Care Home: Eckett House

Similar services:

• 2 Perhaver Park
• The Vicarage
• St George`s
• 5 Seafield Road
• Radfords
• Honeybourne House
• 32 Beaumont Way

What the care home does well Eckett House is a terraced house and the style of the property is in keeping with the local community. The town centre shops and facilities are within walking distance of the home. People have well established activities during the week and make good use of the local shops and cafes. We were told that everybody receives support when going out, although this could be provided in a way which gives the person a degree of independence. This was done for example, by `shadowing` the person while they went into a shop on their own. Meetings take place in the home when people can discuss things together. They can raise concerns, or just talk about the things that they have done, or would like to do in the future. People had recently enjoyed going to a fireworks display and were making arrangements to go Christmas shopping and to see the lights. One person worked at a takeaway for a few hours on one day a week. We heard about other things that people enjoy doing, such as swimming, going to dance shows and going out for meals. People can make decisions in the home, for example by choosing the decor for their rooms and writing the menu for the week ahead. People can also help out in the home, for example by assisting with the domestic routines and helping to prepare the meals. People receive support which helps them to maintain contact with their families. One person goes to church regularly with their parents and has holidays with them. Two other people also attend a local church with support from the home. People receive the support that they need with their personal care and with accessing health services. What has improved since the last inspection? Mrs Thomas said that people are more involved in cooking, and that their skills in this area have improved during the last year. This has also made people more aware of healthy eating and menu planning. We saw one person helping to prepare the evening meal and they told us about the different meals that they had during the week. It was reported in the AQAA that the people at the home were in good health, although `a little overweight`. We were told in the AQAA that, in response to this, sports activities were being arranged which were now showing results in relation to people`s weight. Some new furniture has been bought for the home. Work has taken place to improve the exterior of the house and to repair an area of flat roof at the rear of the property that had been leaking. The staff member has achieved their NVQ (National Vocational Qualification) at level 3. What the care home could do better: The written information about the home needs to be updated so that the details are accurate. Information must also be produced in relation to additional charges and what the fees cover. When money is looked after on people`s behalf, this must always be well recorded to show how their money has been spent. There is a system of care planning in place although the individual plans need to be completed in full to ensure that they reflect people`s views and personal goals. We have recommended that a risk assessment is undertaken concerning the arrangements being made for the security and storage of medicines that are received into the home. A more consistent and planned approach to staff development and supervision is needed, with evidence to show that staff are competent for the work they undertake. It was reported in the AQAA that one of the things that the home could do better would be to have more staff. We were told that recruitment for two new staff members was underway. There have been developments in the running of the home during the last year, although the managers have not yet obtained the required qualifications. Further action is needed to ensure that people`s rights and best interests are safeguarded by the home`s record keeping, policies and procedures. We have made a number of requirements and recommendations in connection with record keeping. This is to ensure that the records are kept up to date, and the information is kept securely and confidentially. Key inspection report Care homes for adults (18-65 years) Name: Address: Eckett House 118 Dixon Street Swindon Wiltshire SN1 3PJ     The quality rating for this care home is:   one star adequate 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: Malcolm Kippax     Date: 1 7 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 34 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 34 Information about the care home Name of care home: Address: Eckett House 118 Dixon Street Swindon Wiltshire SN1 3PJ 01793347929 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mrs Madeleine Thomas,Miss Alicia Thomas care home 3 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 3 The registered person may provide the folowing category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: Learning disability (Code LD) Date of last inspection Brief description of the care home Eckett House is a terraced property close to Swindon town centre. There is an enclosed garden at the back of the house. The accommodation includes three single bedrooms and a communal room that is used as a lounge and dining area. One of the bedrooms is on the ground floor. There is an office and staff sleeping-in room on the first floor. Eckett House is jointly owned and managed by Mrs M. Thomas and Miss A. Thomas. Mrs Thomas and Miss Thomas share the running of the home and provide most of the support. One staff member is employed and agency carers are also used on occasions. Information about Eckett House is provided in a Statement of Purpose. A copy of the Care Homes for Adults (18-65 years) Page 4 of 34 Over 65 0 0 Brief description of the care home last inspection report is available from the home. Inspection reports can also be seen on the Commissions website at www.cqc.org.uk Care Homes for Adults (18-65 years) Page 5 of 34 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: one star adequate 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: Before visiting Eckett House, we asked the home to complete an Annual Quality Assurance Assessment, known as the AQAA. This was their own assessment of how they were performing. It told us what has happened during the last year and about their plans for the future. We looked at all the information that we have received about Eckett House since the last inspection. This helped us to decide what we should focus on during an unannounced visit to the home, which took place on 17th December 2009. During our visit we met with the people who live at the home and with Mrs Thomas and Miss Thomas. We went around the home and looked at some records. The judgements contained in this report have been made from evidence gathered during the inspection and takes into account the views and experiences of people using the service. Care Homes for Adults (18-65 years) Page 6 of 34 What the care home does well: What has improved since the last inspection? What they could do better: The written information about the home needs to be updated so that the details are Care Homes for Adults (18-65 years) Page 7 of 34 accurate. Information must also be produced in relation to additional charges and what the fees cover. When money is looked after on peoples behalf, this must always be well recorded to show how their money has been spent. There is a system of care planning in place although the individual plans need to be completed in full to ensure that they reflect peoples views and personal goals. We have recommended that a risk assessment is undertaken concerning the arrangements being made for the security and storage of medicines that are received into the home. A more consistent and planned approach to staff development and supervision is needed, with evidence to show that staff are competent for the work they undertake. It was reported in the AQAA that one of the things that the home could do better would be to have more staff. We were told that recruitment for two new staff members was underway. There have been developments in the running of the home during the last year, although the managers have not yet obtained the required qualifications. Further action is needed to ensure that peoples rights and best interests are safeguarded by the homes record keeping, policies and procedures. We have made a number of requirements and recommendations in connection with record keeping. This is to ensure that the records are kept up to date, and the information is kept securely and confidentially. 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 8 of 34 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 34 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Nobody has moved into Eckett House for several years. Information is available to people who may be interested in using the service. However this needs to receive attention to ensure that all the relevant details are included and are up to date. Evidence: There was a Statement of Purpose and a Service Users guide, which gave information about the home and the service provided. The Statement of Purpose that we saw had not been revised to ensure that the details remained up to date. For example, it included the name of the National Care Standards Commission which no longer exists, rather than the Care Quality Commission. There was no written information which showed what the fees covered and what people would have to pay for themselves from their personal money and other allowances. We were told that two people had lived at Eckett House for the last twelve years and one person for six years. There had therefore been no new admissions to the home in Care Homes for Adults (18-65 years) Page 10 of 34 Evidence: recent years. This meant that we could not get an up to date view of the homes preadmission arrangements and the outcome for people. We were given very little information in the AQAA in relation to this outcome group. See Conduct and Management of the Home section of this report. We have looked at the admission process at previous inspections. The home has an admission procedure and peoples needs were assessed by their care managers prior to moving into the home. Care Homes for Adults (18-65 years) Page 11 of 34 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples care plans and assessments include a range of relevant information. However they need to receive further attention to ensure that they are fully completed and reflect peoples views and personal goals. People are supported with making decisions and can take part in activities that involve a degree of risk. Evidence: People who live at the home had individual files which contained a range of assessment and care plan forms. Information in the care plans was recorded under a variety of headings, which included for example: Mobility, Accommodation, Managing Finances, Personal Activities of Daily Living and Domestic Activities of Daily Living. Some sections of the plans covered peoples personal care and health needs (see Personal and Healthcare Support section of this report). There were sections in the plans for the inclusion of service users comments and Care Homes for Adults (18-65 years) Page 12 of 34 Evidence: carers views, although these parts had not been completed consistently. People had not signed their care plans, although there was a section for this on the plans. The care plan format included various sections, such as My Life, Things that matter to me, My Skills, and My Future, which were designed to provide more personal, person centred information about peoples backgrounds and the things that were important to them. Some of these sections were blank, which meant that the plans were not as informative as they should have been. These included, for example, the sections Things I want to plan and About keeping safe and about how people were going to be helped. It looked liked peoples plans were at different stages of completion, with some sections filled in and others blank. The care plans had been written in August 2009. Miss Thomas said that the plans were still being worked on and that she was in the process of updating all the information and documentation on peoples personal files. It was recorded on the plans that they were due to be reviewed in February 2010. This would provide the opportunity for all the appropriate sections to be completed or amended, where necessary. There was a reference in the Statement of Purpose to care plans being reviewed at least annually; under National Minimum Standards it is expected that the plans will be reviewed at least every six months. We met with people when they returned from their day activities later in the day. We heard about the things that people enjoyed doing, such as going to dance shows and singing. One person we spoke to said that they were keen to find some sort of employment. Mrs Thomas said that people were now more involved in cooking, and that their skills in this area had improved during the last year. This had also made people more aware of healthy eating and menu planning. We saw one person helping to prepare the evening meal and they told us told us about the different meals that people had during the week. We heard how choices and decisions were being made in the home. People had personalised their bedrooms and chosen the paint colour and decor. People helped to plan the menu. There were pictures on the kitchen cupboards to help identify their contents. Meetings were taking place in the home when people discussed things together. We read in the minutes of meetings that people had talked about the things that they had done, and made decisions about future events. At the meeting in November 2009, we Care Homes for Adults (18-65 years) Page 13 of 34 Evidence: read that people had enjoyed going to a fireworks display and had made arrangements to go Christmas shopping and to see the lights. People told us that they went shopping locally and visited the nearby cafes. Mrs Thomas said that everybody received support when going out although this could be provided in ways which gave the person a degree of independence. We were told for example that this could include shadowing the person while they went into a shop on their own. We saw records of risk assessments that had been undertaken in connection with peoples activities. There were assessments in relation to Clients Holiday, and Shopping and others which covered tasks such as ironing. The benefits of the activity, for example encourages independence were identified, as well as the hazards. Some of the assessment forms were not dated, and did not show a date when they would be reviewed. As with the care plans, it is good practice to review the assessments on a regular basis to ensure that they reflect peoples current needs. Care Homes for Adults (18-65 years) Page 14 of 34 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. People are part of the local community and keep in contact with their family members. People are involved in the domestic routines and help to choose and prepare the meals. Evidence: Mrs Thomas said that people at the home had a well established programme of activities during the week, which primarily involved attending a local resource centre. The home had been told that the number of sessions that people could attend would decrease in the coming months. Mrs Thomas said that other ideas were being followed up to help ensure that people had the same level of occupation. Information was recorded in the form of Activity Plans showing what people did during the week. Care Homes for Adults (18-65 years) Page 15 of 34 Evidence: We met with the people who live at the home when they returned from their day activities during the afternoon and they told us how they spent their time. Some activities in the community were arranged through the resource centre that people attended. We heard that people went swimming and ice skating, and liked going out for meals. Sometimes people did things locally, such as going to the shops or to a cafe after they had been to the resource centre. One person said that they had their hair cut at a local barber. We were told that one person worked at a takeaway for a few hours on one day a week. Another person said that they were keen to have a job. We heard that the home was working with the resource centre to help with this. Mrs Thomas said that family members had attended peoples recent review meetings, and each person saw their relatives on a regular basis. This included having weekend stays, and meals during the week. We were told that one person went to church with their parents regularly and had holidays with them. The other two people also attended a local church with support from the home. During our visit we saw people helping out in the home, for example by washing up and assisting with the evening meal. Mrs Thomas said that people could manage some kitchen items, such as the toaster, by themselves but were supervised when using the cooker. Daily reports were being written which included information about what people had done each day. We read that people helped to plan the menu for the week ahead. A record was being kept to show what meals people had eaten during the week. Care Homes for Adults (18-65 years) Page 16 of 34 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. People receive the support that they need with their personal care and with accessing health services. Some of the health related records should receive attention to ensure that they are up to date. People are generally protected by the homes practices in relation to medicines, but improvements could be made in this area. Evidence: There was information recorded in peoples individual files about their personal support needs and health care arrangements. As reported under the section Individual Needs and Choices, some parts of the individual plans had not been completed. Completion of the plans will help to ensure that there is good information about peoples personal preferences and how they liked to be supported in different areas of their lives. Much of the support that people received was by way of prompting and encouragement. We read in the AQAA that people did not need supervision in areas such as using the toilet and with managing continence. Care Homes for Adults (18-65 years) Page 17 of 34 Evidence: It was reported in the AQAA that the people were in good health, although a little overweight. We were told in the AQAA that, in response to this, sports activities were being arranged which were now showing results in relation to peoples weight. Mrs Thomas told us that people were also being given advice about healthy eating, and supported with this, for example by being offered two pieces of fruit to take in their lunch boxes. There was a water cooler in the kitchen which provided people with an alternative to sweetened drinks. We saw that peoples weight was being recorded on a regular basis, so that the outcome of the action being taken could be monitored. Peoples individual care plans included a My Health section. We read in one persons plan that they wanted to eat healthily although the section about the help that they would need with this had not been completed. We also saw a Health Action Plan on the persons file. This had not been dated and did not include the name of the facilitator. The plan had not been reviewed since 2007. There were other records which gave more information about peoples health care arrangements. We read about the appointments that people had had with GPs and other with other health care professionals. One person had attended a Well Man clinic and another person had recently had an annual health check. Mrs Thomas said that all the people at the home were to be provided with this check. We were also told that, following their recent review, arrangements were being made for one person at the home to see a specialist nurse in connection with their behaviour. Mrs Thomas said that people received a chiropody service at no charge to themselves. We saw letters that had been written from a GP in relation to two people who live at the home. This was in response to the homes request for feedback, and surveys had been sent out for the purposes of quality assurance. The GP reported that they saw people on a twice-yearly basis, and found staff to be pleasant, helpful and knowledgeable, and to have good relationships with the people at the home. Another person who had completed one of the homes surveys commented that people were Always well dressed. People at the home received support with managing their medicines and keeping them safe. We saw a letter on one persons file from a consultant psychiatrist which showed that their medicines had been reviewed in March 2009. Care Homes for Adults (18-65 years) Page 18 of 34 Evidence: The home received peoples prescribed medicines from a local pharmacist in the form of pre-prepared dosette boxes. There was a lockable cabinet in the home for the storage of medicines, although this appeared to have been designed for the use of first aid items, rather than for medicines. We discussed this with Miss Thomas, and we also noted that there was no form of sealed cover on the medicines that came in the dosette boxes, as is usual when medicines are supplied as part of a monitored dosage system. Records were being maintained to show when medicines had been received into the home, and when they had been administered. No medication was being prescribed for use on a PRN as required basis. We saw that the records for the administration of medicines included a number of handwritten instructions, which showed when a change had been made in a persons medicines. The handwritten entries had not been signed or include a comment as to who had authorised the change. Care Homes for Adults (18-65 years) Page 19 of 34 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. People have the opportunity to express their views and discuss any concerns. There are procedures in place which help to protect people from harm and abuse. Further attention is needed to ensure that the arrangements being made for supporting people with their personal money are clear and well recorded. Evidence: A complaints procedure was displayed in the home. Information about making a complaint was also included in the Service Users guide. We were told in the AQAA that no complaints had been received during the last year. Meetings were being arranged when people at the home could discuss things together. The minutes of these minutes showed that concerns were being raised and people were being asked if they were happy with things in the home. Review meetings had also recently been held, when people had the opportunity to talk about any concerns on an individual basis. The home had not yet received the paperwork in relation to these reviews. Mrs Thomas said that one outcome of the meetings was that people were settled and happy at the home. The home had produced a number of policies and procedures in relation to the protection of people and their interests. These included guidance about safeguarding adults and the prevention of abuse, including the disclosure of bad practice (whistle blowing). Information was available about Wiltshire and Swindons procedures (No Secrets) for safeguarding adults. Care Homes for Adults (18-65 years) Page 20 of 34 Evidence: We were told in the AQAA that there was a policy on the management of service users money, valuables and financial affairs, but not one about Gifts to staff. Mrs Thomas told us about the support that people received with managing their personal money. People had individual savings accounts and an amount of their money was also kept in the home for use on a daily basis. Notebooks were being used for recording transactions involving peoples personal money. We looked at examples of these records. There were occasions when the use of personal money had been recorded in detail with receipts obtained, and other times when there was less information recorded about the expenditure and no receipts were available. We talked to Mrs Thomas about two such occasions, concerning money that had been taken out for clothes and for a holiday. Mrs Thomas said that receipts had been obtained in connection with this expenditure, but she didnt know where they were. We have written to Mrs Thomas about this since visiting the home. See Conduct and Management of the Home section. Mrs Thomas said that people paid for their own holidays and the home covered the costs of staffing, and for food when self-catering. In relation to peoples everyday expenditures, there was no written information which showed what the fees covered and what people would have to pay for themselves from their personal money and other allowances. See Choice of Home section. Care Homes for Adults (18-65 years) Page 21 of 34 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 live in homely surroundings. The accommodation is kept clean and there are facilities in place which reduce the risk of cross-infection. Evidence: Eckett House is a terraced property close to Swindon town centre. We were told in the AQAA that people regularly went into town as it was within walking distance. The style of the house was in keeping with the local community and there was good access to the towns shops and facilities. There was an enclosed garden at the back of the house. It was reported in the AQAA that the garden although risk assessed could be made a nicer environment to sit in. There were plans to improve the garden during the next twelve months. Additional lighting was also to be provided in the front porch. We were told that the frontage to the home had improved in the last year and items had been purchased for the home which had improved the environment. Some work had taken place on a section of flat roof which had been leaking. We were shown around the home. The accommodation included three single bedrooms and a communal room that was used as a lounge and dining area. One of Care Homes for Adults (18-65 years) Page 22 of 34 Evidence: the bedrooms, and a bathroom and toilet, were on the ground floor. Mrs Thomas said that everybody was aware of safety issues and there were no concerns about people being able to use the stairs. People had chosen the decor for their own rooms. We saw some new furniture that had been bought. Pictures were being used to help one person with the storage of their clothes. The bedrooms varied in size and did not have the space and en-suite facilities that are expected under the standards for new care homes. Space for socialising was limited in the two first floor bedrooms the largest room on this floor was being used as an office and staff sleeping-in room. There was an under stairs cupboard where cleaning materials could be locked away for safety. The home looked clean and tidy. Mrs Thomas said that a high priority was being given to personal hygiene and reminding people about good practice. Hand washing gel was available to help reduce the risk of cross-infection. Care Homes for Adults (18-65 years) Page 23 of 34 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People receive most support from the managers themselves, although plans are being made to enlarge the staff team. A staff member has gained a relevant qualification since the last inspection. However, a more consistent and planned approach to staff development and supervision is needed, with evidence to show that staff are competent for the work they undertake. Evidence: Mrs Thomas and Miss Thomas shared the running of the home and provided most of the support to people. One staff member was employed and agency carers were also used on occasions. It was reported in the AQAA that one of the things that the home could do better would be to have more staff. We were told that recruitment for two new staff members was underway. No new staff members had been employed since the last inspection. We looked at the records that had been kept in relation to the staffing of the home. These were not being kept securely and included supervision notes, references and Criminal Record Bureau (CRB) disclosure certificates for a number of staff who were no longer working at the home. This meant that their personal data was not being kept confidentially. Care Homes for Adults (18-65 years) Page 24 of 34 Evidence: We were told in the AQAA that one improvement during the last year had been the achievement of the staff member in obtaining their NVQ (National Vocational Qualification) at level 3. There were plans for this to be followed by NVQ at level 4. We were given little information in the AQAA about the training that was taking place. It was reported in the AQAA that staff were fully trained and there were plans to continue to improve our training. We had recommended at the last inspection that more training should be introduced which is specific to the needs of people with a learning disability. We saw a training plan in the home which listed a number of topics, such as medication, fire, moving and handling and food hygiene, which would be covered with staff. The list also included Induction although there was no information about an induction programme which was consistent with Skills for Care common induction standards. We were told at the last inspection that information about this had been obtained and that a suitable programme was to be set up. Staff training records were not available when we visited and since visiting we have asked for further information about the training that has been undertaken. We saw a record of staff supervision which showed that the most recent supervision session had taken place in June 2008. Miss Thomas said that supervision took place frequently on an informal basis, but she acknowledged that there needed to be a more formal structure. We had made a recommendation about supervision at the last inspection. Miss Thomas said that agency staff received verbal instruction in areas such as the homes fire procedures. Records were not being maintained to show when this instruction had taken place and the details of what was being covered. Care Homes for Adults (18-65 years) Page 25 of 34 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There have been developments in the running of the home during the last year, although the managers have not yet obtained the required qualifications. Further action is needed to ensure that peoples rights and best interests are safeguarded by the homes record keeping, policies and procedures. Peoples health, safety and welfare are generally being protected. Evidence: Eckett House is jointly owned and managed by Mrs Thomas and Miss Thomas. Mrs Thomas and Miss Thomas share the registered managers role and have several years of experience of running the home on a joint basis. There have been some concerns at previous inspections about how this arrangement was working in practice. We were told at the last inspection that the roles had been clearly defined, with Miss Thomas overseeing peoples care and support and Mrs Thomas having responsibility for the financial management and staffing. When we visited on 17th December 2009 we were shown a written agreement that had been drawn up and signed to confirm how the management tasks would be covered between Mrs Thomas and Miss Thomas. Care Homes for Adults (18-65 years) Page 26 of 34 Evidence: There has been a requirement at previous inspections that Mrs Thomas and Miss Thomas, as registered managers, complete the Registered Managers Award (RMA). This is so that they have the necessary qualification to manage the care home. We reported at the last inspection that Mrs Thomas was undertaking the RMA and that Miss Thomas was commencing the new Leadership and Management for Care Services Award. During our visit on 17th December 2009, Miss Thomas said that she was hoping to complete the Leadership and Management Award in January 2010. Mrs Thomas told us that she had started the Registered Managers Award, but there had been difficulties with the training provider and she had not continued with the course. Mrs Thomas completed the AQAA, which gave us basic information about the home. There was a lack of detail in some areas and we talked about the importance of the AQAA in providing us with good information which described what was happening in the home. Surveys had been given to the people who live at the home, and to other interested parties, since the last inspection. The home had received a number of surveys back and collated the outcome of these. We were told that the home would be developing quality assurance by focussing on particular areas in the coming year. These included the standard and choice of meals, the standard of accommodation, and cleanliness in the home. During our visit on 17th December 2009, we found that action needed to be taken in relation to record keeping. As reported under Staffing for example, some records were not being kept securely and confidentially. There were also occasions when the use of personal money had not been recorded in detail, with no receipts available in relation to expenditure. We had recommended at the last inspection that comments in peoples records, such as bad behaviour and no problems should be avoided, and replaced with objective information about observations and peoples actions. We saw that terms such as bad behaviour and play up continue to be used in peoples records. We read in the minutes of staff meetings that fire precautions were being discussed. The homes fire alarm system was being tested regularly and fire drills undertaken. Records were being maintained. Miss Thomas said that the fire equipment was also being checked although this was not being recorded. The portable electric appliances had been checked in October 2009. There was a Gas safety certificate dated 02.04.09. Care Homes for Adults (18-65 years) Page 27 of 34 Evidence: We saw risk assessment forms that had been completed in relation to the environment and to tasks that were being undertaken in the home, including moving and handling. Guidance had also been produced about safe systems of work, for example in relation to cooking and to putting out rubbish. Some of the risk assessments had not been reviewed since 2007. A fire risk assessment could not be located and we also talked to Miss Thomas about carrying out a risk assessment in respect of lone working. Care Homes for Adults (18-65 years) Page 28 of 34 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 37 9(2)(b)(i) The registered managers 31/05/2009 must ensure they have the necessary qualification to manage the care home and must complete the Registered Managers Award. This is outstanding from the end of 2005. Care Homes for Adults (18-65 years) Page 29 of 34 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 1 5 Guidance must be produced in relation to additional charges and what the fees cover. This is to ensure that people have good information about the services that they will receive and there can be no misunderstandings about what they are expected to pay for out of their own money. 28/02/2010 2 1 6 The homes Statement of Purpose must be kept under review, and where appropriate, reviewed. This is to ensure that the details are accurate and up to date. 28/02/2010 3 20 13 Handwritten entries in the medicine administration record must be signed and dated. 28/02/2010 Care Homes for Adults (18-65 years) Page 30 of 34 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 This is to ensure that any changes have been appropriately authorised. 4 35 17 An up to date record of staff training must be kept in the home and available for inspection. This is to ensure that there is evidence of the training that staff have received and when this took place. 5 41 17 Records must be kept securely and confidentially This is to ensure that peoples privacy is protected and their interests are safeguarded. 6 41 17 When people receive support with looking after their personal money, any transactions must be clearly recorded to show how the money has been used. This is to ensure that peoples money is well accounted for and there can be no misunderstandings about how the money has been used. 7 42 13 A fire risk assessment must be available in the home. This is to show that fire 28/02/2010 28/02/2010 28/02/2010 28/02/2010 Care Homes for Adults (18-65 years) Page 31 of 34 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 related hazards are being assessed and appropriate action is being taken in response to these. 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 1 That the written information about the home is checked to ensure that the contents are up to date and provide an accurate picture of the home. That all sections of peoples individual plans are completed as a matter of priority. That all assessment forms are dated, and include a date to show when the assessment is to be reviewed. That people receive support to ensure that their Health Action plans are completed in full and updated when necessary. That a risk assessment is undertaken concerning the arrangements being made for the security and storage of medicines that are received into the home. That the format being used for recording transactions involving peoples personal money is reviewed. This is in order to have a record which includes appropriate sections and shows the signatures of those people involved in the transaction and whether a receipt was obtained. That a policy is produced in relation to Gifts to Staff. That the use of the upstairs rooms is kept under review. This is with a view to seeing if changes could be made which would be beneficial to the people who live at the home, for example by providing them with a larger bedroom and / or an en-suite facility. That the training plan is developed to include the range of mandatory and specialist subjects, including those relating to equality and diversity, that are expected for people Page 32 of 34 2 3 4 6 9 19 5 20 6 23 7 8 23 24 9 35 Care Homes for Adults (18-65 years) 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 working in a learning disability setting. 10 11 35 35 That staff members complete the Learning Disability Induction Award (Common Induction Standards) That the instruction given to agency carers in relation to the homes policies and procedures is documented, to show the subjects that have been covered and when the instruction was given. That staff receive regular supervision at least six times a year. The focus should be away from task. The meetings should cover the homes philosophy and aims, together with personal training and development needs (recommendation from last inspection). Comments such as bad behaviour and no problems should be avoided (recommendation from last inspection). That a risk assessment is undertaken in relation to lone working by staff. 12 36 13 14 41 42 Care Homes for Adults (18-65 years) Page 33 of 34 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. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 34 of 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!