Care Home: Errol House

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What the care home does well Most people using the service on the day of the visit, had complex needs and were unable to use verbal communication. One person said they enjoyed their visits to Errol House, saying, "Yes, it`s really good here". Others smiled and nodded when asked if they liked the service. In the AQAA, the manager also told us that a relative had returned a questionnaire to them saying, "The staff are all very good with my daughter and i find it very good that if i give information about her to anyone it is followed up and carried out". Staff have very good knowledge of people`s individual support needs and could describe people`s routines well. Staff make sure there is a wide variety of activities for people during their stay. People who use the service said they enjoy their time at the home and that there is always something to do. One person said, "We do good and interesting things, I have been looking forward to my stay". Staff said they have received good training in meeting the health needs of people who use the service. Training has included: nutritional needs, PEG feeding, moving and handling and pressure ulcer prevention. In a recent questionnaire sent out by the home to families and carers of people who use the service, people spoke highly of the staff. Their comments included: "Complete confidence and trust in all the staff" "All the staff are very helpful and caring and gives you peace of mind when you walk away to leave my daughter in your care" "Staff are very helpful at all times and always aware of my son`s special needs" A person using the service said, "The staff are nice, good fun and you get what you ask for". Staff spoke highly of the support and leadership they get from the manager. Their comments included: "We get very good management support" "Never feel on your own, someone always there for you" "Fantastic communication from manager and deputy" "They are really supportive". What has improved since the last inspection? Although improvements are needed in its use, a new format for pre-admission assessments has been introduced. This is comprehensive and includes the use of pictures and symbols to make it more accessible to people who use the service. The home now has two vehicles which gives greater flexibility for outings for people during their stay.The manager and staff have recently developed an activity plan that goes out to people who use the service at the booking stage so they can arrange their visits around activities or events they would be interested in. Events include the celebration of religious festivals such as Diwali and special `transitions` weeks to cater for the needs of younger people. Improvements to the way medication is stored and administered have been made. This makes sure it is safer and reduces the risk of errors occurring. Staff have now received training in safeguarding children. This means they can protect the interests of young people aged 16-17 properly. In the AQAA the manager told us how the environment in the home had been improved. She said, `Several communal areas within the house have been redecorated, a new kitchen has been installed. We have had a new dishwasher, industral washing machine and a parker bath.` A new shower trolley has also been purchased. There is a large summer house in the garden that has been equipped with sensory equipment. The manager said this is well used in the summer months. What the care home could do better: Pre-admission assessments should be completed in detail for all people who use the service, to make sure the home has considered how they can meet people`s needs fully. Although some improvements have been made to care plans and risk management plans, there is still some work to be done to make sure plans are in place for everyone who uses the service. Care plans should continue to be developed from the preadmission assessment information and should include full details of the care and support to be provided. This will make sure that people`s needs are not missed or overlooked. Also, risk management plans should continue to be fully developed for all people who use the service based on the risks and needs identified in pre-admission assessments to make sure everyone`s needs are fully met. Safeguarding referrals must be made to the local authority for any incidents where people`s safety or welfare has been placed at risk. This will make sure people are properly protected. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Errol House 155 High Street Boston Spa Leeds West Yorkshire LS23 6BH     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Dawn Navesey     Date: 0 3 0 4 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 33 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 03000 616161 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 33 Information about the care home Name of care home: Address: Errol House 155 High Street Boston Spa Leeds West Yorkshire LS23 6BH 01937849392 01937849725 b.dowling@wilfward.org.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Wilf Ward Family Trust care home 6 Number of places (if applicable): Under 65 Over 65 0 learning disability Additional conditions: 6 Six service users may be accommodated from the age of 16 years of age. The maximum number of service users who can be accommodated is: 6 The registered person may provide the following category of service only: Care home only - Code PC To service users of the following gender: Either 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 The Wilf Ward Family Trust owns Errol House. The Trust was established in 1986 and has been providing services for people with learning and physical disabilities since 1988. Errol House aims to provide an atmosphere where everyone can feel they have a useful role to play with dignity. It is their intention that the person with a disability will experience as high a quality of life as possible whilst resident and that this will have a positive impact on their lives. There are five single rooms plus an annex with a bedroom, activity room and bathroom. This can be used as part of the house or as a separate unit. One of the five rooms is on the second floor of the home. The home Care Homes for Adults (18-65 years) Page 4 of 33 Brief description of the care home does not have a lift. The home is staffed on a 24-hour basis. The service is respite care only which offers a flexible approach to enable people to have from an overnight stay of one or two weeks. The house has its own transport. This enables people using the service to have outings and visits to various community activities and events. The fees range from nine pounds ninety nine pence to one hundred and seven pounds sixty pence per night. This information was provided at the April 2009 inspection. The home should be contacted directly for more up to date information. Additional charges are made for hairdressing, leisure activities, magazines and toiletries. Further information about the home is available in the homes Statement of Purpose. Care Homes for Adults (18-65 years) Page 5 of 33 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 quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. The Care Quality Commission (CQC) inspects homes at a frequency determined by how the home has been risk assessed. The inspection process has now become a cycle of activity rather than a series of one-off events. Information is gathered from a variety of sources, one being a site visit. More information about the inspection process can be found on our website www.cqc.org.uk This visit was unannounced and was carried out by one inspector who was at the home from 12-15pm - 6pm on the 3 April 2009. Care Homes for Adults (18-65 years) Page 6 of 33 The purpose of the inspection was to make sure the home was operating and being managed for the benefit and well being of the people staying there. And also to monitor progress on the requirements and recommendations made at the last inspection. Before the inspection evidence about the home was reviewed. This included looking at any reported incidents, accidents and complaints. This information was used to plan the visit. An AQAA (Annual Quality Assurance Assessment) was completed by the home manager before the visit to provide additional information. This was well completed and gave us all the information we asked for. Survey forms were sent out to people using the service, staff and health care professionals. None of these have been returned at the time of writing this report. During the visit a number of documents and records were looked at and some areas of the home used by the people staying at the home were visited. Some time was spent with the people who use the service, talking to them and interacting with them. Time was also spent talking to staff and the manager. Feedback at the end of the visit was given to the manager, deputy manager, area manager and development manager. The last inspection of this home was on 4 April 2007. What the care home does well: What has improved since the last inspection? Although improvements are needed in its use, a new format for pre-admission assessments has been introduced. This is comprehensive and includes the use of pictures and symbols to make it more accessible to people who use the service. The home now has two vehicles which gives greater flexibility for outings for people during their stay. Care Homes for Adults (18-65 years) Page 8 of 33 The manager and staff have recently developed an activity plan that goes out to people who use the service at the booking stage so they can arrange their visits around activities or events they would be interested in. Events include the celebration of religious festivals such as Diwali and special transitions weeks to cater for the needs of younger people. Improvements to the way medication is stored and administered have been made. This makes sure it is safer and reduces the risk of errors occurring. Staff have now received training in safeguarding children. This means they can protect the interests of young people aged 16-17 properly. In the AQAA the manager told us how the environment in the home had been improved. She said, Several communal areas within the house have been redecorated, a new kitchen has been installed. We have had a new dishwasher, industral washing machine and a parker bath. A new shower trolley has also been purchased. There is a large summer house in the garden that has been equipped with sensory equipment. The manager said this is well used in the summer months. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –03000 616161. Care Homes for Adults (18-65 years) Page 9 of 33 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 33 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. In the main, people are provided with a standard of pre-admission assesment which makes sure the service can meet their needs. Evidence: In the AQAA, the manager said, A respite support assessment is completed before admission and support staff are encouraged to study these plans and contact guests, families, carers and other interested persons to determine any gaps in the information that need filling. This assessment plan can also be used to update Risk assessments and highlights key areas of interests/concerns. We have improved a considerable amount with respect to pre assessment and continuing assessment of a guests support needs. Staff are more involved in this process and the new format is a tool which allows us to update support information and peoples choices as they change. Care Homes for Adults (18-65 years) Page 11 of 33 Evidence: We looked at four peoples assessments that had been completed on the new documentation as mentioned above. The initial assessment is completed by parents or carers of people who use the service. For some people it was clear that the home have then added to this information or clarified where further details were needed. However, for some this had not happened. They were not signed by the homes staff and some details did not give clear directions for the care and support needed. For example, when asked to assess a persons moving and handling needs, the assessment information said, hoist. This is not enough information to make sure a persons needs can be met safely. Pre-admission assessments should be completed in detail for all people who use the service, to make sure the home has considered how they can meet peoples needs fully. Staff said they contact parents or carers prior to every respite stay and after the stay to see if there are any changes in needs or choices for people. They also said that medication and nutritional needs are re-assessed at every visit. We saw the documentation that parents or carers complete for this and in the main, it gave good information on peoples changing needs. The manager said that people are referred to the service from a variety of sources, including care management. She said they always try to obtain a care management assessment as part of their pre-admission assessment to make sure they can provide the service. Most people using the service on the day of the visit, had complex needs and were unable to use verbal communication. One person said they enjoyed their visits to Errol House, saying, Yes, its really good here. Others smiled and nodded when asked if they liked the service. Care Homes for Adults (18-65 years) Page 12 of 33 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. People are encouraged to make decisions about their lives and are involved in planning their care and support. However, gaps in care planning and risk management could lead to peoples needs being missed or overlooked. Evidence: In the AQAA, the manager said, We gather information from parents and carers and the guests themselves. our care and support plans allows us to update support information regularly from external sources such as parents, carers, support staff, care managers and health care professionals. Risk assessments are in line with the support plan and are updated and reviewed within the given time scale but also when new risks are identified or current risks are Care Homes for Adults (18-65 years) Page 13 of 33 Evidence: diminished and no longer need the same level of risk management Senior support workers have been appointed and they head 4 groups, who are responsible for staff as part of a key worker system. This has been up and running since last October and appears to be a consistent approach to ensuring guests have up to date support plans, risk assessments and reviews. In the AQAA, the manager also told us that a relative had returned a questionnaire to them saying, The staff are all very good with my daughter and i find it very good that if i give information about her to anyone it is followed up and carried out. We looked at care plan and risk assessment records for some people who live at the home. For some people, we could see that improvements had been made as mentioned in the AQAA information above. The plans and risk assessment information was person centred and had fairly clear and detailed instruction on how the needs of people who use the service are to be met. This was especially evident when parents or carers had provided very detailed information on care and support needs. However, for some people, the risk assessment and risk management plans could not be located and the manager and deputy manager could not account for their whereabouts. These people had clear risks around issues such as choking and self harm. Staff however, had very good knowledge on these risks and were able to say how they were managed. Risk management plans should be developed for all people who use the service based on the risks and needs identified in pre-admission assessments to make sure everyones needs are fully met. For some people, the assessment information is still being used as a plan of care. This information is not always detailed enough and care plans have not been drawn up from the information. This could lead to important care needs being missed or overlooked. Care plans should be developed from the pre- admission assessment information and should include full details of the care and support to be provided. The manager and deputy manager are aware of the gaps and omissions in the care plan and risk assessment information and have been working through them, supporting staff as mentioned in the AQAA information above. Despite these gaps in the documentation, staff had very good knowledge on peoples care needs and could speak confidently about the care they give. They had very good knowledge of peoples individual support needs and could describe peoples routines well. Staff also said they found the assessment and care plan information useful and would always ask for clarification if there wasnt enough information. Some staff Care Homes for Adults (18-65 years) Page 14 of 33 Evidence: acknowledged that there was not enough information at times but said there was always someone to ask. In the AQAA, the manager said, Guest meetings are held weekly and the Trust service user group meet regularly to discuss topical issues which are important to them. People are encouraged to make choices and decisions about what they do. Staff said they encourage people to make choices in their every day lives such as what to do, what to eat, what to wear and where to go out. We saw people being offerred choices throughout the visit. Staff also responded well to requests for anything from the people staying at the home. We saw people were supported to make choices, using a variety of communication methods such as pointing, signing, touch and facial expression. Staff showed they had a good understanding of how people communicate. Staff are currently working on a choices file, putting a library of picture images together for people to be able to choose activities and foods. Care Homes for Adults (18-65 years) Page 15 of 33 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 who use the service are able to make choices about their lifestyle. Social, educational, cultural and recreational activities meet peoples expectations. They also benefit from a good, healthy and varied diet. Evidence: In the AQAA, the manager said, Staff offer guests a choice of planned activities prior to their short break. They also ask the guests if there are any activities they specifically would like to do. All planned activities are optional; we do have themed days and would like to develop these into themed stays. We are involved with our local community and are invited to hold stalls at local fund-raising events, we attend local community events for example; coffee mornings held at the local church, pubs and local shops. Care Homes for Adults (18-65 years) Page 16 of 33 Evidence: Records showed that people experience a wide variety of activity during their stay at the home. Activities include, theme park visits, cinema, bowling, pub visits, meals out, ice skating, trips to the seaside and other places of interest. Activity such as crafts, baking, bird feeding and world food nights are also offerred and carried out within the home. The manager and staff have recently developed an activity plan that goes out to people who use the service at the booking stage so they can arrange their visits around activities or events they would be interested in. Events include the celebration of religious festivals such as Diwali and special transitions weeks to cater for the needs of younger people. The home now has two vehicles which gives greater flexibility for outings for people during their stay. In the AQAA, the manager said she is planning to improve the service, saying, We are planning an Errol House news letter which will give guests information on forthcoming events, staffing, activities, photographs, trust events and any other relevant information. We hope to incorporate a guest section for them to submit any snippets of news they may have. We have also asked them for their opinions on what they feel the news letter should contain. People who use the service said they enjoy their time at the home and that there is always something to do. One person said, We do good and interesting things, I have been looking forward to my stay. Staff said that they felt they had enough staff to support people with their activities. Also there was plenty of social interaction between the staff and people who use the service. It was clear that staff and people who use the service get on well. In the AQAA, the manager said, Prior to each visit a nutritional assessment form is completed to ensure that guests nutritional needs are continually reviewed and met We looked at menus at the home. These are planned around peoples likes and dislikes. Staff also make sure that any special dietary requirements such as vegetarian or soft diets are catered for. One person said they enjoyed the food and staff were good cooks. They also said they could help themselves to drinks and snacks whenever they wanted, just like at home. Menu records showed a wide variety of food is available. Care Homes for Adults (18-65 years) Page 17 of 33 Care Homes for Adults (18-65 years) Page 18 of 33 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. Overall, peoples general healthcare needs are well met and based upon their individual needs. Evidence: In the AQAA, the manager told us that a relative had returned a questionnaire to them saying, We are now retired and trying to get in as many holidays as our health allows us to- especially hoildays abroad. Knowing our daughter is in safe hands is a God send allowing us to meet up again batteries recharged. She also said, The support plans communicate how each individual service user would like to be supported with their personal care needs. For example, whether they like a bath or shower etc. They also detail the amount of support each person requires and what they can do for themselves. As mentioned in the Individual Needs and Choices section of this report, we found there were some gaps in the support plans and more detailed, specific care plans need Care Homes for Adults (18-65 years) Page 19 of 33 Evidence: to be developed to make sure the health and personal care needs of people who use the service are not missed or overlooked. However, staff had good knowledge of peoples personal support needs. Staff were thoughtful, discreet and respectful of peoples dignity when attending to any needs. People staying at the home looked well cared for and well groomed. Staff were clear on the need to respect peoples privacy and dignity. They also said it was important to maintain peoples independence. One said, Its about their pride and having a sense of achievement. The manager also told us in the AQAA of improvements planned for the service. She said, We have liaised with our service user involvement officer within our organisation and asked for support to develop a tool for people with complex communication barriers in order for them to choose how they would like to be supported with regards to their personal care needs. Staff said they have received good training in meeting the health needs of people who use the service. Training has included: nutritional needs, PEG feeding, moving and handling and pressure ulcer prevention. In the AQAA, the manager said, Most staff have attended accredited Medication Training and other training specific to the individual for example; the administration of Buccal Midazalom, Epilepsy Management and First Aid training. At our last inspection of the home, we asked them to make some improvements to the way medication was stored and administered. In the AQAA, the manager told us, Because we are short breaks provision guests bring in medications in original packaging with a signed consent form, all staff have accredited medication training and follow the policy and procedure for the administration of medication which is in place. All controlled drugs are stored in accordance with current regulation and guidance issued from the Royal Pharmaceutical Society. We record all controlled drugs in our controlled drug recording book. During the visit we observed staff checking medication into the home. It is always done by two staff to reduce the risk of errors occurring. This is good practice. We also checked some medication administration records (MAR) sheets and found them to be in good order. Care Homes for Adults (18-65 years) Page 20 of 33 Care Homes for Adults (18-65 years) Page 21 of 33 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 who use the service are able to express their concerns and in the main, are protected from abuse. Evidence: In the AQAA the manager said, We have a clear and effective complaints procedure in place which is available in a service user format. The staff team are aware of our complaints policy and procedure and implement the guidelines when necessary. The registered manager acts immediately on any concerns which are raised and encourage people to make a complaint, we explain that we feel the complaints procedure is not entirely negative as we can improve our service and the support we can give our guests. We looked at complaints records in the home and saw that complaints have been recorded and investigated properly. However, one complaint that had been made had a safeguarding element within it and this had not been reported as a safeguarding issue. The manager explained that the people involved had been satisfied with the outcome of their complaint and had not wanted to report it as a safeguarding matter. We reminded the manager that it is the local authoritities responsibility to investigate safeguarding and that this issue should have been reported to them to protect the interests of people using the service. Care Homes for Adults (18-65 years) Page 22 of 33 Evidence: There has been one other safeguarding issue within the home. This has been dealt with properly, with appropriate action being taken. In the AQAA, the manager said, All allegations of abuse are recorded in the abuse log book, all staff have POVA, POCA and CRB checks prior to starting their employment. Service user policy is in place in each service users bedroom on how to report abuse. All staff receives POVA and POCA training so they are aware of how to report abuse and how to recognise the signs for abuse. We also have policy and procedures in place for guidance on recording and reporting abuse as well as on whistleblowing. Records showed that staff have received training in safeguarding adults and children. They were able to say what action they would take if they suspected abuse or had an allegation of abuse made to them. They were also able to describe the different types of abuse. They were familiar with the whistle blowing procedure and said they would have no hesitation in using it if they thought they needed to raise concerns outside of the home or organisation. People who use the service said they would speak to staff if they were unhappy about anything. They also showed us the information file which is kept in each bedroom which tells them how to make a compaint. Records are kept of the finances of people who live at the home and their monies are kept safe. Care Homes for Adults (18-65 years) Page 23 of 33 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 for people who live at the home. Evidence: In the AQAA, the manager said We are wheelchair accessible both to the front and rear of the building as well as inside the property. We have monthly health and safety checks which are carried out by a variety of staff and members of management. We report damages and faults so that they can be repaired. Specialist equipment such as hoists, parker baths, profile beds and shower trolley are regularly serviced. Utilities such as boiler, gas, electricity, fire/smoke alarm, emergency lighting are regularly serviced, risk assessments are in place. The home is clean and hygienic, service users are encouraged to bring in their own personal belongings (slings). Errol House is decorated to a high standard, all bedrooms have recommended hand drying facilities. In the AQAA the manager also told us how the environment in the home had been improved. She said, Several communal areas within the house have been redecorated, a new kitchen has been installed. We have had a new dishwasher, industral washing machine and a parker bath. A new shower trolley has also been purchased. A tour of the home was carried out. Communal areas, bathrooms and bedrooms were Care Homes for Adults (18-65 years) Page 24 of 33 Evidence: visited. The home looked clean, homely and well maintained. People who use the service said, Its lovely and clean here Its nice and warm. We also looked at the gardens which are attractive and well set out. There is a large summer house in the garden that has been equipped with sensory equipment. The manager said this is well used in the summer months. The manager also told usd they are having a ramp built so that people who use wheelchairs can access it. Clinical waste is properly managed. Staff have received training in infection control as part of their induction and were able to say what other infection control measures are in place. Hand washing and hand drying facilities were available in all areas of the home. Liquid soap or paper towels were available. This ensures good hygiene practice. Care Homes for Adults (18-65 years) Page 25 of 33 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. Staff are trained skilled and in sufficient numbers to support people who use the service. Evidence: In a recent questionnaire sent out by the home to families and carers of people who use the service, people spoke highly of the staff. Their comments included: Complete confidence and trust in all the staff All the staff are very helpful and caring and gives you peace of mind when you walk away to leave my daughter in your care Staff are very helpful at all times and always aware of my sons special needs In the AQAA, the manager said, In a recent quality questionnaire we conducted, 100 of the people who responded said that the staff were polite and friendly and knew the support needs of their family member. A person using the service said, The staff are nice, good fun and you get what you ask for. We looked at rotas and they showed that there are sufficient staff and that they work Care Homes for Adults (18-65 years) Page 26 of 33 Evidence: flexibly to meet the needs of the people who use the service. In the AQAA, the manager said, We ensure that there are enough staff on duty to support the guests who are staying. 1 to 1 support staffing is in place where it is a requirement of their individual support. Staff said they had enough staff to meet peoples needs well. We looked at the recruitment records that are kept in the home. These take the form of a pro-forma showing that all the required recruitment checks have been carried out. This is then signed by the organisations human resources personnel and the homes manager. These showed that recruitment is in the main, properly managed by the home; interviews are held and CRB (Criminal Record Bureau) checks are obtained before staff start work and checks are made to make sure staff are eligible for work. However, the three pro-formas we looked at had not been fully completed. They did not say if references had been taken up for staff. The manager and area manager said they had been and it was an administrative error in that the pro-forma had not been completed fully and they would correct this. Induction training is based on the Skills for Care common induction standards. Staff said their induction had been good and prepared them well for their job. In the AQAA, the manager said, All staff have a thorough in house induction as well as all mandatory training such as LDQ, manual handling, first aid, fire, food hygiene, infection control, medication, POVA, POCA, epilepsy management and specialist training to support individual service users For example, Makaton, Autism, Intensive interaction, dementia, gastrostomy and supporting people to eat and drink . The option of NVQ 2 and NVQ 3CCYP are also available. We looked at training records and these showed that most staffs training was up to date or if updates were needed, they were planned. The manager has developed a training plan which clearly shows who has done what training and when their updates are due. Staff said they received good training. There is a commitment from the organisation for staff to complete their NVQ (National Vocational Qualification) in level 2 or above. Over half of the staff team have now achieved an NVQ in level 2 or above. This means they are qualified to carry out their job. At our last inspection of the service we said that 80 of the staff team must have or be working towards NVQ 3 in Caring for Children and Young People as the home provides a service for people aged 16-17. The manager said they continue to work towards this but have had difficulties as staff who gained the qualification have then Care Homes for Adults (18-65 years) Page 27 of 33 Evidence: left the service. We looked at staffs supervision records and saw that regular one to one sessions are provided for staff to discuss their roles. Staff said they were happy with the support they get. Care Homes for Adults (18-65 years) Page 28 of 33 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 home is well managed, the interests of the people who use the service are seen as important to the manager and staff and are properly safeguarded overall. Evidence: In the AQAA, the manager said, The registered Manager has an RMA and has completed her NVQ 4 in health and social care. She also has an impressive portfolio of training courses and vast experience in the field of care. The support,safety,health and welfare of the guests are paramount to the manager. The registered Manager is now a member of The Leeds Learning Disability Partnership Board which she attends on a monthly basis , this keeps her up to date on current topical issues which matter to people with learning disabilities and she is able to cascade this information to the rest of the organisation. When asked what the service does well, the manager said, Errol House has a friendly relaxed and welcoming atmosphere, which offers a flexable short breaks service to Care Homes for Adults (18-65 years) Page 29 of 33 Evidence: guests with the emphasis on promoting independence and offering choice. With an aim to create short breaks as a meaningful experience. Staff have a good knowlegde of guests needs, treat them as individuals, offer choices, are flexible and approachable. Staff spoke highly of the support and leadership they get from the manager. Their comments included: We get very good management support Never feel on your own, someone always there for you Fantastic communication from manager and deputy They are really supportive. Records we looked at showed that regular health and safety checks are carried out. In the AQAA the manager said relevant health and safety policies and procedures were in place, and reviewed. She also said equipment has been serviced or tested as recommended by the manufacturer or regulatory body. Records showed that certificates on gas and electrical safety were up to date. The organisation provides a comprehensive manual of policies and procedures for staff to refer to. We looked at accident reporting and spoke to staff about this. Staff were clear on their responsibilites and how to report and record accidents or incidents. We also looked at environmental risk assessments. The organisations area manager conducts monthly provider reports with requirements for improvement. The organisation also sends out annual questionnaires to people who use the service and their families or carers. This makes sure they are always looking at ways the service can be improved. The manager receives regular supervision from the area manager to support her in her role. Care Homes for Adults (18-65 years) Page 30 of 33 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 31 of 33 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 23 13 Safeguarding referrals must be made to the local authority for any incidents where peoples safety or welfare has been placed at risk. This will make sure people are properly protected. 30/04/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 2 Pre-admission assessments should be completed in detail for all people who use the service, to make sure the home has considered how they can meet peoples needs fully. Care plans should continue to be developed from the preadmission assessment information and should include full details of the care and support to be provided. This will make sure that peoples needs are not missed or overlooked. Risk management plans should continue to be fully developed for all people who use the service based on the risks and needs identified in pre-admission assessments to make sure everyones needs are fully met. Page 32 of 33 2 6 3 9 Care Homes for Adults (18-65 years) Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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. 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