Care Home: Eldermere

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What the care home does well Eldermere has a warm relaxed atmosphere and people living at the home appeared content in their surroundings and comfortable with the staff who were supporting them. The home is well run; the manager was not at the home on the first day of this inspection but staff were able to assist us and made all records available. We returned on a second day to review staff recruitment files. The manager was available on this day. There is a commitment to ensuring that people living at the home are involved in the home, whether this is by active participation or observation. Support plans give clear guidance for staff . The procedures for the administration of medication are good and promote safe practice. People have access to healthcare professionals in line with their individual needs. There is a range of leisure and social activities for people to take part in. The home assists people to visit family and friends and to access community facilities. There are robust recruitment procedures which minimise the risk of abuse . Staff working at the home stated that they received training, which was relevant to their role and the needs of the people at the home. What has improved since the last inspection? Since the last inspection the home has undergone a complete refurbishment and decoration. The service was relocated during this time. The refurbishment has been completed to a very high standard. The home is now provides a clean, up to date and accessible home for people who live there. Following the refurbishment people living at the home now have full access to all areas of the home including the kitchen and laundry which were previously kept locked. People living at the home are now supported by staff to participate in all aspects of life. This includes undertaking house hold task such as shopping, cooking and doing laundry. The home has purchased two cars which enables people to access the community more easily as staff do not needs specialist training to drive the vehicles. People living at the home are being supported to hold keys both to their individual bedrooms and to the front door. This is a significant shift in culture as at previous inspections it was staff who held the keys to areas of the home. What the care home could do better: The care and support plans did not give clear guidance to staff on how people at the home should be supported to make choices and decisions in line with the Mental Capacity Act nor the Deprivation of Liberties. Staff had not received training in either of these documents. This is required to ensure that people views and wishes are taken into account. The manager needs to submit an application to register with us to enable us to assess her skills and competencies. Key inspection report Care homes for adults (18-65 years) Name: Address: Eldermere Knowle Lane Shepton Mallet Somerset BA4 4PF     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Justine Button     Date: 2 9 0 1 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 27 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 27 Information about the care home Name of care home: Address: Eldermere Knowle Lane Shepton Mallet Somerset BA4 4PF 01749344642 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: sescott@somerset.gov.uk Somerset County Council (LD Services) care home 6 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: Service users may be admitted who have concurrent sensory impairment Date of last inspection Brief description of the care home Eldermere is a home providing care and support for six adults who have severe learning difficulties, multi-sensory and physical impairments. In addition, a high level of support is required in communication needs. Eldermere is a large detached property, with secure gardens at the rear and is located approximately two miles from Shepton Mallet. The accommodation is arranged on two floors. On the ground floor there is a lounge, dining room, laundry facility, kitchen and one bedroom with en-suite facilities. Five further bedrooms are located on the first floor. Service users have access to the homes shared transport. A team of staff throughout a twenty-four hour period supports the people who live at Eldemere. The home is owned by Somerset County Council Social Services. 6 Over 65 0 Care Homes for Adults (18-65 years) Page 4 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The focus of this inspection visit was to inspect relevant key standards under the Commissions Inspecting for Better Lives 2 framework. This focuses on outcomes for service users and measures the quality of the service under four general headings. These are excellent, good, adequate and poor. One inspector carried out this inspection over one and half days. The home completed an Annual Quality Assurance Assessment (AQAA) in 2009. This gave clear details about the home and demonstrated a commitment to ongoing improvement. Many of the people living at the home are unable to fully express their views but we were able to meet with service users and observe care practices. Care Homes for Adults (18-65 years) Page 5 of 27 We were given unrestricted access to all areas of the home and all records requested were made available. Care Homes for Adults (18-65 years) Page 6 of 27 What the care home does well: What has improved since the last inspection? What they could do better: The care and support plans did not give clear guidance to staff on how people at the home should be supported to make choices and decisions in line with the Mental Capacity Act nor the Deprivation of Liberties. Staff had not received training in either of these documents. This is required to ensure that people views and wishes are taken into account. Care Homes for Adults (18-65 years) Page 7 of 27 The manager needs to submit an application to register with us to enable us to assess her skills and competencies. 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 27 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides appropriate information to people thinking of moving into the home. This based on the needs of the individual. This can include a visit to the home and a trial period. Staff at the home lisase with other healthcare professionals to ensure that they have all required information and to ensure that the home can meet the needs of the individual Evidence: It should be noted that all the people who live at home have done so for a number of years. There are currently no vacancies at the home. The staff described how any new people thinking of moving into the home would be given information according to their individual needs. Staff stated that this would include a visit to the home (on more than one occasion if this was required). This may include a meal or staying over night if this is required. Everyone living at the home has details of what is included in the fee and items that Care Homes for Adults (18-65 years) Page 10 of 27 Evidence: individuals will need to purchase for themselves. The manager and staff gave evidence that they monitor the needs of individuals and take appropriate action if they feel the home may no longer be meeting someones needs. Care Homes for Adults (18-65 years) Page 11 of 27 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans are person centered and contain good detail. People are involved in the development of their care plans. The care plans need to contain details of how staff support people to make decisions in line with the mental Capacity Act. People are encouraged to make their own decisions and choices wherever possible. Risk assessments are carried out to support people to take responsible risks and increase independence. Evidence: We looked at two care plans. These were person centered and contained a good level of detail. They provide good information and guidance for staff to follow so that they know how to best support people. The care plans included peoples preferred daily routine, likes and dislikes. The plans included learning objectives which since moving back to the home included information on how staff could support people to have keys to their individual bedrooms and or front door keys to the main house. This is a significant improvement on the previous inspection visits when staff held the keys to many areas. Care Homes for Adults (18-65 years) Page 12 of 27 Evidence: Areas such as the kitchen are now accessible at all times to people living at the home. The Plans did not contain any information with regard to Deprivation of liberties nor the Mental Capacity Act. The Mental capacity act supports people with impaired capacity so that they are given every opportunity to make decisions for themselves. This would be particularly important at Eldermere where some people have limited verbal communication and also some learning difficulties. We were told by staff that they continue to support people to develop communication strategies. There were limited tools, such as pictures and symbols, observed around the home. Staff told us that these are not in place as they would be of no value to people living at the home. Care Homes for Adults (18-65 years) Page 13 of 27 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are offered a wide range of activities. Each person has their own individualised activity planner. People are supported to maintain contact with family and friends. Staff support people to meet their goals. The home encourages people to be as independent as possible. People are involved in food shopping and planning menus. Evidence: Each person who lives at the home has an individual activity timetable that reflects their interests. Currently no person living at the home attend college or employment outside the home. The staff encourage people to be involved in household activities, this may be active participation or observation. For instance the we observed one person being supported Care Homes for Adults (18-65 years) Page 14 of 27 Evidence: to complete laundry. This is an improvement on previous inspections when people were not actively encouraged to undertake household tasks. The home assists people to keep in touch with family and friends. Staff were supporting one person to organise their birthday party. Dates were observed in the care plans of birthdays and anniversaries of family and Friends. Staff then support and remind people at the home to purchase cards and gifts as appropriate. There is a weekly menu that is discussed and written with people at the home a week in advance to ensure that everyone is able to make choices about the food in the home. People living at the home are then supported to purchase food for the set menu. The main meal of the day is in the evening with a lighter meal at lunchtime. We observed the lunchtime routine. People were encouraged to be as independent as possible and specialist cutlery and crockery was provided where required. Care staff are responsible for cooking all meals in the home once they have undertaken basic food hygiene training. The home has recently acquired two new cars to replace the old minibus. These are more accessible to people at the home as staff no longer need to undertake specific training to drive the cars. This has enable more frequent access to the community. Care Homes for Adults (18-65 years) Page 15 of 27 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported in their preferred way. People are supported to access a range of health professionals. Individual health plans are being developed. The homes medication policies and procedures protect people from risk of harm. Evidence: Each person has a health file. This contains details of appointments, letters and reports. People have access to a range of health professionals including GP, dentist, dietician, optician, chiropodist, speech and language therapist, psychologists and psychiatrists. Staff and management currently administer medication for everyone who lives at the home. We looked at the homes medication and records. All medicines are stored securely. The home uses a Monitored Dosage System. We looked at the Medication Adminstration Sheets (MAR). There were no gaps in these. Where people were prescribed as required medication, the home had written a protocol for this. This provides information for staff so that they know signs to look for, guidance for administration and recording. Where MAR Sheets had been written by hand, two Care Homes for Adults (18-65 years) Page 16 of 27 Evidence: signatures were obtained. Care Homes for Adults (18-65 years) Page 17 of 27 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a complaints policy. The homes policies relating to abuse and whistleblowing protect people from the risk of harm. Evidence: The home has a complaints procedure. An accessible complaints procedure with symbols and pictures is availbale. People who live at the home knew who to speak to if they are not happy. The home has not received any complaints in the past 12 months. We found that staff recruitment files contained all of the required checks to protect people from risk of abuse. The home has a whistleblowing policy and staff spoken with knew what to do if they suspected or witnessed abuse. As previuosly stated ther eis little evidence in the care and support plans relating to Deprivation of Liberties nor the mental Capacity Act. In addition it could not be confirmed that staff have recieved training in this area. Care Homes for Adults (18-65 years) Page 18 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The environment is homely, comfortable and safe. The home has undergone a complete refurbishment including redecoration and new furniture. Peoples bedrooms are personalised to reflect their individual tastes and interests. The home is clean and tidy. Evidence: Since the last inspection the home has undergone a full refurbishment. This has been completed to a high standard. The home now provides a very homely enviroment. The kitchen/ diner and laundry are now fully accessible to all people living at the home. We reviewed two bedrooms (with the premission of the indivduals) Bedrooms were personalised with items to reflect peoples interests and tastes. The bathrooms have also been udated and an accessilbe bathroom is now provided. There is a secure garden to the rear of the property and ample parking to the front. Care Homes for Adults (18-65 years) Page 19 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staffing levels are adequate the majority of time however some staff recruitment is required. Staff received the majority of training to enable them to fulfill their role however no staff have received training that would support people at the home to make choices and decisions Staff recruitment procedures are satisfactory Evidence: There is a clear staffing structure for the home. Unfortunately at the present time there are some staff shortages. These shortages are being covered on the whole by part time staff increasing their hours and a member of staff has been transferred from another home for a period of six months whilst staff can be recruited. The staff shortages have not had a major impact on the people living at the home however it should be noted that in one of the care plans viewed it was noted that the individual could not go out as often as he would like due to staff shortages. The home employs 16 care staff, 6 have a National Vocational Qualification (NVQ) in care at level 2 or above. (Figures taken from AQAA completed by the manager) In addition to NVQ training, staff have access to a large range of training opportunities. Records showed Care Homes for Adults (18-65 years) Page 20 of 27 Evidence: that staff have undertaken training in autism, dementia, mental health issues, equality and diversity, the mental capacity act and health and safety issues. All staff who completed questionnaires felt that they received training that was relevant to their job. New staff undertake the County Councils induction programme as well as completing an in house induction programme and shadowing more experienced staff. At times new staff have to wait some weeks before being able to attend the induction programme which limits the amount of involvement that they can have in the home when they begin work. Staff however have not received training with regard to the Mental Capacity Act or Deprivation Of Liberties. This may be the reason why these documents and guidelines are not reflected in the care and support plans. Given the needs of people living at the home staff should be supported to obtain training in this area. The inspector observed that care in the home was very task centered but interaction between staff and service users was friendly and respectful. We viewed the recruitment file of the two most recently appointed member of staff. This gave evidence of a robust recruitment procedure that included obtaining written references, checks against the Protection Of Vulnerable Adults (POVA) register and an enhanced Criminal Records Bureau (CRB) disclosure. Care Homes for Adults (18-65 years) Page 21 of 27 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management team has a commitment to ongoing improvement. Helath and safety is maintained Evidence: The home has a manager who has been in post for some time. The manager however is yet to register with us. Registration with us is required under the Care Standards Act to ensure that managers have the skills and competencies to run a home. The manager needs to submit an application as soon as possible. All staff spoken to stated that the management in the home was extremely open and approachable. There are regular staff meetings to gauge views and seek opinions. The deputy manager and the Annual Quality Assurance Audit (AQAA) gave evidence that the home is committed to ongoing improvement. There are annual reviews for all people living at the home where views on the care provided are sought from representatives and professionals. The home is continually Care Homes for Adults (18-65 years) Page 22 of 27 Evidence: looking at further enabling people to express their views. The home carries out audits on medication and accidents as part of their quality monitoring systems. Appropriate measures are in place to ensure the health and safety of people living at the home and staff. There are regular checks and servicing for equipment and staff receive training in health and safety issues. The staff undertake regular training in fire safety and practice fire drills are carried out. The inspector and deputy discussed how the home would be evacuated in the event of a fire at night and there appears to be no clear policy or guidance at the present time. Up to date certificates of insurance and registration are on display. Care Homes for Adults (18-65 years) Page 23 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 24 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 12 The care plans should clearly 08/04/2010 demonstrate how people living at the home are support ed to make decisions and choices in line with the mental Capacity Act This will ensure that people receive the correct support when making any decisions 2 32 18 Staff should receive training in the Metal Capacity Act and Deprivation of Liberties guidance. This will ensure that people at the home are supported to make decisions about things that affect them. 22/04/2010 3 37 9 The manager must submit and application to become registered with us. This will ensure that the manager has the competencies and skills to run the home. 23/04/2010 Care Homes for Adults (18-65 years) Page 25 of 27 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 26 of 27 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 27 of 27 - 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!