroom and shower room. Delbrook House DS0000072899.V375182.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means that the people who use this service experience adequate quality outcomes The key inspection has used information from different sources to provide evidence these include: • • • • Reviewing information that has been received about the home since the last inspection. Information provided by the registered person on an Annual Quality Assurance Assessment AQAA. Comment cards returned from people who live at the home relatives and staff. A visit to the home carried out by one inspector. A site visit was carried out which lasted 5 hours. We spoke with the people who live at the home and staff. We looked at records relating to the people who live at the home, staff and the management activities of the home. During the visit care practices were observed where appropriate, and time was also spent watching the general activity within the home. 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. This is the homes first inspection as it is new registration. The owner was available to assist throughout the day. Current weekly charges range from £560 to £707 per week. What the service does well: The home is small and when full can only accommodate four (4) people, because of this it can provide, for those who need this, a close intimate homely environment. The home is well maintained and clean and all areas are welcoming. The owners make sure that all the staff have had the proper employment checks in place before they start working at the home and this makes sure the people who live there are safe. The owners also make sure the staff are trained to look after people with a learning difficulty. Delbrook House DS0000072899.V375182.R01.S.doc Version 5.2 Page 6 The owners make sure that people can stay at the home before they move on a trial basis and provides them with lots of information about the home before they decide to move in. This makes sure that the person has made the right choice and does not feel rushed into moving in to the home. What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Delbrook House DS0000072899.V375182.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Delbrook House DS0000072899.V375182.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are provided with enough information about the home to make an informed choice about staying there. People’s needs are assessed prior to moving into the home and there is a contract in place which is clear and provides the right amount of information. EVIDENCE: We saw that the home had produced a Service User Guide and a comprehensive Statement of Purpose. The Statement of Purpose contained all the information required by legislation and would provide enough information for prospective users of the service to make an informed choice about living at the home. The Service User Guide while containing plenty of information was written in way that did not make it accessible to people looking to live at the home. The owner told us that she had identified this and was working on the Service User Guide to make it more user friendly. We looked the files of the people who live at the home and we saw that these contained an assessment undertaken by the placing authority; the home had used this information to then create a plan of care. Delbrook House DS0000072899.V375182.R01.S.doc Version 5.2 Page 9 The home currently has two (2) people who live there one (1) of whom is there temporarily with a view to staying permanently. He told us that he would like to stay at the home but also understood that he was on a trial stay and does not have to make a rushed decision. The home’s admission procedure clearly states that anyone who is thinking of moving into the home can have over night stays and can visit the home as many time as they wish before they are expected to make a decision about staying there permanently. This is the process which is happening at the present time with the man who is staying at the home with a view to permanency. We saw that the home have issued contracts to the person who lives at the home and the Statement of Purpose clearly outlines the contractual obligations of both parties with regard to the stay at the home. Delbrook House DS0000072899.V375182.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people are involved in the day to running of the home due to it’s small nature, however their care plans do not reflect their goals or their involvement in the formulation. EVIDENCE: We saw that the home had a care plan which had been formulated using the information provided by the Local Authority care plan and assessment. We saw that this was not person centred and while it gave clear picture of the persons needs and how to meet them it did not demonstrate that the person had been involved in the process or had been involved in the decision making process. We saw that people were going about their daily lives and were making decision about what they did and when they did it. Delbrook House DS0000072899.V375182.R01.S.doc Version 5.2 Page 11 One person was able to go the local shops and he instigated this. The other person was able to move about the home freely and we saw that she was able to use her room and other parts of the home unrestricted. The home is very small and currently there are only 2 people who live there and, while there is no formal Quality Assurance system (QA) in place which seek the opinions of the people who live at the home and other stakeholders, by its very nature the home is inclusive. Delbrook House DS0000072899.V375182.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): This is what people staying in this care home experience: People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are encouraged and supported to experience opportunities for personal development and be part of the local community. The home actively encourages visits from family members. The people are supported to eat healthily and to maintain a healthy well balanced lifestyle. EVIDENCE: We saw that one of the people who live at the home is attending day care services. The owner told us that she is looking into accessing the local adult education centre and has spoke with the person who is there temporarily if he would like to attend the adult education centre, he has agreed and they are exploring options. We saw that the people who live at the home are able to access the local community either independently or with support if needed. We saw that they Delbrook House DS0000072899.V375182.R01.S.doc Version 5.2 Page 13 go the local shops, use the local pubs and visit the nearby park on a regular basis. We saw that the home actively encourages visit from family and friends and one of the people who live at the home regularly receives visits from her sister. The manager told us that due to the small amount of people who live at the home the meals are flexible and are set around their needs. This would also be the case if the home were full. Both of the people who live at the home have specific dietary needs and these are closely monitored by the home. The owner told us that they try to provide a healthily diet and encourage people to eat healthily but this is balanced with treats once in while. Delbrook House DS0000072899.V375182.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are not involved in the formulation of their care plans and the care plans are not written in a person centred way. People do not have a health action plan which would detail health needs and help staff to meet these. People are protected by the home handling of medication and staff have received the proper training. EVIDENCE: We saw that the home devise a plan of care by using information provided by the placing authority. The care plans contain very comprehensive risk assessments and these cover every aspect of the person daily life; this includes moving around the home, personal safety when out of the building, falls and dietary needs. We saw that the staff complete daily notes on the person’s wellbeing. We did not see any evidence that the person had been involved with the formulation of their care plan, or that the care plan was written in a person centred way. We did not see any evidence of health action plans which detailed the person’s health needs and how these were to be monitored and met. This Delbrook House DS0000072899.V375182.R01.S.doc Version 5.2 Page 15 would demonstrate that the person knew that information is kept about them, had been involved in its formulation and could influence decision making. We saw that the home handled the people’s medication safely and the storage was safe. We saw on staff files that they have received accredited medication training from the local authorities training department. The owner told us that no one currently self medicates but she is working towards supporting the person who is there temporarily to be responsible for his medication as assessments have shown he would be safe and capable of doing this. She feels it would further enhance his self esteem and confidence. Delbrook House DS0000072899.V375182.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are protected by the homes complaints procedure and kept safe from harm by the homes procedures and policies regarding safeguarding of adults. EVIDENCE: We saw that the home have a complaint policy and procedure in place and this displayed around the home. The policy and procedure is also available in the Statement of Purpose and the Service User Guide. The CQC have received no complaints or concerns about the service since it has been registered and the home is not subject to any ongoing safe guarding adults investigation by the Local Authority Safe Guarding Team. The owner showed us the format by which any complaint would be recorded and this detail any investigation and its outcome and whether the complaint was satisfied with this. No complaints have been received by the home. We saw on staff file that they had attended training on the Protection of Vulnerable Adults (PoVA) provided by the Local Authority training department. Delbrook House DS0000072899.V375182.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a home which is clean, tidy and well maintained. EVIDENCE: The home has of four (4) bedrooms one is on the ground floor and has an ensuite shower. The bedrooms are nicely decorated, clean and tidy. The furniture is a mixture of old and new pine furniture. The people who live at the home have a choice of two lounges. The main lounge on the ground floor is large and contains a TV and plenty of seating; there is one on the first floor which is quieter. The home has a large dinning room and this would easily seat four (4) people. There are plenty of toilets for people to use and there is a bathroom and shower room. Delbrook House DS0000072899.V375182.R01.S.doc Version 5.2 Page 18 The home provides lifting aids and adaptations for the staff to use to safely move someone who may need this type of assistance. The owner told us that no one needs to use the equipment at the present time. The home has achieved a B rating form the Local Authority Environmental Health Department for the cleanliness and running of the kitchen. The owner told us they are working toward an A. Delbrook House DS0000072899.V375182.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are cared by staff in sufficient numbers who are trained and competent to do so. People are protected by the homes recruitment and selection practises. EVIDENCE: Currently the home has two (2) people living there so the current staff numbers are adequate to meet their needs. We saw that the home have robust policies and procedures in place for the recruitment of staff. We saw that all the proper checks are done before someone starts working at the home. We saw staff recruitment files which contained copies of references from previous employers where possible; Criminal Records Bureau (CRB) checks, completed application forms, records of interviews and supervision records. Staff files included copies of job descriptions and information about conduct and disciplinary procedures. Staff have received induction training which is line with the guidelines issued by recognised training bodies this ensures the staff are trained and competent to do their job. Delbrook House DS0000072899.V375182.R01.S.doc Version 5.2 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a home which well run and run in their best interest. There is no formal QA system but people are involved in the day to day functioning of the home. People’s health and safety is promoted and protected as far as reasonably possible by the policies and procedures at the home. EVIDENCE: Both owners are registered with the CQC and are sufficiently qualified and experienced to run a care home. From speaking to the manager and staff it is clear that the homes ethos is to promote participation and inclusion for the people who live at the home. The smallness of the home enables the people who live there to be included in the day to day running, there are no formal means of QA but the people who Delbrook House DS0000072899.V375182.R01.S.doc Version 5.2 Page 21 live at the home have daily contact with the owners are cared for on almost a one to one basis. We saw that the home has developed policies and procedures which were required for the registration process and these were available to staff for reference. These included health and safety policies and fire procedures. Fire equipment is tested on regular basis and we saw a record of this. The staff have undertaken mandatory training which includes first aid, health and safety, fire, lifting and handling and basic food hygiene; however some of this was done through previous employer or a long time ago and needs up dating All the equipment in the home is tested at the appropriate intervals and all maintenance certificates are up to date. Delbrook House DS0000072899.V375182.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 2 3 3 3 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 3 32 3 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 3 3 2 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 3 3 3 3 3 3 3 3 3 Version 5.2 Page 23 Delbrook House DS0000072899.V375182.R01.S.doc No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA18 Regulation 18 Requirement The home must ensure that the care plans in place reflect the people’s preferences in the way they are supported and contains evidence of their involvement with the process. The home must make sure that each person has a comprehensive health action plan which clearly details their needs. Timescale for action 01/11/09 2 YA19 18 01/11/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard YA1 YA10 Good Practice Recommendations The home should make the Service User Guide is more user friendly and provide it in formats which are more suited to the individual. The home should make sure that all the people who live there are fully involved in the care planning process and they know that information is kept about them and what it is used for. The home should make sure the people who live there are DS0000072899.V375182.R01.S.doc Version 5.2 Page 24 3 YA19 Delbrook House fully involved with their care and this is reflected their care plans. Delbrook House DS0000072899.V375182.R01.S.doc Version 5.2 Page 25 Care Quality Commission Yorkshire & Humberside Region PO Box 1254 Newcastle upon Tyne NE99 5AR National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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