Care Home: Derriads

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What the care home does well New people and their representatives are provided with information about what they can expect from the service. The home makes sure that people’s care and support needs are known before they move in. Staff try to ensure that people use the same bedroom for each of their stays. Care plans identify how people communicate. Staff members work well with families to ensure that they know whether people’s needs have changed. People benefit from having staff members available at time when they need them. Staff members are well known to people who use the service and good relationships are established.DerriadsDS0000032436.V378776.R01.S.docVersion 5.3People continue to do the things they like to do when they are at home. People are offered a healthy diet as well as favourite snacks during their stay. People choose who supports them their personal care. Staff members know how to use the local procedure for reporting any allegations or observations of abuse. A member of staff takes the lead on safeguarding vulnerable people. The local Environmental Health Department awarded the home five stars for the kitchen. People are protected by a robust recruitment procedure. No one starts work without checks on their suitability to work with people who are vulnerable. Staff have good access to training and are well supervised. Mrs Andrews is clear about how she wants to develop the service for people’s benefit. Each staff member has an area of delegated responsibility for many of the administrative duties. What has improved since the last inspection? Mrs Andrews has been appointed as manager and is planning to be registered with us. Seven new staff have been appointed and there is less reliance on agency staff. There are plans for staff members to work exclusively at Derriads rather than working across the two homes in the respite service. All but three staff have completed training in person centred care planning. A further course was booked for January 2010. People have health action plans. Staff members keep in regular contact with people and their families when they go home so that any concerns or changes can be addressed. New care planning and risk assessment documentation has been implemented and is more regularly reviewed. People’s care planning files are reviewed in staff supervision, team leader meetings and checked by the service manager. One of the staff has been given the lead for developing the activities programme. Consideration is being given to people doing the things that they are interested in. People and their representatives are consulted about activities following each of their stays. Sensory equipment has been purchased. Different ways for people to choose what they eat are being established.DerriadsDS0000032436.V378776.R01.S.docVersion 5.3An in house complaints procedure has been developed in large print and pictorial format. Records of complaints are kept in the home with detail of the outcome of investigations and response to complainants. There has been a lot of effort put into improving the environment for people’s safety and comfort. The building has been re-decorated throughout and all of the windows replaced with double glazing. New furniture is being installed. What the care home could do better: All documents and amendments should be signed and dated. Entries in people’s daily reports should be continuous rather than having a line in between, where other entries could be made at a later date. Staff members must receive training in tissue viability, so they can assess people’s risk of developing pressure damage. Staff should also receive updated training in applying continence aids. The home should consult with the pharmacist and people’s families about reducing the need to cut tablets in half. This should reduce the risk of people not receiving the correct dose. Body maps should record size of any marks or wounds and whether the skin is broken. Key inspection report CARE HOME ADULTS 18-65 Derriads Respite Care Home 70 Derriads Lane Chippenham Wiltshire SN14 0QL Lead Inspector Sally Walker Key Unannounced Inspection 16th December 2009 09:25 Derriads DS0000032436.V378776.R01.S.doc Version 5.3 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. Derriads DS0000032436.V378776.R01.S.doc Version 5.3 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 Derriads DS0000032436.V378776.R01.S.doc Version 5.3 Page 3 SERVICE INFORMATION Name of service Derriads Address Respite Care Home 70 Derriads Lane Chippenham Wiltshire SN14 0QL 01249 652814 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) Wiltshire Council Manager post vacant Care Home 4 Category(ies) of Learning disability (4) registration, with number of places Derriads DS0000032436.V378776.R01.S.doc Version 5.3 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of care only: Care home providing personal care - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: 2. Learning disability- Code LD The maximum number of service users who can be accommodated is 4. Date of last inspection 21st January 2009 Brief Description of the Service: Derriads is an extended bungalow situated in a quiet residential area on the outskirts of Chippenham. The home provides respite care for up to four people at a time, who have complex physical and learning disabilities. The home is owned and managed by Wiltshire Council. The manager and staff team also run Meadow Lodge, which is part of the Chippenham Respite Service. There is 24-hour staff cover to provide support for people who use the service. Staffing levels vary depending on the needs of people who visit. There is always a minimum of two staff members on duty if people are there during the day. At night there is a minimum of one waking staff member or one staff member sleeping on the premises. Derriads is an attractive home, with a large lounge and comfortable furnishings. There is a separate dining room, a kitchen and two bathrooms. There are four single bedrooms, all with wash hand basins and ceiling tracks for hoists. To the rear of the house is a large, secluded garden, which is accessible to people, with aromatic plants and attractive features. Fees for respite care range from £102.90 per week for people aged 60 or over, £65.20 per week for people aged 25-59 and £52.65 per week for those people under the age of 25. Derriads DS0000032436.V378776.R01.S.doc Version 5.3 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This unannounced key inspection took place on 16th December 2009 between 9.25am and 5.30pm. Mrs Tania Andrews, who had been appointed as manager was present during the inspection. The service manager from Wiltshire Council was also present during the inspection. We spoke with two people who use the service and one staff member. We made a tour of the building. We looked at care plans, risk assessments, medicines, staff recruitment and training records and menus. We asked the home to complete an Annual Quality Assurance Assessment (known as the AQAA). This was their own assessment of how they were performing. It told us about what has happened during the last year and about their plans for the future. As part of the inspection process we sent survey forms to the home for people who use the service, staff and healthcare professionals to tell us about the service. We did not receive any comments. The last key inspection was on 21st January 2009. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. What the service does well: New people and their representatives are provided with information about what they can expect from the service. The home makes sure that people’s care and support needs are known before they move in. Staff try to ensure that people use the same bedroom for each of their stays. Care plans identify how people communicate. Staff members work well with families to ensure that they know whether people’s needs have changed. People benefit from having staff members available at time when they need them. Staff members are well known to people who use the service and good relationships are established. Derriads DS0000032436.V378776.R01.S.doc Version 5.3 Page 6 People continue to do the things they like to do when they are at home. People are offered a healthy diet as well as favourite snacks during their stay. People choose who supports them their personal care. Staff members know how to use the local procedure for reporting any allegations or observations of abuse. A member of staff takes the lead on safeguarding vulnerable people. The local Environmental Health Department awarded the home five stars for the kitchen. People are protected by a robust recruitment procedure. No one starts work without checks on their suitability to work with people who are vulnerable. Staff have good access to training and are well supervised. Mrs Andrews is clear about how she wants to develop the service for people’s benefit. Each staff member has an area of delegated responsibility for many of the administrative duties. What has improved since the last inspection? Mrs Andrews has been appointed as manager and is planning to be registered with us. Seven new staff have been appointed and there is less reliance on agency staff. There are plans for staff members to work exclusively at Derriads rather than working across the two homes in the respite service. All but three staff have completed training in person centred care planning. A further course was booked for January 2010. People have health action plans. Staff members keep in regular contact with people and their families when they go home so that any concerns or changes can be addressed. New care planning and risk assessment documentation has been implemented and is more regularly reviewed. People’s care planning files are reviewed in staff supervision, team leader meetings and checked by the service manager. One of the staff has been given the lead for developing the activities programme. Consideration is being given to people doing the things that they are interested in. People and their representatives are consulted about activities following each of their stays. Sensory equipment has been purchased. Different ways for people to choose what they eat are being established. Derriads DS0000032436.V378776.R01.S.doc Version 5.3 Page 7 An in house complaints procedure has been developed in large print and pictorial format. Records of complaints are kept in the home with detail of the outcome of investigations and response to complainants. There has been a lot of effort put into improving the environment for people’s safety and comfort. The building has been re-decorated throughout and all of the windows replaced with double glazing. New furniture is being installed. 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. Derriads DS0000032436.V378776.R01.S.doc Version 5.3 Page 8 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 Derriads DS0000032436.V378776.R01.S.doc Version 5.3 Page 9 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): 2 People who are considering using the service have information available to them so that they can decide if the home is suitable to meet their needs. The home makes sure that as much as possible is know about people’s needs before they move in. 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. EVIDENCE: Most people had been using the service for a number of years and it was well known to them and their families. People were allocated a number of days throughout the year. People could usually choose which periods of time they wanted to use the service. The service manager told us that sometimes people who already used the service could be offered emergency respite when needed. Emergency admissions were only possible for people who were already using the respite service. People often came to the home having spent the day at their day service; then when their stay was finished; they would go to day services and return home afterwards. Derriads DS0000032436.V378776.R01.S.doc Version 5.3 Page 10 There was regular contact with people and their carers when they were not using the service, either directly when at home or through their day services. This meant that any change in care need would be known to staff before people used the service again. The home obtained people’s community care assessments and reviews with people’s social workers. In the AQAA Mrs Andrews told us “service users, families and carers are offered home visits and numerous tea visits, to ease the transition for a service user in to the service. Prior to a service user’s first stay, we ask for as much information as possible, to include the ways they would like to be supported, to ensure that we provide a high quality service, consistent with their choices and wishes.” Derriads DS0000032436.V378776.R01.S.doc Version 5.3 Page 11 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): 6, 7 & 9 New care planning documentation means that people’s care and support needs and any risks to their wellbeing are written down. People’s care and risk assessments are more regularly monitored. 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. EVIDENCE: The home tried to make sure that people used the same bedroom each time they stayed. Some people with more complex care needs made use of the profiling bed in one of the bedrooms. This was a bed which could raised or lowered so that the person could be moved more comfortably. The home also made sure that people who knew each other and got on together came to stay at the same time. Derriads DS0000032436.V378776.R01.S.doc Version 5.3 Page 12 People’s care and support needs were set out in their care plans. Action had been taken to address the requirement we made at the last inspection of 21st January 2009 that care plans are kept under review. A new care planning format meant that care plans were now being regularly reviewed. Mrs Andrews told us in the AQAA that “the introduction of one page profiles has changed the format of the support plans and highlights key indicators of the individual’s needs. This will ensure that staff have a clear understanding of the range of needs for each service user. Derriads has now introduced a quarterly meeting called ‘Service User’s Discussion. This allows staff to discuss all areas of the individual’s needs covering equality and diversity.” Part of the care plan had sections entitled ‘how best to support me’, ‘what’s working’ and ‘what’s not working’. The files had a profile with essential information about what people considered to be the most important things about them and how they liked to live. There was information about how people made decisions and communicated. One person’s file had drawings of the Makaton gestures that the person used. Another person’s care plan gave details of vocalisations, facial expressions and how they should be interpreted and responded to. We saw that staff members knew each person’s individual communication methods. Staff members included people in conversations and did not talk exclusively with each other. People were asked about different things and encouraged to communicate whether or not they used speech. Action had been taken to address the requirement we made at the last inspection that identified risks are assessed and kept under review. Risk assessments, entitled ‘keeping me safe’ and ‘what we can do to make it less dangerous’, were carried out with people on their moving and handling needs, going out, bathing, getting up at night and their environment. The risk assessments were highlighted and cross-referenced with the care plans which showed what should happen to reduce or minimise any risks. There was clear guidance that staff must let people know what was happening; in providing personal care and throughout the day. Moving and handling risk assessments provided photographs of how to use a hoist and the use of safety straps when people went out in a wheelchair. Advice had been sought from the occupational therapist about the use of any equipment. People’s relatives had signed up to care plans and risk assessments. Action had been taken to address the good practice recommendation we made that person centred planning was further developed. Mrs Andrews told us that all but three of the staff had received training in person centred planning. This was evident from the care plans. There was guidance to staff about how people liked to be addressed and their preferred routines for personal care during the mornings, evenings and at night. There was guidance on reducing behaviours, with headings such as “I do not like to have to wait” and “I do not like having intimate personal care”. Some information in people’s files was in large print. Some of the documents and amendments had not been signed or Derriads DS0000032436.V378776.R01.S.doc Version 5.3 Page 13 dated. We also suggested that there should not be a line left between entries in the daily reports. This is to ensure that all recording is contemporaneous. Action had been taken to address the good practice recommendation we made that some people with a sensory loss would benefit from having aids and equipment. Some equipment had been purchased and set up in the sitting room. Derriads DS0000032436.V378776.R01.S.doc Version 5.3 Page 14 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: 12, 13, 15, 16 & 17 People have the opportunity to continue to do the things they do when they are at home. The appointment of an activities co-ordinator means that things to do are better planned for people. Things that people do are better recorded. Good links with families and carers are well established. People benefit from a healthy diet. 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. EVIDENCE: Most people continued to go to their different day services and clubs during their stay. People had a communication book which they took with them to day services, the respite service and when they went home, so that information could be shared. There were plans to reduce day services across Wiltshire in future when people had a period of respite care. In response to Derriads DS0000032436.V378776.R01.S.doc Version 5.3 Page 15 this, the home was preparing to provide more things for people to do during their stay. Action had been taken to address the good practice recommendation we made that evidence was provided of activities both at the home and in the locality. We also said that there should be an evaluation of these activities. Mrs Andrews had designated a member of staff to take responsibility for providing a range of suitable activities that people could be involved in. Another staff member supported them with this. A new record of activities was being completed. This was regularly evaluated to ensure that each activity was designed for a positive outcome for each person. We thought that training in providing activities with people with learning disability should be offered to those staff taking the lead in activities. In the AQAA Mrs Andrews told us that staff members responsible for activities in each of the different respite services in Wiltshire planned to meet every few months to create programmes which could be personalised for each person. She also told us that she planned for more use of local facilities and groups so that people could develop relationships with people who did not have a disability. Mrs Andrews had developed a service review form which was sent to people following their stay. This included requests for comments about the activities which each person had been involved in. The daily reports showed which activities people had been offered and engaged in each day. People went to the Gateway club, to the cinema, arts and crafts and cultural and religious preference was noted in the care plan. Mrs Andrews told us that people would be supported to access their religious networks. The activity co-ordinator was producing a programme taking into consideration each person’s ability and what they liked to do during their stay. There were plans for more community events with photographs, so people could choose what they wanted to do. People’s files contained details of what they were doing at day services during the week. In the AQAA Mrs Andrews told us that a newsletter would be produced to let people know what activities were planned during their stay, incorporating people’s particular requests to do things. Cards with the address of the home were available if people were going out alone. Both homes shared a minibus which was historically kept at the other home. Some people went out for walks in the locality and other people who had difficulties with long distances, went out in wheelchairs pushed by staff members. People also used public transport. Risk assessments were completed for when people went out. Some people liked to be involved in preparing and cooking the meals. One person from the other home had come to cook their own lunch. This was Derriads DS0000032436.V378776.R01.S.doc Version 5.3 Page 16 because staff at the other home were attending a staff meeting at Derriads and they would be left on their own. The home does not have a set menu as most people only stay for a few nights. Staff members knew what people liked to eat and planned the shopping around who was staying that week. One staff member was cooking ‘bangers and mash’ with onion gravy for two people who were staying that night. We looked at the records for what people had eaten. People took a packed lunch with them if they were going out for the day. There was good information in people’s care plans about how people were supported with eating and drinking and maintaining a healthy diet. In the AQAA Mrs Andrews told us that she had developed a food file with photographs and pictures of different types of foods so that people could choose what they wanted to eat. We saw one person without speech take the manager to the kitchen so that she could make them a drink. There was a ‘half door’ on the kitchen to discourage some people from accessing the kitchen when meals were being cooked. There were snacks such as crisps and chocolate kept in one of the cupboards. Derriads DS0000032436.V378776.R01.S.doc Version 5.3 Page 17 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): 18, 19 & 20 People benefit from having all their care and support needs set out in care plans and risk management plans. People’s preferred routines are included in their care plan. People have good access to healthcare when needed, in consultation with their families and carers. Safe systems are in place for managing people’s medicines. 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. EVIDENCE: People’s files contained details of medical history and whether they had any medical conditions clinically diagnosed. Everyone had a health action plan. People and their families took the main responsibility for managing people’s wellbeing, as most people only stayed at the home for a short time. There was guidance on how staff should support people with any medical conditions. It was clear from the records that staff referred any concerns to people’s GPs in an emergency. They discussed any medical issues with parents and relatives. People’s files contained contact details of any special healthcare professionals. Derriads DS0000032436.V378776.R01.S.doc Version 5.3 Page 18 People’s care plans identified their preferences for receiving personal care. People could choose who provided their intimate personal care. The home discussed how people were supported at home with people’s families, for continuity of care and support whilst they were at Derriads. Families were encouraged to keep in regular contact with the home, either by phone or letters. There was also a communication book which people took home with them. Risk assessments and guidance on the use of bed rails was in place and regularly reviewed. We saw that some people who used the service had either reduced mobility, spent a lot of time in their wheelchair or needed support with moving their position during the night. We recognised that some people only spent a short time at the home, but advised that the home sought training on reducing people’s risk of developing pressure damage. Risk assessments and guidance were in place for managing behaviours. There was guidance from a specialist nurse on safe physical intervention when some people attempted to harm themselves. Most people’s medicines were held safely on their behalf. The medicine administration records were pre-printed by the home. Records were kept of all medication received from people or their relatives. There were records of medicines given back to them or their relatives when they returned home. These entries in the medicine administration record were witnessed, signed and dated. Mrs Andrews told us that she had changed the administration of medicines procedure following her investigation of a recent medicine error. The person had not been affected by the omission of their medication and staff had contacted the person’s GP immediately. Two staff now administered medicines. The door to the medicine room was to be shut whilst each medicine was checked by both staff against the medicine administration record, to make sure it is properly given. A new medicine administration record was now printed off for each stay, so that it was clear what people were taking. All staff had undergone checks on their continued competency to administer medicine. One of the senior staff told us that they had recently been given the delegated responsibility for medicines and told us about the training sessions that they were delivering the following week. New staff could not administer medicines until they had undertaken training and had their competency confirmed. We saw that two people’s tablets were being cut in half prior to being administered. We advised that, in consultation with the person and their family, the home should ask the pharmacist whether there was any other means of ensuring the correct dose without staff members, or indeed the person’s family, having to cut the tablets. Derriads DS0000032436.V378776.R01.S.doc Version 5.3 Page 19 We saw that another person’s medicine was put in their food. The care plan stated that staff were to tell the person this each time it was administered in this way. No controlled medicines were being administered. There was a suitable cabinet available if controlled medicines were needed in the future. We looked at the CD register. The individual drug and strength had not been recorded. The senior staff with responsibility told us that they would review and revise the home’s procedure to address this. They told us the training they planned had a section on safe administration of controlled medicines. Care plans identified when medicine prescribed to be taken only when needed should be given. One example was for pain relief. Regular checks were made with each person’s GP to make sure that they were taking the correct medicines. Some people had epilepsy profiles which were regularly monitored by the learning disability specialist nurse. There was clear guidance to staff on supporting people to manage their condition and when the emergency services should be called if people had a seizure. Staff members had received training from the learning disability specialist nurse in working with people with epilepsy and administering buccal midazolam. Body maps were being kept of any marks or injuries and the date they were noted. We advised that more detail should be recorded, for example, the size of any marks and whether the skin was broken. Some medicine needed to be stored in a small locked fridge. Staff kept a record of the fridge temperature to ensure that the medicine did not spoil. Derriads DS0000032436.V378776.R01.S.doc Version 5.3 Page 20 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): 22 & 23 Systems are in place so that anyone can make complaints about the service. Staff members are confident in reporting any abuse of people who use the service. 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. EVIDENCE: People and their families were given a copy of the Council’s complaints procedure. Complaints forms were separated into formal and informal complaints. Mrs Andrews told us that informal complaints were when anyone wanted to tell her about something they were not happy with but did not want to make a complaint. People were guided to the Council’s formal complaints form if they wanted to complain. These complaints would be investigated and actioned by the service manager. Action had been taken to address the requirement we made that records of all complaints made to the service must be kept within the home, including actions, timescales and outcomes. The home kept a record of all complaints. There was one complaint under investigation. Mrs Andrews told us that prior to this there had been no complaints since she became manager. She told us that she intended to sort things out at the time when things went wrong for people. Mrs Andrews had developed a service review form which was sent to Derriads DS0000032436.V378776.R01.S.doc Version 5.3 Page 21 people following their stay. The form invited people and their relatives to comment or make complaints about the service. Mrs Andrews told us that a phone call would be made if no reply was received. This was to give people and their families different opportunity to comment or complain about the service. Care plans identified how people managed their money. Some people kept small amounts of cash in the safe for them to spend during their stay. Records were kept of all transactions and the balances were checked each day. We asked staff about what they would do if they saw or were told about any allegations of abuse of people who use the service. They were very quick to tell us how they would report the allegation using the home’s procedure and they described the local safeguarding procedure. They told us they would report directly to the local safeguarding unit or care manager, if Mrs Andrews or senior managers were not available. Staff had been given a copy of the local safeguarding booklet and received regular training. One of the staff responsible for this training showed us the questionnaire which staff were expected to complete at the training session which was soon to take place. This member of staff had the delegated responsibility for safeguarding at the home. They told us there was also online training available through the elearning. Staff were also provided with training on sexuality and relationships. Mrs Andrews told us that staff were asked questions about safeguarding vulnerable people at interview. Derriads DS0000032436.V378776.R01.S.doc Version 5.3 Page 22 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): 24 & 30 People are benefiting from the recent upgrading of the building. The environment continues to improve for people’s comfort. The home is clean, warm and well maintained. 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. EVIDENCE: All the bedrooms are singles. In the AQAA Mrs Andrews told us that she planned to support people to personalise their bedrooms better during their stay. She said people were invited to create a personalised poster for the outside of their bedroom door during their stay. Significant effort had been made to improve the environment for people who use the service. One of the bathrooms had been extended and refurbished with a special bath. The whole of the interior was nearing completion of a Derriads DS0000032436.V378776.R01.S.doc Version 5.3 Page 23 redecoration programme. New double glazed windows had been installed. New furniture was on order; sofas were being delivered the following week. New lighting had been provided in the corridor so that people with impaired vision could see better. New blinds were being fitted. The service manger was in the process of hanging new pictures and paintings in the hall and sitting room. Mrs Andrews told us that she had got rid of lots of items which were not used anymore and were cluttering up the home. She had purchased new more modern crockery. In the AQAA Mrs Andrews told us that new furniture was being purchased. The service manager told us that funding was being sought for the home to be extended to provide a separate dining room. The old dining room was lost when the bathroom was extended. Currently people were eating their meals either in the kitchen or at the dining room table in the sitting room. The home was cleaned to a good standard. In the AQAA Mrs Andrews told us that in order to reassure parents of the high standards of hygiene, records were kept of continence pad changes. Staff members were provided with disposable gloves and aprons if needed. In the AQAA Mrs Andrews told us that the local authority Environmental Health Department had awarded the home five stars for the kitchen. Derriads DS0000032436.V378776.R01.S.doc Version 5.3 Page 24 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): 32, 34, 35 & 36 People benefit from having staff members available when they need them. People are protected by a robust recruitment process. There is less reliance on agency staff. No one starts working in the home until a check has been made on their suitability to work with vulnerable people. Staff members have good access to relevant training. 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. EVIDENCE: When we arrived at the home, staff from both homes were about to join a staff meeting. Three members of staff were on duty, including an agency worker. Seven new permanent staff members had been appointed and there was less reliance on agency staff. However long term sickness cover was proving difficult to cover. Wiltshire Council had a group of bank staff but the home’s own staff members generally covered the shifts. The staffing rota was arranged according to the needs of those people living at the home at the Derriads DS0000032436.V378776.R01.S.doc Version 5.3 Page 25 time. Mrs Andrews told us that during the day there were usually three or four staff members. At night the minimum was one member of staff sleeping on the premises. This could be increased to waking night staff if people needed them. One of the senior staff had the delegated responsibility for compiling the staffing rotas. They said this was a challenge due to current staff sickness. They said that permanent staff were flexible and covered most of the shifts. There was an on call system for staff to contact senior staff in an emergency. We looked at the staffing rota which identified which of the two homes staff members were allocated to. Mrs Andrews told us that she planned for staff to be allocated to only one home as their place of work; staff were currently choosing which would be their place of work. A team leader would deputise in each home. There would be a separate rota for each home. Mrs Andrews had recruited another team leader and two care staff were acting up as team leaders. She said she had employed a permanent waking night staff member so that people feel comfortable with someone they have known for a long time. Each staff member had a delegated area of responsibility, for example, training, safeguarding, staffing rota and medicines. Staff members were allocated four hours each month on the rota for administrative duties. Staff members records and information about recruitments were kept centrally by Wiltshire Council’s human resources department. Mrs Andrews showed us the records she kept of all the information and documentation required by regulation. She told us she was in the process of making her own checks of some of this information as proof of staff members identity. The Council sought all the documents and information for the recruitment process and would inform Mrs Andrews when this was confirmed. Mrs Andrews shortlisted applicants and interviewed potential staff members with her line manager. There was evidence that no one commenced working with people who may be vulnerable until a negative Criminal Records Bureau certificate had been obtained. New staff were inducted into their role with records kept. New staff were expected to undertake the Learning Disability Qualification. Although there was no formal gender working policy, the service manager told us that there was clear guidance about intimate personal care being given by staff of a different gender in the staff job descriptions and the code of conduct for good practice. One of the staff told us about their previous experience of working in other services with younger people with learning disabilities. They said they, and other staff had not undergone a proper induction when they were appointed by the previous manager. They went on to say that this had been remedied since Derriads DS0000032436.V378776.R01.S.doc Version 5.3 Page 26 with regular supervision sessions. They said they now had the delegated responsibility of carrying out induction with new staff. Staff supervision sessions were identified on the staffing rota. Staff told us they had eight supervision sessions with records kept on their personal files. In the AQAA Mrs Andrews told us that staff members had worked at the day service to see how people were supported and to encourage consistency in skill development. One staff told us there was ‘loads of training’. There was a computer where staff booked time to complete e-learning provided by Wiltshire Council. The Council’s training co-ordinator published a plan of training sessions to be provided throughout the year. Training needs were discussed at supervision and Mrs Andrews authorised training according to need. Mrs Andrews kept a record of when each staff member achieved mandatory training and when updates were needed. Staff had undertaken the Learning Disability Qualification, moving and handling, person centred thinking, first aid, medication, fire prevention, health and safety, the Mental Capacity Act 2006, food hygiene, epilepsy awareness, infection control, safeguarding vulnerable people, administering rectal diazepam, positive behaviour management, dementia and learning disability, PEG specialised feeding techniques and Makaton. Mrs Andrews told us that staff had received training in equality and diversity the previous week. Agency and relief staff had access to the training programme. In the AQAA Mrs Andrews told us that she planned to offer courses in sexuality and relationships. We asked about training in applying a conveen continence aid. Some staff had been trained in the past, but most staff had learnt by watching others. We said that further training should be sought from the continence nurse, particularly for the newer staff. Derriads DS0000032436.V378776.R01.S.doc Version 5.3 Page 27 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): 37, 38, 39 & 42 Since Mrs Andrews had been appointed, she has improved the quality of the service. Systems are more organised. Mrs Andrews is clear about how she wants the service to develop and has already made changes to long established practices where necessary. The home is run in people’s best interests. People and their families contribute to the quality audit. Systems are in place to monitor everyone’s health and safety. 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. EVIDENCE: Mrs Andrews was appointed as manager in July 2009. Mrs Andrews also manages the other respite home in Chippenham. She told us she was waiting Derriads DS0000032436.V378776.R01.S.doc Version 5.3 Page 28 for her Criminal Records Bureau certificate to arrive so that she could start the registration process with us. Mrs Andrews told us she was completing NVQ Level 4 in management and care. She said she had signed up to start the Leadership and Management for Care Services Award in January 2010. Mrs Andrews showed us her training record. She had the NEBS management qualification, BTec Level 3 in care and had recently undertaken training in recruitment and selection and appraisal. Mrs Andrews had also undertaken all the mandatory training listed in the staffing section of this report. Since she became the manager, Mrs Andrews had made many improvements and changes to the service. She told us she had produced what she described as a ‘wish list’ following discussion with people who use the service and staff. Questionnaires were sent to people and their representative each year as part of the quality audit. Results of the findings were put in an action plan. We advised that staff should also be included in the audit for their views on the service. Reports of regular senior management unannounced visits on behalf of Wiltshire Council were sent to us. In the AQAA Mrs Andrews told us that coffee mornings were held for people and their parents and carers to feedback on the service and any changes they wanted to make. In the AQAA Mrs Andrews told us that an external manager monitored quality through the monthly unannounced visits and set out an action plan in their report. The action plans were monitored at each visit. Mrs Andrews told us that she was in the process of reviewing the risk assessments for the environment and tasks that staff were involved in. Wiltshire Council provided generic risk assessments and Mrs Andrews carried out specific risk assessments that were individual to the home. Risk assessments for individual people were available in their care plans. Derriads DS0000032436.V378776.R01.S.doc Version 5.3 Page 29 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 X 2 3 3 X 4 X 5 X 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 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 3 3 X X 3 X Version 5.3 Page 30 Derriads DS0000032436.V378776.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 YA19 Regulation Requirement Timescale for action 31/03/10 18(1)(c)(i) Members of staff must receive training in tissue viability, so they can assess people’s risk of developing pressure damage. Staff should also receive updated training in applying specific continence aids. 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 3 Refer to Standard YA41 YA41 YA20 Good Practice Recommendations All documents and any amendments should be signed and dated, for monitoring purposes. Entries in people’s daily reports should be continuous, rather than having a line in between, where further entries could be made at a later date. In order to reduce the risk of people receiving varying doses of medicine, the home should consult with parents and the pharmacist about reducing the need to cut tablets in half. Body maps should record size of any marks or wounds and whether the skin is broken. DS0000032436.V378776.R01.S.doc Version 5.3 Page 31 4 YA41 Derriads Care Quality Commission Care Quality Commission Citygate Gallowgate Newcastle Upon Tyne NE1 4PA 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. 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). 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