Care Home: Duchess Close

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What the care home does well The home is well managed and clear leadership is provided for staff, which ensures that the people who live in the home receive good care. There is an experienced and stable staff team, which maintains the quality of care provided to the residents. There are excellent person-centred care plans to guide staff about how they can best meet residents needs in a consistent way, including risk assessments that identify potential harm to residents welfare. There are well established links with the community and the residents take part in a range of stimulating activities. This provides the opportunity for their personal development. Complaints are clearly recorded and prompt action is taken to ensure that complaints are taken seriously. Staff receive regular supervision, to support them in caring for the residents and enhances their personal development and they receive training that is appropriate to the care they provide. The home has good systems to safeguard residents from financial abuse and health and safety procedures ensure that residents and staff welfare is protected. What has improved since the last inspection? Since the last inspection, there has been substantial improvement in the general maintenance of the home with many repairs carried out to the fabric of the building. Medication that is self-administered by a specific resident is now kept locked when not in use. All the staff have attended training in the protection of vulnerable adults. What the care home could do better: The temperature of the medication cupboards must be monitored to ensure that it does not exceed 25 degrees C. to prevent the medication deteriorating and we recommend that the date that liquid medication is opened should be written on the label of the bottle so that staff are aware of expiry dates. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Duchess Close 5 & 6 Duchess Close 5 & 6 Friern Barnet London N11 3PZ     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: THOMAS McKERVEY     Date: 0 8 0 4 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 27 Information about the care home Name of care home: Address: Duchess Close 5 & 6 Duchess Close 5 & 6 Friern Barnet London N11 3PZ 02083687131 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : ecummings@adepta.org.uk PentaHact Limited trading as Adepta care home 6 Number of places (if applicable): Under 65 Over 65 0 learning disability Additional conditions: Date of last inspection Brief description of the care home 6 5 & 6 Duchess Close, is a residential care home for six adults, male and female, who have a learning disability with an autistic spectrum disorder. The home was first registered in November 2000, and was established in partnership with Birnbeck Housing Association and Barnet Council. The home, which was built as part of a larger general needs housing development, on the old Friern Barnet Hospital site, is situated in a quiet cul-de-sac. The property is comprised of two adjoining semi-detached houses, with through-access on the ground floor. This arrangement provides separate group-living areas, each with their own kitchen-diner, lounge, toilet and bathroom. There is a bedroom on the ground floor, and two first-floor bedrooms in each house. There is space for car parking at the front, and a large garden at the rear of the property. There is a good range of shops, pubs and restaurants nearby, and there is good public transport access to the area. The last inspection report and purpose and function document are available to be viewed in the staff office. The current fee is #416.00 per week. Care Homes for Adults (18-65 years) Page 4 of 27 Care Homes for Adults (18-65 years) Page 5 of 27 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: This unannounced inspection took place over a period of four and a half hours. The inspection was carried out as part of the Commissions inspection programme to check compliance with the key standards. The manager was not present when we arrived but joined us at a later stage and was present for the majority of the inspection and fully cooperated in the process. We carried out a tour of the building and spoke with a number of the residents and members of the staff team. We also examined various records and documents including residents case files, staff records and documents pertaining to the running of the home. Only one resident is able to converse, but they left the home to attend a day centre before we could speak to them. However, we were able to observe how the other residents spent their day and how they interacted with the staff. We would like to thank the manager, residents and staff for their openness Care Homes for Adults (18-65 years) Page 6 of 27 and participation during the inspection. 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 set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 27 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 27 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. There is good information provided about the service to enable prospective service users to decide if the home is suitable for their needs and people can be confident that a through assessment is carried out of their needs before they are admitted to the home. Evidence: One person has moved on to more independent living. There was one vacancy, which the manager hopes to fill, having recently assessed someone. The manager stated that this person has visited the home and is happy to move in. The home has an up-to-date statement of purpose, including information about the new manager and his previous experience. The document provides sufficient information to ensure that prospective service users are able to make an informed choice about whether the service can meet their needs. Residents files, which were examined, contained comprehensive needs assessments by the placement officer and the home manager prior to admission. The files also Care Homes for Adults (18-65 years) Page 10 of 27 Evidence: contained a contract of terms and conditions, which was in a pictorial form to ensure that the information is easier to understand by the resident. The AQAA states that all residents had a conmprehensive service revue by local commissioners as part of the fair pricing programme. This involved inut from relatives and service users. Care Homes for Adults (18-65 years) Page 11 of 27 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in the home can be confident that there are clear care plans for each person, which provide clear objectives of the support they require. There are good systems in place to involve the residents in the running of the home and to enable and support them in making decisions about their lives. Evidence: Three care plans were examined. The manager demonstrated how care plans were computerised. All staff have been trained on this system, which is password protected. The care plans specified the areas in which the residents can be supported to make decisions about their lives; for example, how the person likes to be addressed and how they express wishes and choices. This is contained in a Communications Passport. There is guidance about how to interpret the wishes of residents who are unable to communicate verbally, by using, for example, objects of reference. The care plans were person centred and risk assessments were well documented. The risk Care Homes for Adults (18-65 years) Page 12 of 27 Evidence: assessments identify potential hazards. This enables residents to enjoy a range of activities within the home and in the community with a minimum of risk to their safety. Assessments were comprehensive and covered physical and emotional health, commmunication and mobility. All the residents have a degree of autism and challenging behaviours. The manager has particular experience and expertise in this field and is used by Adepta to train staff in this subject. In discussion with staff, it was evident that they understood this condition and were competent to support the residents appropriately. We saw minutes of regular meetings that are held between the staff and the residents to involve them in the running of the home. For example, activities are planned and reviewed, and the menu for the week is decided at these meetings. Care Homes for Adults (18-65 years) Page 13 of 27 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in the home can be confident of having opportunities to develop their skills and live rewarding lives. They are also supported to maintain contact with their families and to express their sexuality. There are good systems in place to protect residents rights and they are supported to choose a nutritious diet. Evidence: Each person has an individual programme of activities which include attendance at day centres and colleges of education. The programmes are designed to maximise the persons potential and to build and maintain relationships in the community, for example going to local shops to make personal purchases. One person is supported to use the bus by themselves to visit their family in Edgeware and another has begun going to a sports centre to develop their skills. Some people like going to the cinema, pubs, restaurants and other leisure facilities. These activities are documented in daily Care Homes for Adults (18-65 years) Page 14 of 27 Evidence: logs by staff. In the AQAA, the manager states that parent meetings are held to involve them in the development of the service. All residents had a holiday last year and we were informed that a holiday abroad is being planned for this year. We saw a Rights checklist in case files which is drawn up for each resident. This includes having keys to the front door and bedroom, privacy, self advocacy and the right to vote. The daily records showed that some residents go to church or the synagogue. Visits are frequent from relatives and there were records of residents going home to visit their families for overnight stays. There is guidance for staff about how to support residents sexual needs in their care plans. Each resident is supported to choose their own menu, in accordance with their preferences. The menus were varied and nutritious. One person is on a special diet that includes supplements to enable them to gain weight in accordance with advice from a dietician. There was fresh fruit available, and residents can have cold or hot drinks when they wish. Care Homes for Adults (18-65 years) Page 15 of 27 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 residents can be confident that staff are fully aware about how the residents wish to be supported with their personal care and their health and welfare is maintained by access to a full range of healthcare professionals. There are good procedures for the administration of medicines which safeguard residents safety. Evidence: At the time of the inspection, the staff were concerned about one resident who had lost. significant weight. This resident was being investigated by specialists and a special diet was advised by a nutritionist. This persons weight was being monitored weekly and showed that this was improving. This resident was also attending appointments with a psychologist following the recent death of their mother. All other residents were being weighed monthly and were reported as well. Staff are required to sign that they have read all letters from health professionals, before being filed in case records. This is good practice to ensure that all staff are aware of healthcare advice. The case files we inspected, included good records of healthcare appointments, for example the GP, psychiatrist, psychologist and dentist, which indicated that physical and emotional health care needs are being met. Accident and incidents involving Care Homes for Adults (18-65 years) Page 16 of 27 Evidence: residents were appropriately recorded. The administration of medicines records were inspected and found to be in order with no gaps in staff signatures. The medication stock coming in to the home and that which was returned to the pharmacy was recorded. The medication is stored securely in locked cupboards but the temperature of the cabinets was not being recorded, so a requirement is made to address this. We also recommend that the date of opening liquid medication is written on the label so that staff are aware of expiry dates. One of the residents is self-medicating and has a drawer in the bedroom for storing medication. However, this drawer was not locked, which could present a risk to the other residents. The staff corrected this during the inspection by finding a key that fitted the lock. Care Homes for Adults (18-65 years) Page 17 of 27 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The residents can be confident that they are cared for in a warm and courteous manner, and complaints about the service are addressed promptly. Staff are aware of, and have been trained in, the protection of vulnerable adults, which safeguards the welfare of the residents. Evidence: The complaints log showed that four complaints had been made since the last inspection. These complaints were made by neighbours about the noise made be the residents. The manager met with the neighbours and resolved the concerns. The residents appeared well cared for and there was a very good relationship between them and the staff who were very caring in their dealings with the residents. The staff that I spoke to, were very knowledgeable about their role in preventing abuse. There were records of training sessions on this subject, and staff recruitment records showed that proper checks had been carried out before they started working at the home. Care Homes for Adults (18-65 years) Page 18 of 27 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The residents can be confident that they have a comfortable and homely environment to live in and the majority of people have bedrooms that are well decorated in a style that reflects their tastes. However, some issues regarding bedrooms need addressing. The home is clean and tidy and there are good infection control measures in place to protect residents from health hazards. Evidence: We carried out a tour of the building, including bedrooms. We found that Birnbeck Housing Association, which owns the building, has carried out many improvement works that were identified at the last inspection as needing addressing. At this inspection, we noted that there were several areas of damage to walls in the home that were caused by a particular resident who exhibits challenging behaviour. During the inspection, a contractor was assessing this damage to provide quotes for repairs. Otherwise, the home was in good decorative order and there were no major deficits identified. The furniture in the lounge and dining areas was comfortable and in a good state of repair as were the kitchen units. The garden was well maintained and looked attractive. The bedrooms we visited were adequately furnished and individually decorated to the residents tastes. However, the rear wall in one bedroom needs to be Care Homes for Adults (18-65 years) Page 19 of 27 Evidence: redecorated and the wardrobe doors in two rooms need to be rehung. The waste bins in the toilets need to be replaced with ones that have lids to promote good hygiene. We have made requirements about these issues. There is a control of infection procedure and appropriate waste disposal measures in place to prevent health hazards. A person is employed to thoroughly clean the home once a week. Otherwise, the staff undertake day-to-day cleaning. At the time of this inspection, the home was very clean and tidy and there were no offensive odours. Care Homes for Adults (18-65 years) Page 20 of 27 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. People who live in the home can be confident that there are sufficient numbers of staff on duty at all times to meet their needs. The staff are well trained to adequately support the residents and they receive regular supervision to support them in their work. Evidence: The staff rota showed that adequate numbers of staff were available to meet the residents needs. It was evident that the rota was organised to ensure that the maximum number of staff was available at the busiest times of the day and in accordance with the resident activities. The staff on duty during the inspection matched those on the rota, and all the staff I spoke to, were familiar with the residents and their needs. They also stated that they felt the staffing levels were sufficient to cope with the work. There were no vacancies at the time of this inspection, but one staff was on maternity leave. We were informed that these shifts are covered by the existing staff pool and limited agency staff are used. Staff records indicated that they had undergone a written induction to the home and had been trained in health and safety subjects including food hygiene and fire prevention. Training had also been provided in autism, epilepsy and care planning. Two new staff had been employed Care Homes for Adults (18-65 years) Page 21 of 27 Evidence: since the last inspection, however it was not possible to examine recruitment records as these are held at Adepta head office in agreement with the Commission. We are assured that recruitment procedures are thorough including references and Criminal Records Bureau checks. There were records to show that all staff receive regular formal supervision and an annual appraisal. The staff said that supervision was important to them because they could express training needs and discuss aspects of their work with the manager. The staff we spoke to were very knowledgeable about the residents and their individual needs. According to the AQAA, six staff have attained National Vocational Qualification level 2 and four others were currently on this course. The deputy manager has attained NVQ 3. Care Homes for Adults (18-65 years) Page 22 of 27 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 people who live in the home benefit from having a competent and experienced manager who provides clear leadership and runs the service efficiently. Records are properly maintained to ensure that residents personal finances are accounted for. Residents and staff are involved in the running of the home and they are protected by good health and safety procedures. Evidence: The manager has been in charge of Duchess Close for the past three years and has many years of experience of working with people with autism and learning disability. He is an accredited trainer in SCIP, Crisis intervention and prevention and holds a NVQ Level 4 in care management. The staff expressed strong confidence in the managers ability and his efficient style of running the home. The AQAA states that the staff team has been together for a long time, which promotes consistency for residents. The staff said that their morale was very good and they worked well together. This was confirmed by our observation that there was a Care Homes for Adults (18-65 years) Page 23 of 27 Evidence: relaxed and friendly atmosphere in the home. There are regular team and resident meetings at which the day to day running of the home is discussed. Staff told us that they are able to put their own items on the agenda for discussion and they also valued the individual supervision they have from line managers. We examined how the home manages personal finance on behalf of the residents by looking at two cash tins at random and the petty cash. We found these to be in order and noted that receipts were retained for audit against purchases by residents. We noted that one resident pays for private chiropody because of their special needs. There were records of weekly fire alarm tests and regular fire drills being carried out. Regular health and safety audits are carried out and cleaning materials and other hazardous substances were stored securely. The gas, fire and electrical systems had all been serviced in the past year and an employers liability insurance certificate was on display. Care Homes for Adults (18-65 years) Page 24 of 27 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 25 of 27 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 20 13 The temperature of the medication cupboards must be monitored to ensure that it does not exceed 25 degrees C. To prevent the medication deteriorating. 11/05/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 20 The date of opening liquid medication should be written on the label of the bottle so that staff are aware of expiry dates. Care Homes for Adults (18-65 years) Page 26 of 27 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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