Care Home: Dixon House

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What the care home does well Dixon House provides people using the service with a comfortable, homely environment to live in. The staff team successfully meet the residents needs treating them with respect and giving them the support they need to make decisions about their own lives. People using the service could move freely around the home using all communal areas and their bedrooms at any time. Daily routines were flexible to meet the residents needs.When asked about the standard and quality of food served at Dixon House a resident said, "Staff help me to cook, I`m ok here". We asked a visiting relative to give us his views on the home and he told us, "They`ve done a lot and it looks much better". Individual person centered care plans are being developed and the management team are committed to making sure the individual care plans are reviewed regularly to reflect the residents changing needs. People using the service contribute to the development of their care plans where possible and staff support them in doing this. What has improved since the last inspection? Individual person centered care plans are being developed and the management team are committed to making sure the individual care plans are reviewed regularly to reflect the residents changing needs. Since the last key visit the management team have continued with the schedule of planned improvements at the home. Bedrooms, kitchen and communal areas have been completely refurbished and 4 bedrooms are now en suite. The work has increased residents opportunity for privacy and autonomy and more freedom to receive guests as they wish. What the care home could do better: Written records to demonstrate the arrangements for both managers to brief each other should be available so that each are clear about their roles and responsibilities and agreed tasks are actioned within the set timescales. Key inspection report Care homes for adults (18-65 years) Name: Address: Dixon House 17a Gorse Road Blackburn Lancs BB2 6LY     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Christine Mulcahy     Date: 1 5 1 2 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 25 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 25 Information about the care home Name of care home: Address: Dixon House 17a Gorse Road Blackburn Lancs BB2 6LY 01254665522 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: smscare@tiscali.co.uk S.M.S CARE LIMITED care home 12 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The registered person may provide the following category of service only: Care home only - Code PC To people of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning disability - Code LD The maximum number of people who can be accommodated is: 12 Date of last inspection Brief description of the care home Dixon House is registered to accommodate 6 people who have a learning disability. SMS Care Ltd are the registered persons for Dixon House and the day-to-day management of the home is the responsibility of a registered manager. The house is a split level modern detached property, set in its own well established grounds, with a private garden to the rear. At the front of the house is an elevated outdoor porch area and parking is available at the front of the property. Dixon House is located close to bus stops with easy access into Blackburn via the bus services. The home has a Statement of Purpose and a Service Users Guide that tells prospective residents about the home. Fees are determined by a comprehensive needs assessment and can be discussed with the registered person. Care Homes for Adults (18-65 years) Page 4 of 25 Over 65 0 12 Brief description of the care home Residents are responsible for paying for their own leisure activities, holidays, hairdressing and clothing requirements. Care Homes for Adults (18-65 years) Page 5 of 25 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: Dixon House received a key (main ) inspection on 15/12/2009. before the inspection took place the manager was asked to complete a document called an Annual Quality Assurance Assessment (AQAA). This document provides information on the services strengths and weaknesses and any future plans to develop the service. Surveys were also made available to people living at the home and staff to find out their views. Other information since the last inspection was also reviewed. As part of the key visit we used a system called case tracking. This is a method that allows us to follow or track a particular situation so we can be sure it was dealt with appropriately. There have been no complaints received by the Commission since the last key visit. The quality rating for this service is two star. This means the people who use the service experience good quality outcomes. Care Homes for Adults (18-65 years) Page 6 of 25 What the care home does well: 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. Care Homes for Adults (18-65 years) Page 7 of 25 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 8 of 25 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service and their representatives were given clear information about the home to help them make an informed decision before moving in. Residents are admitted following a full needs assessment to ensure staff at the home can meet their needs. Evidence: There is a comprehensive statement of purpose and service user guide that are specific to the people who live there. The documents set out the objectives and philosophy of the service and show people the service they can expect like the level of care and quality of the accommodation, staff qualifications and experience and how to make a complaint and the Commission inspection findings. Copies of these documents can be made available in formats that meet the capacity of prospective residents. Information from the care plans of some of the people using the service showed a needs assessment was done before they moved into Dixon House. Review Care Homes for Adults (18-65 years) Page 9 of 25 Evidence: assessments for existing residents were seen and showed a focus around the residents wellbeing, achievements and outcomes. A contract agreed by the resident their representative or relative clearly detailed the fees and charges and the manager said these were reviewed periodically. Care Homes for Adults (18-65 years) Page 10 of 25 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The needs of people using the service were set out in a plan of care so that support workers could maximise autonomy and choice. Written risk assessments ensured residents were safeguarded from harm. Evidence: Case tracking of a person using the service confirmed there was a plan of care that included enough detail for support staff to meet their assessed needs. The care plan showed the resident had undergone regular reviews of care and staff were fully committed to supporting the resident to lead a purposeful and fulfilling life. The care plan was a comprehensive up to date working tool that was used by the staff and resident for reference and guidance on ensuring their needs and choices were met. The care plan could be used and understood easily by new support workers so there would be a consistent approach in meeting the residents needs. The care plan addressed the residents daily living needs, vision, diet, medical history, memory and social interests. It was signed by the resident and key worker to verify Care Homes for Adults (18-65 years) Page 11 of 25 Evidence: their agreement on the details. Residents also signed to confirm they were willing to be supported to take control of their own lives and make real decisions that would improve their lives. When a resident was asked to give an example about something they had done to become more independent, they told us that they voted at the polling station on election days. Risk assessments relating to holding a key to the front door of the home and self medicating, were reviewed regularly and showed residents were supported to take risks as part of an independent lifestyle. People using the service were always consulted about how the home should be run and this was always accompanied by understandable information in formats that could be used by the residents. Regular residents meetings are held as a forum to make decisions about the day to day running of the home. Notes from the meetings were examined and showed that the home acts on the results of these meetings to influence some of the decisions in the home like menu choices, communal space decor, colour schemes and furniture. Care Homes for Adults (18-65 years) Page 12 of 25 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. Leisure, recreational and employment opportunities available to people using the services met their personal interests and preferences. Visiting from relatives and friends was flexible. Meals and snacks ensured variety and nutrition. Evidence: The philosophy and ethos of Dixon House strongly promotes the rights of the people who live there to an ordinary and meaningful life. The manager said that wherever possible residents could make choices about all aspects of their lives like waking and going to bed times and handling their own finances and medication. There is a strong commitment to enabling residents to integrate into community life Care Homes for Adults (18-65 years) Page 13 of 25 Evidence: and use facilities like work experience, sports opportunities, volunteering and college courses to develop their skills and reach their full potential. Discussion with residents and observations of the support received confirmed that as far as possible their independence was maintained. When we asked some of the residents about the variety of activities and opportunities available to them one person said, The staff are all good, Im ok and I cook. Menus and meal times is varied to suit the people who live at Dixon House. Meals recorded on the recently reviewed menu sheet were well balanced and nutritional with choices that catered for the cultural and dietary requirements of the residents. We asked a residents about the choice of food on the menu and how this was decided and they told us, We go to Asda on Thursdays, we all take turns in writing the list and doing the shopping. Residents religious and cultural needs had been assessed and identified on moving into Dixob House as part of the initial admission process. Where these needs had changed the manager told us that staff would always be sensitive to this and support the residents in their decisions. Another person told us that thew go to college and the manager said that she was always looking for new opportunities for residents to be a part of so they could maintain their independence and continue to make informed choices about areas of their lives and their daily living. Care Homes for Adults (18-65 years) Page 14 of 25 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. The health care needs of the people using the service were identified in a plan of care. Medication administration procedures and up to date staff training ensured residents were safeguarded from mis administration. Evidence: Examination of 2 residents care plans confirmed that all residents health details were recorded in a person centered plan of care and reviewed regularly. Access to health professionals like GP, optician and dentists were available and records of these visits were documented in the residents health care files along with medication and health reviews. There is an effective medication policy supported by procedures and practices that staff understand and follow. Examination of the homes medication trolley and medication administration records (MAR) showed that medication administered by support workers was stored and managed properly.Medicine recorde were fully completed and signed by designated workers. The registered manager is vigilant in this area and regularly checks to monitor compliance in all areas including receipt, administration and safekeeping of medicines. All of the staff team have received Care Homes for Adults (18-65 years) Page 15 of 25 Evidence: accredited training to administer medication. Following an assessment as able to self administer medication 2 residents retain and administer their own medication and are protected by the homes policies and procedures. These residents have a lockable space in which to store their medication and staff have access to this with the residents permission. Records for those self administering is maintained in the home by the resident and copies are kept by the manager in the homes MAR folder. Medication information leaflets are also kept in this folder so that support workers have easy access to this information and can better monitor the condition of residents and know when to contact medical professionals if they are concerned about any change in condition that might be a result of medication. Care Homes for Adults (18-65 years) Page 16 of 25 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. Complaints policies and procedures were available and gave clear guidance to those using them. Care staff and people using the service knew when and who to report complaints and abuse allegations to. Evidence: At Dixon House there is an open culture that enables residents to express their views in a safe and understanding environment. There is a complaints procedure that is clearly written, easy to understand and can be made available in different formats. People using the servixce are given a copy of this procedure with the service user guide and these can also be made available on request. The manager said that residents at Dixon House know that problems will be dealt with immediately before they become complaints and it was important to sort things oput because people live in close proximity and share facilities. The homes complaints procedure is clear and effective and includes the stages and timescales for the process. A complaints book was examined and we noted there had been no complaints recorded since the last inspection. There is a clear policy and procedure to safeguard people using the service.which includes robust staff recruitment procedures, and clear procedures for responding to suspicion or evidence of abuse or neglect including passing on concerns to the CQC. Care Homes for Adults (18-65 years) Page 17 of 25 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. People using the service live in a homely comfortable and safe environment that suit their needs and lifestyle. Evidence: The registered provider has made sure that the physical environment of the home provides for the individual requirements of the people who live there. All communal, shared and individual rooms are on one level. The laundry room is on the lower level of the house. A tour of the home and examination of residents bedrooms showed the residents had personalised their own bedrooms with new soft furnishings which had been chosen by them. Four of the six bedrooms are ensuite and all of the bedrooms are spacious, well furnished and decorated to a high standard. The kitchen, lounge and all 6 bedrooms have been newly refurbished and the residents at home on the day of the key visit were very happy to show us around the home. Residents took a great deal of pride in their home which was well well lit, very clean and tidy and smelled fresh. The current environment is fully able to meet the changing needs of residents and is designed for small group living where residents can enjoy maximum freedom in a non institutional setting. Care Homes for Adults (18-65 years) Page 18 of 25 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. At Dixon House staff are trained, skilled and in sufficient numbers to support the people who live at the home. The homes recruitment policy and procedure ensure these people are safeguarded from abuse. Evidence: The staff rota at Dixon House showed the home was sufficiently staffed. particular attention was given to busy times of the day and specific needs of residents like medical appointments, leisure interests and at peak times of activity. We observed staff throughout the visit who were involved in a number of activities with residents which showed there were enough staff available to support the residents. Discussion with the registered manager confirmed that training was ongoing and staff were expected to attend courses identified to enable them to support the people using the service. The small staff team of 5 have combined training and qualifications in the following areas. medication administration, health emergencies, moving and handling, infection control, mental health awareness, safeguarding, nutrition care and deprivation of liberty and safeguarding (DOLS). Two people have been trained to NVQ level 4 in health and social care promoting independence. One person is trained to NVQ Level 4 in leadership in management in health and social care. Care Homes for Adults (18-65 years) Page 19 of 25 Evidence: There is a good recruitment procedure that clearly defines the process to follow and ensures the protection of residents. The culturally diverse team reflects the gender and culture of the residents. Staff were observed being happily welcomed by residents with hugs and smiles and communication in a friendly and effective manner and tone. It was apparent that residents and support workers enjoyed each others company and staff demonstrated a variety of skills appropriate to use to meet residents needs. Discussion with two support workers and examination of staff files confirmed pre employment checks required to protect the residents were done. Examination of staff meeting and staff supervision records showed the wellbeing of residents was regularly discussed and their needs were paramount at all times. Care Homes for Adults (18-65 years) Page 20 of 25 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management and administration of the home is based on openness and respect. People using the service benefit from a well run home where their health safety and welfare is promoted and protected. Evidence: The registered manager has the required qualifications and experience and is competent to run the home. She has a clear understanding of the key principles and focus of the service. She is person centered in her approach and is aware of current developments and can plan the service accordingly. We examined records of residents finances and transactions were verified by staff and residents signatures and receipts were kept as proof of purchase. Many of the homes policies and procedures including health and safety were reviewed recently to ensure safe working practices. Records and documents showed that appliance equipment and home safety checks including fire safety were done regularly Care Homes for Adults (18-65 years) Page 21 of 25 Evidence: and staff sign to show they know how to follow these. Good practices, monitoring and record keeping ensure a low number of preventable accidents and the manager complies with statutory reporting requirements and other relevant legislation. The manager plans for future internal audits to be carried out that will determine residents and their relatives satisfaction of the service and the results of these will be included in the homes information brochure. There is a good strong working relationship between the registered manager and the registered provider and both have a good understanding of the risk assessment process in all aspects of the safe running of the home. The manager ensures staff training is ongoing and up to date and staff training records reflect this with planned training up dates. Record keeping was of a consistently good standard and these were kept securely. The home has the necessary insurance cover in place to fulfill any loss or legal liabilities Care Homes for Adults (18-65 years) Page 22 of 25 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 23 of 25 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 41 12 The registered provider and 15/02/2010 manager shall in relation to the conduct of the care home maintain a good personal and professional relationship with each other and with residents and staff. All professionals need an element of support and supervision including managers and owners. Records of discussions and observations of professional practice should form part of the report with outcomes and timescales 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 24 of 25 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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. 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