Care Home: Elizabeth House [Gloucester]

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What the care home does well Elizabeth House provides accommodation of the highest standards which is well maintained and has specialist adaptations and equipment to meet the diverse needs of students living there. As part of the National Star College the home has access to their excellent resources for recruiting and selecting of staff, training of staff, health and safety and quality assurance systems. Students are involved in monitoring key areas such as catering, health and safety and activities. They are supported to be independent and their opinions are valued. Students said "staff are great" and that they are able to take part in lots of activities in the local town. students particularly enjoy going out to clubs and restaurants and were planning day trips further afield. They have access to the Internet and interactive games. One student commented, "I like Liz House it has changed my ways of thinking as a more positive person." What has improved since the last inspection? A maintenance person has been appointed to maintain the high standards of accommodation in the home. Environmental improvements have included replacing carpets with washable floors in communal areas and installing a second lift. The garden is now accessible to students who use wheelchairs. Overall the house has a more homely feel making good use of art work produced by students. The staff team have coped well with changes to the administration of medication. What the care home could do better: No requirements were issued at this inspection. Recommendations included making sure that up to date documents produced by the college are available in the home and providing bumpers to protect bed sides. We suggested some improvements to the systems of administering medication. Key inspection report Care homes for adults (18-65 years) Name: Address: Elizabeth House [Gloucester] Denmark Road Gloucester Glos GL1 3HW     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: Lynne Bennett     Date: 2 7 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: Elizabeth House [Gloucester] Denmark Road Gloucester Glos GL1 3HW 01452782960 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): jgeorge@natstar.ac.uk National Star College Name of registered manager (if applicable) Mrs Julie George Type of registration: Number of places registered: care home 24 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 physical disability Additional conditions: That a member of the Management Team of Elizabeth House holds a current qualification as a Registered General Nurse. Date of last inspection Brief description of the care home Elizabeth House is one of two residential homes providing off site accommodation to students from the National Star College. The college owns the property, which was converted and fully refurbished into accommodation for 24 students with a physical disability. Situated in a residential area, the home provides easy access to the centre of Gloucester. Most students have single accommodation, some with en-suite facilities, which include a shower. There are three double rooms and sufficient bath/shower rooms and toilets. An independent living flat and training kitchen are also provided. Students have access to a spacious and comfortable lounge and a dining room. There is also an IT suite and two kitchenettes which they can use. The home has two mini buses and students also use taxis and local transport systems. The home does not Care Homes for Adults (18-65 years) Page 4 of 31 Over 65 0 24 Brief description of the care home currently provide 24 hour nursing support on site but support from nurses can be accessed from the campus during the day. The provider supplies information about the service, including the most recent CQC report, to students and their advocates on request. 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: This inspection took place in April 2010 and involved a site visit to the home on 27th April. The registered manager completed an AQAA (Annual Quality Assurance Assessment) as part of the inspection, providing considerable information about the service and plans for further improvement. It also provided numerical information about the service (DataSet). She was present during our visit. We (the Care Quality Commission) had received surveys from 7 students and 10 staff prior to our visit. We talked to 3 students living in the home, and asked staff about those students needs. We also looked at the care plans, medical records and daily notes for these people. This is called case tracking. We also sampled other files. We examined a range of documents including staff files, health and safety and quality assurance records. We walked around the environment and inspected most students rooms. Care Homes for Adults (18-65 years) Page 6 of 31 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: 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 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 9 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Students have access to the information they need and the option of visits and trial stays, enabling them to make a decision about whether they wish to live at the home. Assessments make sure that the home is able to meet their needs. Evidence: Students living at Elizabeth House have lived either on campus (National Star College) or at Overton House in Cheltenham. They are asked to identify where they would like to live at the end of the summer term and the registered manager said they have the opportunity to visit or stay over at the home prior to the start of the new term. The AQAA confirmed we encourage visits from prospective students and facilitate trial stays. It also stated, we liaise with the college multi-disciplinary team and individual assessments are comprehensive. A survey from a student said, when I first started they made me feel really welcome. Students are given copies of the colleges Statement of Purpose and Student Handbook prior to the start of the new college year. This document is reviewed and updated annually although the copy examined in the home was not the most recent version containing some out of date information about the Care Quality Commission. Care Homes for Adults (18-65 years) Page 10 of 31 Evidence: Since our last key inspection the needs of students living at Elizabeth House have substantially changed and there is no longer 24 hour cover from nurses at the home. Most students spend their days on the main campus where they have access to nurses if needed. Students who require nursing support would not be admitted to Elizabeth House. Students commented that this has in effect restricted their choice of off site accommodation but were positive about the opportunities now offered for students to develop skills for a more independent lifestyle. Care Homes for Adults (18-65 years) Page 11 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Students are being involved in developing their care plans that reflect their aspirations and needs. Positive communication is promoted enabling students to express their wishes and needs. Risks are managed safeguarding students safety and wellbeing. Evidence: We case tracked the care of 4 students living at the home. All students have a main file, a personal development file, information on Cardex and ILS and care support notes. The college were exploring new ways of presenting care plans and support plans for future use, promoting personalisation, reducing duplication and using more efficient systems including new technologies. These will be cascaded to all services to ensure consistency of approach and continuity of care. Initial assessments completed when students started at college had been reviewed annually and formed the basis of their care plans and risk assessments. The records examined for all students were up to date and provided evidence of review this year. Where changes in need had occurred these were noted and records amended. Care Homes for Adults (18-65 years) Page 12 of 31 Evidence: Students confirmed they had key workers and were scheduled to have weekly key worker meetings. We observed one taking place during our visit. The frequency of these meetings was being monitored through the homes quality assurance system. Care plans were clearly and succinctly written providing a personalised approach to how students wished to be supported. Staff spoken with confirmed that staff strive, to look at the support needed from their (students) perspective. Surveys from staff stated that there was, good reporting and recording. Staff spoken to during our visit confirmed that there were systems of communication promoting continuity of care and a consistent approach. Students had the opportunity to sign records in their files if they wished and also had copies of care plans and risk assessments discreetly stored in their rooms. Personal development plans indicated how students were being supported to develop their independence in such areas as community skills, social or recreational activities, self medicating or developing culinary skills. Students were observed working towards these targets during our visits. One student had chosen and shopped for a meal and another was making telephone queries. Students communication needs were clearly identified in their care plans and where needed students had access to assistive technologies these were available. Their care plans indicated where they needed the support of a Speech and Language Therapist. One student had a communicator and another person used a bliss board. A member of staff was learning Makaton sign language. Good use was being made around the home of photographs and pictures to illustrate policies and procedures and staff rotas. Records indicated that for students with visual difficulties thought was being given to how information was presented and made accessible to them. The AQAA indicated that students had access to advocacy to support them with a range of issues. Students can access local advocacy groups or an advocacy service recently set up by the college. This was confirmed from records of students receiving advocacy and notes of students meetings discussing how to access advocates. Where restrictions or restraints were in use such as lap belts, care plans and risk assessments made clear reference to this and provided the rationale for their use. When inspecting the accommodation for one student case tracked we noted that they had bed-sides on one side of their hospital bed. They confirmed with us that they used these. This had not been identified in their care plans or risk assessments although a record had been made that they had a fear of falling out of bed. These records should be amended to reflect this. Consent for the use of bed-sides should also be obtained in line with the Mental Capacity Act and Deprivation of Liberty Safeguards. We examined Care Homes for Adults (18-65 years) Page 13 of 31 Evidence: care plans and risk assessments for another person who had bed-sides and these clearly identified why they were in use, although again consent for their use had not been identified. As mentioned a range of risk assessments were in place supporting students to take risks as safely as possible minimising known hazards and putting the necessary safeguards in place. Where incidents or near misses had occurred these were being monitored and audited by the college and any changes to practice or support implemented. Moving and handling risk assessments were clear and specific about the procedure, numbers of staff and equipment needed for each moving and handling task. Robust assessments were in place for students accessing the community providing staff support until they had gained a community passport enabling them to be independent. 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. Students make choices about their lifestyle, and are supported to develop life skills. They have the opportunity to take part in social, educational and recreational activities and keep in touch with family and friends. Students have a nutritional diet and their diverse needs are catered for. Evidence: Surveys from students stated, opportunities to go out and enjoy yourselves with friends, I enjoy Saturday nights best because of DJ night. Students we met during our visits said they love being near to town and make full use of the pubs, restuarants, cafes and clubs. They also said they were planning day trips to London and to Badminton Horse Trials and Oxford. Students can also choose to remain on campus after their college sessions to use the Star Cafe and Bar or to take evening courses. Students had set up an activities committe and a large notice board provided Care Homes for Adults (18-65 years) Page 15 of 31 Evidence: information about what they were discussing and providing. A range of clubs were also provided at Elizabeth House including animal club, where students could get up close to a variety of animals including domestic pets and reptiles. Other clubs included arts and crafts and writing. A staff survey indicated that the clubs could be more organised because often there was not enough time. Students had access to a WII and other interactive games as well as a large television in the communal lounge. They were using the Den for arts sessions and also had access to an IT suite. Students also had access to the internet in their rooms. Students ILS/daily notes indicated what activities they had taken part in and how they had spent their free time. Students spirituality or choice of religion was noted in their care plans and each person had a plan entitled Faith and Belief providing clear information about their personal wishes and how they would like to be supported. For one person case tracked they asked that each evening sections of the bible were read to them. Staff confirmed this was being done. Their ILS occasionally made reference to this. Some students were going each Sunday to a local church and one student had recently been baptised. Students were being supported in work experience placements. Students were visiting Slimbridge Wildfowl centre with a view to doing a work placement and another student had a work placement in town. Students also had the opportunity of a work placement in the homes office. Students leaving the college at the end of this academic year were being supported with their transition to work, further education and accommodation. Students said they can have much contact as they wish with parents and friends. One student described how initially they had wanted to see their parents each weekend but now they were happy to see them at holidays. Students keep in touch using the intranet, telephone and by visits. Students personal development plans indicated where they had personal goals to enable them to become more independent in areas such as planning meals, cooking, cleaning and using public transport. The AQAA stated that the housekeeper had helped advise a domestic task programme for students to support them with the learning and practice. Students were observed going out to shop for ingredients for a meal, making drinks and washing up after their meal. A breakfast club each morning enables students to make their own breakfast which includes the option of a hot meal. They also have access to a kitchenette on the ground floor where they can prepare meals and snacks. Another kitchenette is available on the top floor of the home. A flat in the basement provides the opportunity for students to live in a bedsit whilst having Care Homes for Adults (18-65 years) Page 16 of 31 Evidence: staff support available if needed. This area is due for refurbishment. Access to the students laundry had recently been improved after observations by the maintenance person that students were struggling to load machines. Students have regular house meetings where they discuss issues, activities and are kept informed about the colleges policies and procedures. Students also have the opportunity to sit on campus committees and the student union. The AQAA stated we provide a choice of freshly cooked meals every day to include fruit and vegetables. Students had the opportunity to participate in a food committee working with the cook. Over the past twelve months the home has promoted a healthy lifestyle. Some students have opted out of having daily meal records kept unless there are concerns about their health and wellbeing. ILS records provided some indication of whether students had eaten and the fluids they had drunk whilst at home. Weight records were being maintained. Students spoken with said the the quality of meals was hit and miss mostly due to the loss of one of the cooks. Care facilitators cook meals when the cook is not on duty. They have completed food hygiene training. The cook confirmed that none of the present students had any specialist dietary requirements. Care Homes for Adults (18-65 years) Page 17 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. Personal care support is offered in a way that responds to students needs and preferences, promoting their dignity. Medication processes are in place that should safeguard students from possible harm. Evidence: Surveys from staff stated we provide, good standards of care, high standards of personal care and good quality of all aspects of care to enable our students to promote their own independence. Some care plans indicated where students had preferences about the gender of staff providing their personal care. If this was not available plans indicated how staff should promote sensitivity and dignity when meeting their personal care needs. One student stated, the care support is very good. Another student said they would like more time in the mornings to use their independent living skills during their morning routines. During our visit students remaining at home for their personal development day were observed having individualised support with their routines. The AQAA stated, we deliver individualised care of a very high standard, which is informed by comprehensive care plans and assessments. Care Homes for Adults (18-65 years) Page 18 of 31 Evidence: Tissue viability care plans were in place and ILS records indicated that students were getting bedrest and/or having access to creams and preventative treatment. Where needed Nurses were involved and maintaining the necessary records. The registered manager stated that photographs would be used to supplement documentation where necessary as a means of monitoring any tissue viability concerns. Students mostly retain the services of health care professionals from their home county but if needed will be supported to access services within Gloucestershire. They also have access to the colleges General Practitioner, Nurses and also Physiotherapists, Speech and Language Therapists and Occupational Therapists employed by the college. The Cardex system provides an overview of their medical needs alongside a medical assessment and care plans. Any appointments were being recorded in students notes and on signficant conversation records. Since the last inspection systems for the administration of medication have been changed to reflect the needs of students now living in the home. As mentioned 24 hour nursing support is no longer provided in the home but from the college campus. Care facilitators have all received training in medication and Designated Persons have been trained in the safe handling of medication. Nurses have assessed the Designated Persons as competent after their training and conduct observations of practice termly. Records verified these were taking place. We spoke to staff with Designated Persons status who were positive about their role and were confident in their training and the ongoing support. They talked through how they administer medication and this was satisfactory. Some medication was supplied in blister packs. Stock records were being maintained on the medication administration record (MAR) and items were labelled with the date of opening. Handwritten entries on the MAR should be countersigned by a second member of staff confirming they are correct. Protocols for the use of as required medication were in place. Training in the use of invasive treatments had not been cascaded to Designated Persons. Controlled drugs were seen to be stored correctly and records maintained. The temperature of the medication cabinet and trolley should be monitored to make sure that medication is stored at below 25 degrees celsius. Some students self medicate and have had thorough assessments and training/support before taking responsibility for their medication. They have lockable facilities in their rooms. Staff confirmed ongoing monitoring to make sure medication is taken regularly. 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. Systems are in place that enable complaints and concerns to be raised by students or on their behalf. Systems are in place which should safeguard students from possible abuse. Evidence: The AQAA stated, we inform students about the complaints procedure and display a copy in all students rooms. The copies of the complaint procedure displayed in students rooms and communal areas was not the current version used by the college. Our details on the document displayed were out of date. The registered manager said she would obtain the current version and replace copies around the home. Students can access the complaints procedure via the college website. Students spoken with said they would express concerns to their key workers or management of the home. Surveys from students indicated they were all aware of how to make a complaint. The home had received 2 complaints over the last twelve months. Copies of these and the outcome of the investigation and response to complainant were inspected. concerns were also being logged in significant conversation records on students files. Students have regular house meetings where they can also discuss concerns and have representation on meetings on campus. The college has robust systems in place to safeguard students from possible abuse and this is promoted by Elizabeth House. The AQAA stated that we foster an open environment and staff are freely available to respond to issues and concerns. A Care Homes for Adults (18-65 years) Page 20 of 31 Evidence: survey from a student stated, I feel very safe. Staff confirmed they have access to training in the protection of vulnerable adults and the local county councils Alerters Guide. The college has also produced a safeguarding toolbox which enables staff to access refresher training. Staff spoke positively about this resource. Information about bullying and harassment was displayed around the home. This had been produced in an accessible format using pictures and photographs. Staff have access to training in the management of challenging behaviour. A new series of workshops have been set up by the college so that staff can pick the course relevant to their service and their students. Where needed the house has access to a team email so that all staff both in the home and on the campus can keep in touch if they have concerns about students. Records confirmed that where this was the case this resource was being used and students also had access to counseling or psychology services. Some students have support to manage their personal finances and can keep their money in the office safe. Records were examined for students case tracked which indicated that balances were being regularly checked and audited. Where students may be at risk of getting into debt staff support them to manage their finances and external support is provided if needed. Inventories were in place detailing students personal possessions. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Students live in a home that is safe, clean and well maintained which recognises their diverse needs creating an environment that matches their personal requirements. Specialist equipment is provided to those students who need it. Evidence: The AQAA listed improvements which had taken place over the last year which included removing carpets and laying non-slip washable flooring on the ground floor and decoration of hallways and entrance hall. A maintenance person has been appointed to take care of the day to day repairs in the home and was redecorating communal areas and fixing protective coverings on walls. Most areas of the home are accessible to students who use wheelchairs. A second lift had been installed since our last visit to the home. Good use had been made of art produced by students which was displayed in communal areas. Notice boards had also been provided to display information in communal areas. The gardens to the rear of the home had been made accessible to students with a patio area and access to a barbecue. The area to the front of the house had been redesigned with a rock garden. Future improvements for the home included refurbishment of the independent living flat, replacing bedding and soft furnishings and changing double rooms to single rooms. Care Homes for Adults (18-65 years) Page 22 of 31 Evidence: A range of specialist adaptations and equipment had been provided including overhead hoists in some rooms, portable hoists, bath and shower chairs. There were two specially adapted wet rooms and further plans to convert bath/showers to wet rooms. Some students had hospital beds and should be provided with bumpers for the bedsides. Students bring their own slings with them. Checks were in place to audit the quality of slings and guidance displayed for staff about their care. Students have access to their own laundry with domestic style washing machines and tumble dryers. There is an additional laundry with sluicing facilities. Housekeepers were employed to maintain communal areas as well as students rooms. The house was clean and tidy during our visit. Personal protective equipment was provided for staff who also had access to infection control training. 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. Students needs are met by a competent staff team, who have access to a comprehensive training programme that provides staff with the opportunity to gain knowledge about the diverse needs of students living at the home. Robust recruitment and selection procedures should protect students from possible harm. Evidence: Staff surveys recognised that they are a good team who have the best interests of students at heart. One member of staff said they felt priveleged to work there. Students commented, staff listen to me and help me to sort out my problems, and they make sure students are happy. One student wished staff had more time to talk to them. Staff indicated that occasionally staffing levels cold be put under pressure. During our visit we discussed this with management, staff and students. Whilst they all recognised that last minute sickness impacted on the home they had no concerns about staffing levels. Staff said they would cover shifts if needed and agency staff were used at peak times if needed. Concerns were expressed in surveys about communication systems but during our visit staff said this had improved and systems put in place such as communication books. Handovers took place at change of shift and staff meetings were being held. Students were often invited to attend staff meetings. Care Homes for Adults (18-65 years) Page 24 of 31 Evidence: The DataSet said that all staff had completed the colleges induction programme which is equivalent to the Skills for Care Common Induction Standards. Staff have access to a National Vocational Qualification (NVQ) programme and 87 per cent had their awards in Health and Social Care. Staff were observed treating students respectfully and with sensitivity. The National Star College has a central Human Resources department which oversees the recruitment and selection of staff for Elizabeth House. This department was inspected by us in January 2010 when we found, comprehensive and robust records were being kept for all new staff. Excellent systems were in place to make sure staff had provided a full employment history, at least two satisfactory references and a satisfactory Criminal Records Bureau check before commencing employment. The registered manager confirmed that the same standard of recruitment was promoted at Elizabeth House. She said they had not appointed any new staff in the last twelve months so we did not inspect any recruitment and selection files. The National Star College has a robust training department which promotes the personal development of its staff. Monitoring of training in the home was delegated to a member of staff who maintains comprehensive records indicating when refresher training was needed, when it had been booked and when completed. A training database was being reviewed by the college for use in the home to complement these systems. As mentioned staff have access to new short courses via tool box sessions when they need refresher training. As well as mandatory training staff have the opportunity to attend a range of courses including equality and diversity, sexuality, learning disability and boundaries. 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. The management and administration of the home is based on openness and respect. Effective quality assurance systems are in place involving students. Systems are in place to maintain and monitor the health, safety and welfare of students, which should safeguard them from possible harm. Evidence: The registered manager has considerable experience supporting students with a physical disability and managing services for the National Star College. She has a National Vocational Qualification, Level 4 in Care and Management. She has delegated responsibility to key members of staff overseeing medication systems, training and health and safety. Staff spoken with were enthusiastic about their roles. She stated that the home had been through a period of change over the last twelve months and that staff morale had significantly improved over recent months. Staff and management had received training in the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. No one in the home was subject to a Deprivation of Liberty Safeguard at the time of the inspection. Care Homes for Adults (18-65 years) Page 26 of 31 Evidence: The National Star College has robust quality assurance systems which involve feedback from students. Regulation 26 visits, as required by us, were taking place and we examined the last two reports. It was evident that any recommendations were being monitored and audited. The registered manager was evidencing compliance as issues were dealt with. A quality assurance audit had been conducted on the service by a colleague in 2009 which included looking at the environment, care planning, staffing and feedback from students. A care audit was also being completed for all staff which involved observation of their practice. The frequency of this audit was determined by the outcome so staff awarded good or outstanding would have an annual audit but for staff with inadequate or satisfactory audits would be completed more frequently. Audits were also in place monitoring medication and health and safety around the home. The DataSet indicated that servicing of equipment was taking place at the appropriate intervals. We examined records confirming that fridges, freezers, hot food temperatures, water outlets and fire checks were taking place. A fire risk assessment had been completed in 2008 and reviewed in 2010. Checks were in place to make sure that students provided with ski sheets had these in situ in their rooms and staff had received training in their use. Generic environmental risk assessments were in place. The home had received 5 stars from Environmental Health and had complied with a visit from a Health and Safety Inspection in 2008. 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 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 2 3 4 5 6 7 8 9 1 7 7 18 20 20 20 22 29 Current versions of the Statement of Purpose should be available in the home. Where bed-sides are used the rationale for their use should be identified in students care plans and risk assessments. Student consent for the use of bed-sides should be documented. The gender of staff providing personal care should be discussed with students and recorded in their care plans. Handwritten entries on medication administration records should be countersigned. The temperature of medication cabinets and the trolley should be monitored and recorded. A current copy of the British National Formula should be available for staff. An up to date version of the complaints procedure should be available to students. Where students have bed sides which are in use they should have bumpers or protective coverings provided. Page 29 of 31 Care Homes for Adults (18-65 years) 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). 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