Care Home: Dunelm Nursing Home

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What the care home does well The service is able to demonstrate its commitment to equality and diversity issues and is user focused. As part of a bigger organisation the service benefits from a good recruitment process which ensures that care workers are suitable to work with vulnerable people. There is a good training programme to ensure that staff are competent and well trained. People are supported by a stable staff team that know them well and that work together to provide a good service for them. People`s cultural and spiritual needs are met. This is in terms of dress and food and also support to worship. People living at Dunelm receive good personal and health care and are supported to remain as healthy as possible. Feedback from staff was that people have many activities to stimulate them and that they are supported to make as many choices as possible. What has improved since the last inspection? People living at Dunelm had been introduced to new activities and have attended concerts at the O2 Arena in London and at the Cliffs Pavilion in Southend. They have also been supported to attend different consultation forums within the organisation. New specialised seating equipment has been purchased as a result of assessments by the occupational therapist. Extra physiotherapist input has been arranged to meet the changing needs of the people living at Dunelm. Staff have had training and now have an understanding of the Mental Capacity Act and the Deprivation of Liberty safeguards. This has been put into practice in particular with regards to people`s finances and consent to treatment. There have been some improvements to the environment. For example new television sets have been purchased, the sensory room has been upgraded, a new central heating system has been fitted and a greenhouse has been erected in the garden. What the care home could do better: The administration of medication is very good and is monitored closely. The development of more detailed guidelines for administration of PRN (as required) medication will ensure that staff are clear as to how and when to administer this as safely as possible. The service continues to grow and develop and staff support people to have a good quality of life and to keep as healthy as possible. Staff are committed to this and continue to look at different ways of improving and developing the service further. The service is part of a bigger organisation. The organisation takes on board advice given and keeps up to date with good practice and other changes Key inspection report Care homes for adults (18-65 years) Name: Address: Dunelm Nursing Home Grove Road Chadwell Heath Romford Essex RM6 4XJ     The quality rating for this care home is:   three star excellent 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: Jackie Date     Date: 1 5 0 4 2 0 1 0 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 31 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 31 Information about the care home Name of care home: Address: Dunelm Nursing Home Grove Road Chadwell Heath Romford Essex RM6 4XJ 02085970429 02085590938 dunelm@rchl.org.uk www.rchl.org.uk Redbridge Community Housing Limited [RCHL] Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Margaret Lutchmiah Type of registration: Number of places registered: care home 12 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 12 The registered person may provide the following category of service only: Care Home with nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Learning disability - Code LD Date of last inspection Brief description of the care home Dunelm is a 12-place care home that provides nursing care for adults with learning disabilities. It is one of a number of homes run by RCHL, a not-for-profit organisation. The home is on the edge of a residential estate in Chadwell Heath, Essex. Most of the people living there have profound learning disabilities and additional physical disabilities. People have little or no verbal communication skills, and limited ability to Care Homes for Adults (18-65 years) Page 4 of 31 Over 65 0 12 Brief description of the care home make decisions about their lives. The home was purpose-built and the ground floor is accessible to wheelchair users throughout. The first floor has an office and staff area. The ground floor has two units each with five bedrooms (one shared) and a large lounge/dining area. The kitchen is between the two units. At present 10 people live at the home. Bedrooms are decorated and personalised, according to peoples likes. There is also a garden with a summerhouse and a barbeque. People use this area when the weather permits. Some people attend day services and others are supported by the staff team. The home has 2 minibuses and people go out a lot. Activities and physiotherapy are provided in the home. The basic charge per week for each person is 1378.88 pounds. This information was provided in the AQAA (Annual Quality Assurance Assessment). Information about the service provided is contained in the service users guide which is available in the home. Care Homes for Adults (18-65 years) Page 5 of 31 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: three star excellent service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The last inspection of this service was on 26th April 2007. This inspection was unannounced and took place over seven hours. It was a key inspection and all of the key inspection standards were tested. Staff were asked about the care that people using this service receive and were also observed carrying out their duties. People using the service have limited ability to communicate verbally and their interactions with staff and their signs of well-being were observed. All of the shared areas and bedrooms were seen. Staff, care and other records were checked. Completed feedback surveys were received from two staff. Services are now required to complete an AQAA (Annual Quality Assurance Assessment) and the completed form was received in March 2010. Information provided in this document also formed part of the overall inspection. This document was comprehensively completed and gave a clear picture of what has been happening Care Homes for Adults (18-65 years) Page 6 of 31 at the service and what the plans are for the future. The inspector would like to thank the people living at Dunelm and staff for their input during the inspection. Care Homes for Adults (18-65 years) Page 7 of 31 What the care home does well: What has improved since the last inspection? What they could do better: The administration of medication is very good and is monitored closely. The development of more detailed guidelines for administration of PRN (as required) medication will ensure that staff are clear as to how and when to administer this as safely as possible. The service continues to grow and develop and staff support people to have a good quality of life and to keep as healthy as possible. Staff are committed to this and continue to look at different ways of improving and developing the service further. The service is part of a bigger organisation. The organisation takes on board advice Care Homes for Adults (18-65 years) Page 8 of 31 given and keeps up to date with good practice and other changes 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 9 of 31 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 10 of 31 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. Assessments completed by the home and information and reports received from health and social care professionals mean that staff have the necessary information to enable them to determine whether or not the home can meet a persons needs. People and their representatives have a written and costed contracts/statement of terms and conditions and therefore will be clear about what they are entitled to. Evidence: Standards 2, 3, 4 & 5 were tested. The organisation has an admission procedure that includes the gathering of information and carrying out assessments. The AQAA (Annual Quality Assurance Assessment) states that people have a detailed assessment of need and other professionals, family members, social workers and the individual concerned are involved with this. It also says that as far as possible a transition team is setup to ensure that the person has consistency during their visits. During these visits the person is able to choose how they would like their bedroom decorated before they Care Homes for Adults (18-65 years) Page 11 of 31 Evidence: move in. A young woman is due to move into the home in the near future and the information available confirms that she has had a detailed nursing assessment and that information had been gathered from a variety of relevant professionals. In addition relevant professionals, working with this service, have been informed of the planned move so that they will be able to take over her support needs when she moves in. Prospective users of the service are given the opportunity to visit and to meet other people who live there before a decision is made about moving into the home. Their relatives are also encouraged to visit. The person that is due to move in has visited with her family and spent time at Dunelm. Shes also been invited on trips to help get to know people and for people to get to know her. A record is kept of these visits and this information has been used as part of the decision-making process. Each person has a contract between themselves and the housing association/provider. These include information about individual financial arrangements. The contracts were available at the home. This means that there is clear information about the service that will be provided to each individual. Care Homes for Adults (18-65 years) Page 12 of 31 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples plans focus on individual needs and abilities and contain detailed information to enable staff to meet these needs in a way that people prefer. Risk assessments are appropriate and up-to-date and ensure that peoples needs are met as safely as possible. People are encouraged and supported to be involved in decisions about what they do and what happens in the home as far as they are able. Evidence: Standards 6, 7, 8 & 9 were tested. Each person has a comprehensive and individualised person centred plan that identifies all of their needs, likes and dislikes. They also indicate peoples cultural and spiritual needs. For example, I like Indian music, curry and shopping in Green Street. I like to visit the temple. Each person has a personal planner that has photographs to Care Homes for Adults (18-65 years) Page 13 of 31 Evidence: help the person understand what is in them. There are specific areas including health needs, communication, getting to know me and health care needs. People living at Dunelm have profound and multiple disabilities and limited communication. The communication plans clearly indicate the best way to communicate with people and to understand what they are trying to convey. For example for one person it states , I say bbb and rub my hands when I am happy. I will clap my hands and hum when Im not happy. Action plans are also in place which include goals for each person. Daily notes are kept and staff record details of what the person has done, what care has been provided and how the individual has been. This information is then used as part of the review process and to monitor peoples well-being. Each person has a key worker and also a named nurse. Individual plans are reviewed regularly and relatives are invited to attend these reviews. Information about peoples needs is comprehensive and up-to-date and therefore give staff the information they need to support each individual and to meet their complex needs. There were up-to-date risk assessments covering the necessary areas. These are relative to each individual, the activities that they do and their own specific behaviours or needs. This means that risk can be reduced and peoples needs can be met as safely as possible. As previously stated people living at Dunelm have profound and multiple disabilities and limited abilities to communicate their needs and wishes. The staff team make every attempt to consult people on aspects of life at the home and they are producing more information in photographic format to assist this process. In addition independent advocates are involved to get feedback from people living at the home. Staff are also using observational skills and knowledge of the person to assess whether they like something and if they are happy in any given situation. The organisation have a number of forums at which users of their services are consulted about what happens. One of these is a service user consultation day which is facilitated by independent drama and advocacy consultants. A member of staff facilitates a user of the service attending the service user forum. Care Homes for Adults (18-65 years) Page 14 of 31 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 are supported to take part in activities, to be part of the local community, to celebrate their own and others cultures, special occasions and milestones in their lives. People are supported to keep in contact with their friends and families and families are made welcome at the home. People are given meals that they like and meet their individual needs and preferences. Evidence: Standards 11, 12, 13, 14, 15, 16 & 17 were tested. All of the people living at Dunelm are extremely dependent on the staff team for Care Homes for Adults (18-65 years) Page 15 of 31 Evidence: support in every aspect of their daily lives. Some people attend local the day centres and others are supported to access activities by the staff team. One person has a oneto-one worker to support her in activities. In addition some people receive support from an outreach worker to access the community. People go out a lot during the course of the week. This includes shopping, bowling, swimming, the cinema, to various shows at Southend and at the O2 Arena, hydrotherapy and meals out. The home has the use of two adapted vehicles which are used to take people out. Last year some people went on holiday and others went on day trips. The home has a sensory room which is well equipped and is popular with the people living there. In addition there is a visiting aromatherapist and also a music therapist. Feedback from a member of staff was that the team try to make sure that people have varied activities and that their life is not mundane. Another member of staff confirmed that peoples cultural issues were addressed. Recently the service has purchased a greenhouse and people that are interested are being supported to grow produce that is then used in the home. Special occasions are always celebrated at the home and family and friends are invited. Recently everyone living at the home went to a family celebration for one persons 50th birthday. There were lots of pictures of this. The home has Christmas parties, celebrations at Easter, St Georges Day, Diwali and any other relevant occasion. Families were invited for a New Years Day meal. Several families and relatives are involved with the home and the Friends of Dunelm has been setup for some time. They organise fundraising and social activities. Relatives liaison meetings are held every six months. The service supports people to have good strong links with their friends and families and welcomes families at the home. Peoples care plans contain information about their dietary needs and their likes and dislikes. Menus are based on the staffs knowledge of peoples likes, dislikes and needs. Meals are made from fresh ingredients rather than using processed foods. Photographs of different foods and different meals are available to help people to choose what they want to eat. The cook knows the people living at Dunelm very well and is aware of their individual preferences and does make individual dishes and alternatives for them. Some people receive their food via a P. E.G (Percutaneous Endoscopic Gastronomy) tube directly into the stomach and the nursing staff are trained to deal with this. Individual plans give clear instructions with regards to the regime for the P.E.G. Some people need different sorts of plates and cutlery to help them to eat as independently as possible and others are supported by staff. Peoples nutritional needs are met and they receive food that they like. Care Homes for Adults (18-65 years) Page 16 of 31 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use this service are supported with their personal care in a way that meets their needs and preferences. The principles of respect, dignity and privacy are put into place. People are actively supported to receive the medical and health care that they need and remain as healthy as possible. People receive their prescribed medication safely as possible and in line with good practice. Evidence: Standards 18, 19 & 20 were tested. All of the people living at Dunelm require a lot of support with their personal care and details of the help that they need and how they prefer to be supported are in their individual plans. There are sections for, my personal care needs and my health care needs. Information in these sections was detailed and up-to-date and also included relevant risk assessments. It was evident that people receive effective personal care Care Homes for Adults (18-65 years) Page 17 of 31 Evidence: and that this is provided in a person centred manner. This was observed in the interaction between staff and the people that use the service. Staff know people well and are aware of non-verbal signals to indicate likes, dislikes and the state of wellbeing of the person. Whenever possible, even if it is to a very limited extent, people are encouraged to be as independent as possible. Individual plans show that people are encouraged to choose either a bath or shower and what to wear as far as possible. The staff team continue to make a lot of effort to ensure that people are always appropriately dressed especially for special occasions and celebrations. Several people have the traditional clothing of their culture and this is either supplied by families or staff from the home purchase this with the individual. Each person is registered with a local GP practice and receives specialist input as and when required. Staff support people to all of their medical appointments. Individual files have details of nursing assessments and health care issues and show that people have regular access to health care professionals. Records are kept of medical appointments and their outcomes. These show that people have checks from the optician, dentist, chiropodist, speech therapist and physiotherapist. The service has purchased extra physiotherapy to meet the changing needs of the people living there and also engaged the services of an occupational therapist to assess peoples mobility and specialist equipment needs. As result of this some new chairs and commodes have been purchased for individuals use. The staff team are trained and competent in health care matters. The service arranges training on healthcare topics that relate to the individual needs of the people living there. Staff members are very alert to changes in mood, behaviour and general well-being and fully understand how they should respond and take action. It was apparent that staff would be very aware if a person was in pain and that they would monitor this and take the necessary action. None of the people living at Dunelm can self medicate and medication is administered by trained nurses. All of the nurses have had update training and this included medication. Medication is appropriately and safely stored in locked cabinets and the keys for this are held by the nurse in charge. Examination of the MAR (Medication Administration Records) found these to be appropriately completed. There are photographs of each person and details of what medication they take. Some people are prescribed PRN (as required) medication and there are some guidelines for administration of this. However the guidance did not contain sufficient detail. This must be updated to indicate the frequency/minimum period before repeating a dose, the maximum number of doses in the timespan, and the action to be taken in the event of the persons symptoms inadequately responding to the medication. This will ensure that staff are clear about when, how and why to administer this medication and that people receive this in line with the best practice. A monthly medication audit Care Homes for Adults (18-65 years) Page 18 of 31 Evidence: is carried out to ensure that everything is correct. Overall the administration and monitoring of medication is robust and ensures that people receive their prescribed medication as safely as possible and in line with good practice guidance. Care Homes for Adults (18-65 years) Page 19 of 31 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are safeguarded by the working practices and support of the staff team. Their rights are actively promoted. People living at Dunelm can be confident that any concerns raised on their behalf will be listened to and acted upon. Evidence: Standards 22 & 23 were tested. There is an appropriate user-friendly complaints procedure and this is available at the home. However due to the degree of their disability it is unlikely that the people living there would be able to make a complaint without support. However people are able to demonstrate if they are unhappy about anything through facial expressions, behaviour changes and vocalisation. In discussions with staff they were able to demonstrate understanding of this non-verbal communication. In addition there is access to advocates who can support people if needed. The Commission has not received any complaints about the service since the last inspection. The organisation has produced a detailed safeguarding policy which tells staff the actions to be taken in the event of abuse/suspected abuse being discovered. In March 2010 the organisation arranged a workshop for users of their services. This was supported by independent drama and advocacy consultants and the purpose was for Care Homes for Adults (18-65 years) Page 20 of 31 Evidence: users of the services to help make a leaflet telling people how they can keep safe. All staff have received safeguarding adults, whistleblowing, Mental Capacity Act and Deprivation of Liberty training. Staff are aware of issues of safeguarding and of their responsibility to people using this service. The home has an open culture and staff feel able to raise any concerns that they might have. The section on staffing later in this report gives information that confirms that there is an appropriate recruitment procedure and this also helps to safeguard people living at the home. All of the people living at Dunelm need help with their finances and do not have the capacity to understand the concept of spending or saving money. Each person has a professional account administered by RCHL. The manager requests cash when required and has to justify under the Mental Capacity Act why expenditures are in the best interest of the person. Records are kept of financial transactions and spot checks are carried out regularly. In addition there is also an annual financial audit. Monies are securely stored in a safe and are accessed by the senior staff on duty. Systems are in place to ensure that people are protected from financial abuse as far as possible and that their finances are appropriately managed and monitored. Care Homes for Adults (18-65 years) Page 21 of 31 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a clean, comfortable home that has suitable aids and adaptations for their needs. Evidence: Standards 24, 25, 26, 27, 28, 29 & 30 were tested. The home is purpose built and is near to local shops and transport networks in the Chadwell Heath area of the London Borough of Redbridge. There are two units in the home and each consists of a large lounge/diner, laundry, bathing facilities and five bedrooms. There is also a large well-kept garden with a summer house and greenhouse. During the course of the last year the home has purchased new television sets and new furniture and curtains for the communal areas. In addition a new fridge, freezer and cooker have been fitted in the kitchen. The bedrooms are well decorated and furnished and have been personalised in line with individual needs and likes. For example one person has a small temple in his room and another now has a ceiling hoist to make moving and handling easier and better. Most bedrooms are now fitted with sensory equipment. There are sufficient baths, showers and toilets and these are adapted to meet peoples individual needs. A new power shower has been fitted in one of the units to improve Care Homes for Adults (18-65 years) Page 22 of 31 Evidence: this facility. An occupational therapist has been assessing peoples needs to ensure that they have the correct equipment and adaptations to meet their needs. The kitchen has appropriate equipment and is clean. The cook carries out the necessary checks to ensure that the environment meets the correct standards of hygiene and that peoples food is prepared in line with good practice. The service has recently had a food safety inspection and received an excellent five-star rating. The building is comfortable and has been made as homely as possible. Maintenance issues are appropriately dealt with and people live in a clean, comfortable home that is suitable for their needs. Care Homes for Adults (18-65 years) Page 23 of 31 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported and protected by the recruitment practices of the service. Staffing levels are sufficient and staff receive the necessary training, supervision and support to meet peoples current needs and provide a very good service for them. People are supported by a competent and experienced staff team who know them well and are committed to providing a person centred service. Evidence: Standards 31, 32, 33, 34, 35 & 36 were tested. The staff team comprises nurses, support workers, a cook, domestic and a driver/handy person. Shift leaders are all qualified nurses. The staff team have experience of working people with learning disabilities and have access to a wide range of training courses. All staff have completed the LDAF (Learning Difficulties Award Framework) as part of their induction and probationary period. Eight members of care staff have completed NVQ level 2 or above. Staff spoken to confirm that there is comprehensive training available and that in addition to mandatory training they are offered other training specific to the needs of the people that live there. For example on the day of the inspection a group of staff were receiving some training on Care Homes for Adults (18-65 years) Page 24 of 31 Evidence: dementia. There were some RCHL relief staff on duty they also confirmed that they had good access to the training that they needed. Nurses receive clinical updates and also advice and support from the local community matron. Staff were clear about their duties and responsibilities towards the people living there and have the skills to meet peoples needs. There are some staff vacancies and these are mainly covered by the staff team and regular relief staff. On occasions agency staff are used but again these are usually regulars. On the day of the inspection one care worker was from the relief team and said that he had been visiting Dunelm for approximately 2 years on a regular basis. The nurse on duty was from an agency and again she confirmed that she had been coming to Dunelm for three years. Therefore people are generally receiving support from a consistent staff team that are aware of their needs and how to meet them. The staffing on the early shift is one team leader (a qualified nurse) and four support workers. The late shift has one team leader (a qualified nurse) and three support workers. At night there is one team leader (a qualified nurse) and two support workers. In addition to this one person has a one-to-one activity work and another has additional one-to-one support because of her needs. There is also a cook, domestic and driver/handy person. From observations on the day, and discussions with staff, staffing levels were sufficient to meet peoples needs. All staff have job descriptions and contracts and were clear about their roles, responsibilities and duties. The organisation has a robust recruitment and selection procedure that includes application forms and interviews. Two references are obtained and POVA (Protection of Vulnerable Adults) and CRB (Criminal Records Bureau) checks are undertaken. People who use RCHL services are involved in the recruitment process. The files of three staff were inspected. They contained all of the necessary information, including proof of identity. Therefore people are protected by the organisations recruitment procedure. Staff, including regular relief staff, spoken to confirm that they are receiving regular supervision and also that staff meetings are held regularly. Staff therefore have an opportunity individually and collectively to discuss issues, concerns and the development of the service. Staff spoken to said that there was good communication between the team and good teamwork. Care Homes for Adults (18-65 years) Page 25 of 31 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Dunelm benefit from a service that is very well managed and where their opinions are sought and valued. They live in a safe home. Evidence: Standards 37, 38, 39 & 42 were tested. The manager has substantial experience of services for people with learning disabilities. She is an enrolled nurse, a registered learning disabilities nurse and has obtained a certificate in management studies and a postgraduate diploma in health service management. The manager communicates a clear sense of direction and staff are aware of the standards expected of them. Equality and diversity issues are promoted. The manager is aware of her responsibilities under the Mental Capacity Act and Deprivation of Liberty safeguards. There is a commitment to providing a service that is tailored to meet the individual needs of the people living there. Feedback from staff was that they can make suggestions and that these are taken on board, also that they would fill comfortable to raise any issues. Another member of staff said that there was a happy and healthy environment for all. Care Homes for Adults (18-65 years) Page 26 of 31 Evidence: A representative of the organisation carries out monthly unannounced monitoring visits to the home and a report on this visit is left at the home. Reports cover the necessary areas and indicate any action that is needed. In addition to this the organisation also carries out a quality audit each year and a financial audit. Service user surveys form part of the quality assurance and an independent advocate is engaged to support people with this. RCHL hold a number of service user participation days at which people are supported to give feedback on the service that they receive and to help shape future services. The quality of the service provided is monitored by the organisation and the manager and the aims, objectives and future plans for the service are clear. The necessary health and safety checks are carried out and a record is kept of these. Records seen were up to date and accurate. In addition the organisation carries out quarterly and annual health and safety checks. Any issues identified are appropriately dealt with. Overall a safe environment is provided for the people living, visiting or working there. Care Homes for Adults (18-65 years) Page 27 of 31 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 28 of 31 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 guidance for the administration of PRN (as required) medication must be updated to indicate the frequency/minimum period before repeating a dose, the maximum number of doses in the timespan, and the action to be taken in the event of the persons symptoms inadequately responding to the medication. To ensure that staff are clear about when, how and why to administer this medication and that people receive this in line with the best practice. 31/05/2010 Care Homes for Adults (18-65 years) Page 29 of 31 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 30 of 31 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. 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