Care Home: Essex Park 49

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What the care home does well The care home has a very welcoming atmosphere. Residents live in a homely environment with quality furnishings, and decoration that is attractive, and meets the needs of people using the service. A person using the service told us that he/she enjoyed living in the home, going out shopping, spending time in the garden, and liked their bedroom. People using the service are supported to have the contact that they wish with relatives and friends. The feedback that we received from relatives of people using the service were positive. Staff feedback from surveys and from speaking to them during the inspection, were positive with regard to their experience of working in the home. They told us that there is good communication between staff and that they work well in a team. Comments included `we look after the service users nicely` and `we do our best to support residents to enable them to live a fulfilling life`. Staff receive varied and appropriate training to ensure that they are skilled in carrying out their roles and responsibilities. Observation, and talking to to staff indicated that staff were aware of each resident`s needs, and how these needs are to be met by the home. Interaction between staff, and residents was positive and respectful. Staff told us that they know the residents well, and understand their needs, (including their communication, and diversity needs), and that they work hard to ensure that the people using the service lead a quality happy life. The manager is experienced, competent and very motivated in ensuring that the service continues to develop and improve, and people using the service (despite having significant needs, including communication needs) are empowered and supported to live the life that they choose as independently as possible, and a quality service is provided to them all. The Annual Quality assurance (AQAA) was fully completed, and gave us the information about the home and the service that it provides to people. There is close liaison with health care professionals, and other specialists as and when required by the residents. All the residents have a key worker who support them in many aspects of their lives. Meals are varied and wholesome, and meet each person`s cultural, religious and specialist dietary needs and preferences. What has improved since the last inspection? The home has now improved from being an adequate service (1*) to a good (2*) rated service. The four requirements with regard to improving the resident`s care plans, and several maintenance issues from the previous inspection (30/09/09) were judged to have been addressed by the service. It was noted that the care plans had been significantly developed and improved, are up to date and record details of resident`s individual needs and guidance of how these needs are met by staff. We were told that residents (and their relatives/representatives) are more involved in the development and review of the care plans of people using the service. We were told that maintenance issues in the home have been addressed or in the process of being completed. It was evident from visiting the home, talking to staff, residents and records that since the last inspection, staff have worked hard to put in place significant improvements to the service provided to people by Essex Park. Several areas of the home have been redecorated and new furnishings, and furniture, have been bought to ensure that the home is an attractive and suitable environment for people living in Essex Park. What the care home could do better: There could be improvement to the format of information relevant, and of interest to people using the service, such as the menu, and service user guide to ensure that it is as accessible as possible to residents who have significant communication needs, have difficulty in reading, and in understanding information. There needs to be an accessible document for recording complaints/concerns. The home needs to ensure that it continues to carry out regular fire drills with staff and residents (depending on their needs) at various times of the day and/or night to ensure that all staff have knowledge and understanding of fire safety. The temperatures of the fridge and freezer need to be monitored, to ensure that food items are stored safely. Key inspection report Care homes for adults (18-65 years) Name: Address: Essex Park 49 Essex Park 49 Finchley London N3 1ND     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Judith Brindle     Date: 0 4 0 5 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: Essex Park 49 Essex Park 49 Finchley London N3 1ND 02083463860 02083463860 essexpk@walsingham.com www.walsingham.com Walsingham Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Sally Jane Green Type of registration: Number of places registered: care home 6 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: Date of last inspection Brief description of the care home Essex Park is a home for six adults of either gender who have learning disabilities. The home is owned and managed by Walsingham, an organisation that provides special needs housing in other parts of the U.K. The home is a detached, two storey building, located in a pleasant residential area of Finchley in North London. It is close to shops and many other amenities. The residents bedrooms are located on the ground and first floor. The communal lounge, dining rooms and kitchen are located on the ground floor. There is a large attractive garden at the rear of the property which is accessible to all residents. Information about the home and the fees are available from the home by contacting the provider. The fees vary depending on the assessed needs of the person using the service. 6 Over 65 0 Care Homes for Adults (18-65 years) Page 4 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: 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 unannounced inspection took place throughout a day in may 2010.The previous key unannounced inspection took place on the 30th September 2010. There was one vacancy at the time of the inspection. We were pleased to meet the people living in the home. The manager was present during most of the inspection. A number of feedback surveys were supplied to the care home prior to the inspection. At the time of writing this the Care Quality Commission had received two surveys from people using the service, two from relatives of residents, and three surveys from staff. Documentation we looked at included residents care plans, risk assessments, staff training records, and some policies and procedures. The inspection included a tour of the premises. Observation was an important tool used in the inspection process, due to the varied and significant communication needs of the of the people using the service. Assessment as to whether the requirements, and the recommendations from the previous key inspection had been met, also took place Care Homes for Adults (18-65 years) Page 5 of 31 during this key unannounced inspection. 26 National Minimum Standards for Adults including Key Standards, were inspected during this inspection. We also looked at a completed an Annual Quality assurance (AQAA) document, which had been completed by the manager. This record includes required information from the manager (and/or owner) about the quality of the service provided by the care home, and, and of any planned improvements. This document had been completed comprehensively. Reference to some aspects of this AQAA record is documented in this report. We thank the people living in the care home, staff the manager, and deputy manager for their significant assistance in the inspection process. Care Homes for Adults (18-65 years) Page 6 of 31 What the care home does well: What has improved since the last inspection? The home has now improved from being an adequate service (1*) to a good (2*) rated service. The four requirements with regard to improving the residents care plans, and several Care Homes for Adults (18-65 years) Page 7 of 31 maintenance issues from the previous inspection (30/09/09) were judged to have been addressed by the service. It was noted that the care plans had been significantly developed and improved, are up to date and record details of residents individual needs and guidance of how these needs are met by staff. We were told that residents (and their relatives/representatives) are more involved in the development and review of the care plans of people using the service. We were told that maintenance issues in the home have been addressed or in the process of being completed. It was evident from visiting the home, talking to staff, residents and records that since the last inspection, staff have worked hard to put in place significant improvements to the service provided to people by Essex Park. Several areas of the home have been redecorated and new furnishings, and furniture, have been bought to ensure that the home is an attractive and suitable environment for people living in Essex Park. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who may use the service have the information they need to choose a home that will meet their needs. Prospective residents have their needs assessed, with their participation (or family member/friend), prior to moving into the care home, which makes certain that the home knows about the person, and the support that they need. Evidence: The home has up to date recorded information about the service. This includes a combined statement of purpose, and service user guide that is in pictorial and written format. The manager told us that he is planning to review this document, and will be looking at further developing the format to improve the accessibility of information that is of significance or interest to people using the service, most of whom have communication needs. This is positive. Feedback from relatives of people using the service told us that they and their relative/friend (person using the service) gets enough information about the service to help them make decisions. We were told that the home has an admission policy/procedure. There was one Care Homes for Adults (18-65 years) Page 10 of 31 Evidence: vacancy at the time of this key inspection. We were informed that a comprehensive initial assessment of prospective residents needs would always be carried out by a competent person, (usually the manager, and/or deputy manager), with the person and their relatives, and that this would form the basis of the persons plan of care and support. It was evident from the two care plans that we looked at that people using the service have received a comprehensive assessment (including; health, personal care, emotional, and equality and diversity needs. The AQAA told us that service users are invited for day visits and over night stays and weekend visits and that the process of moving in depends on the individuals needs and preferences. We were also told that there is a review period and review meetings will take place to establish suitability. 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. People using the service have an individual plan of their needs, which includes details of the care and support that they require from staff. People using the service are supported, and encouraged to make decisions and choices about their lives, and are supported to take risks as part of an independent lifestyle. Evidence: Each person using the service has a plan of care. Two care plans and a support plan were looked at. These care plans are based upon assessment of each persons individual needs. This assessment includes; communication, personal safety, mobility, eating and drinking, personal care, religion, health, sleeping, expressing sexuality, and financial needs. Each identified need included significant detailed guidance with regard to meeting the persons goals/needs and aspirations. It was evident from talking to the deputy manager and manager that the home has worked hard to improve and develop the residents care plans since the previous key inspection in 2009. The information in the care plans is easily accessible to staff, and include details of the Care Homes for Adults (18-65 years) Page 12 of 31 Evidence: background of the person using the service. The care plans indicated that the resident had been involved (as fully as possible with regard to their needs) in their care plan, development and review. Management staff told us that there was presently on-going work to improve the care plans. We were shown a residents My Support Plan. This was a more person centred care plan (when a resident is central to their plan of care and takes a lead in its development), and included information in more full detail, about how the person using the service wanted each of their needs met, and what and who was important in their lives. For example this included information about how the person liked support; with washing, how they liked their hair done, and nails cared for etc, as well as how they wanted their health needs, religious, communication, emotional and lifestyle needs met. We were told that presently one My Support Plan had been completed, and that the others would be completed by the resident and key worker in the near future. This is positive. The manager spoke with us of the challenges (due to the significant communication needs and abilities of people using the service) that the home has in ensuring that people using the service receive information about their care and the service, in a way that is accessible to them. As well as being supported in being involved as fully as possible in their plan of care and support, to ensure that they lead the quality life in the way that they wish. The AQAA told us that for individuals that are unable to express their voice as a result of complex communication needs they would have the opportunity to have an independent advocate. We were also told that the management will put in place support for the service users to voice there views. A previous requirement with regard to the care plans needing to be updated to ensure that they are current and appropriate to meet residents needs was judged to have been met by Essex Park. Records and staff told us that care plans are regularly reviewed with each resident. We were told that each person using the service has a key worker. We were told that this role was in the process of being developed, so that key workers are more fully involved in all aspects of residents lives. The AQAA told us that the home understood the varied cultural and religious needs of people using the service. Records confirmed that risks are assessed, and that each person using the service has a number of up to date risk assessments that meet their individual needs. These risk assessments include, bathing, travel, community activity, kitchen, mobility, eating and drinking, fire, and behaviour risk assessments. These included significant detail about the way these risks are minimised and reviewed. Residents have their weight monitored. Care Homes for Adults (18-65 years) Page 13 of 31 Evidence: Staff were seen to interact with people using the service in a positive and respectful manner during the inspection. Residents were supported to make decisions, and choices. It was evident from records and from talking to staff that staff have a good understanding of the various communication needs of residents. The care plans indicated that people using the service made decisions about their lives, such as when they wished to go to bed, what they wished to wear etc. We were told that residents had had an opportunity to participate in a residents meeting, but they had indicated that they were not interested in attending it. The deputy manager told us that the home had focused on one to one monthly key worker meetings with residents instead, but that the home would be re-looking at again introducing resident meetings in possibly another format in the near future. Feedback from staff surveys told us that they are given up to date information about the needs of the people that they support and care for. A comment from a staff feedback survey told us that the staff do their best to support residents to enable them to live a fulfilling life, at Essex Park. Comments in a feedback surveys from relatives of residents told us that their relative is looked after well by staff, and the home does well by supporting my (relative) in meeting her needs. We spoke with the residents, (some of whom communicated with gestures, sounds and some words), and they indicated that they were happy living in the home. The people using the service had evident signs of well being. They approached staff without hesitation and seemed to be relaxed and happy. A resident spoke to us at length and told us that she/he enjoyed living in the home, and that the staff were nice. She/he spoke of making choices. These include shopping for clothes, toiletries, and choosing activities that she liked. The care home has a management of residents monies policy/procedure. We were told that since the previous inspection, and an incident were some money from a resident went missing (we were told that the money was replaced), the systems for the management of residents monies have been reviewed, and are presently much more robust. We were told that all the people using the service each have their own bank account, and have support with managing their finances. The care plans that we looked at included an individual financial assessment, and details of how to meet the persons financial needs. We noted that records of each persons expenditure is maintained. The deputy manager informed us that records of incoming monies and expenditure are monitored closely. The AQAA told us that there were plans to ensure that there was more involvement by residents with regard to the management of their finances. 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 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, and are supported to develop their life skills, and to take part in a variety of activities that meet their individual needs. The people living in the care home have their rights respected, and their responsibilities are recognised in their daily lives. Meals are varied, and wholesome, and meet the cultural and religious needs of people using the service. The menu information could be more accessible to residents. Evidence: The home is located within walking distance or a short drive to a variety of community facilities and amenities, which include shops, cafes, banks and parks. There are also bus and underground train services near to the home. The manager told us that some residents access community public transport services as well as dial a ride and taxis. We were informed that the home is in the process of purchasing a house vehicle, so Care Homes for Adults (18-65 years) Page 15 of 31 Evidence: that residents will have the opportunity to access a variety of community services more easily, and be more involved in the running of the home, such as doing house food shopping. This is positive. The manager told us that he was in the process of looking into accessing more opportunities for residents to access leisure pursuits, and local activities during the evening and at weekends. During the key inspection each resident participated in a number of activities, including attending resource centres, college, shopping, going out for a walk and watching television as well as participating in a number of everyday living skills. Two residents who had been out shopping with a staff member, kindly showed us their purchases. It was evident from their mood, and excitement that they had enjoyed their shopping trip. We were told that residents had been on holiday recently, which was an activity that they had not had the opportunity to do for sometime. We saw holiday photographs in the dining room, of residents participating in outdoor activities including rock climbing and sailing. We were told of other activities that residents took part in. These included having the opportunity to go to church. Staff informed us that residents lead busy lives, and that accessing more community based activities was a goal of the home. A resident spoke of the various activities that she/he enjoyed. it was noted that during a key worker/resident meeting a resident had communicated that she/he would like to go to the cinema. This goal was not recorded in that section of the care plan, so it was unclear as to how it would be ensured that this wish was met by the home. This and the issue of care plans being a working tool was discussed with the manager. Feedback from surveys completed (with support from staff) by residents told us that they can do what they want at the weekend, and during the day. We were told by management staff that residents are supported in maintaining and developing contact with friends and family as appropriate to them. The visitors book indicated that family members visited the home. We were told that relatives/friends of residents are invited to parties held in the home. Feedback from relatives of people using the service included comments; the house is always clean and well decorated, my (relative) goes on holidays, walks, and outings, my relative enjoys celebrations and social gatherings, is looked after well by carers and staff, and the home does well by supporting my (relative) in her needs. The home has a four week menu, which we were told by staff was flexible and meets the varied needs and preferences of the residents. The deputy manager told us that the menu had been developed from staff asking residents what they liked, and from previous knowledge of the particular food likes and dislikes of the people using the service. The menu is in written format. The home could consider displaying in picture or photograph format each meal. This could improve the accessibility of the Care Homes for Adults (18-65 years) Page 16 of 31 Evidence: information to residents who have difficulty in reading or understanding the written word. Staff told us about the ways that they know the residents (who cannot verbally communicate their food likes and dislikes) food preferences and needs, and how they can tell when these residents do not like some kind of food. We were told that the menu is flexible, the ingredients fresh, and there is always a choice of meal offered to people. Food eaten by residents was not always recorded. The home should ensure that meals eaten by people using the service are recorded this provides evidence that residents dietary needs and preferences are being met by the home, and it can also be significant record if the home ever has to look into an issue such as a resident having a stomach upset etc. Fresh fruit was available in the dining room. People using the service indicated that they enjoyed the breakfast and the lunch that was provided during the inspection. Meals during the inspection were unhurried and drinks were offered regularly to people using the service. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care that people receive is based on their individual needs, and the principles of respect, dignity, and privacy are put into practice. Systems are in place to ensure that medication is stored, and administered safely to people using the service Evidence: It was evident from talking with staff, and from looking at records that staff have knowledge, and understanding of the importance of ensuring that the residents have their health care needs assessed and met. Treatment and care for residents from health care professionals including the GP, and optician, and hospital appointments were recorded. The manager told us that residents all have access to a local dentist, and chiropodist. Each resident has a health action plan. We looked at one. The plan included significant information about the persons health, and how their health needs were met by the home. It also included a summary of information about the persons health, which they could take with them if the person using the service is ever admitted to hospital. The health action plans we looked at are comprehensive, and included detailed up to date guidance about how to meet peoples individual health needs. Care Homes for Adults (18-65 years) Page 18 of 31 Evidence: The personal care needs of each person, and guidance to meet these needs were clearly recorded in the care plans and support plan that we looked at. Staff told us that residents preferences with regard to meeting their personal care needs are listened to, and residents choose what to wear. This was evident during the inspection when a resident, following returning from a shopping trip chose to change back into his/her pyjamas. The home has a medication policy. We were informed that in response to some medication errors that had happened in the home in 2009, the procedures for managing and administering medication had been reviewed and that there were now robust medication processes followed by all staff. We were told that these are monitored closely by management staff. Staff informed us that all the people using the service require support with taking their prescribed medication. We noted that each person has their medication stored securely in a locked medication cabinet in their bedroom. Medication administration records were up to date. We were told that a pharmacist is available for medication support and advice, and checks the medication storage, and administration systems in the care home. The manager told us that all staff receive comprehensive medication training when they start their job, and that prior to staff administering medication to people using the service, they receive an in house medication assessment in the working environment, to ensure that they are competent to carry out the task. We were also informed that all staff receive regular refresher medication training. Two staff carry out the administration of medication to people using the service. 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 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, have access to an effective, robust complaints procedure, and are protected from abuse, and have their rights protected Evidence: We were informed that the home has a complaints procedure. We saw a summary of this in the service user guide. This was in picture and written format. The AQAA told us that there were plans to have the complaints procedure in audio format and we were told that the home always welcomes views and suggestions, and that it aims to have an open and friendly style so service users always feel they are able to approach (staff) to make themselves heard. We were also told that service users have the opportunity to make (their) views heard on a Ad-hoc basis and day to day basis. The AQAA and staff informed us that although residents have communication needs, they generally have understanding of what is said, and are able to make themselves understood, and staff ensure that they are listened to and acted upon. Feedback from relatives of people using the service told us that they knew how to make a complaint, if they need to, about the care provided by Essex Park. Staff told us that they know what to do is someone has concerns about the home. Staff were unable to locate a complaints recording book. The manager and deputy manager told us that this would be put in place promptly. Following the inspection the manager told us that there had been no complaints. During the inspection we discussed with the manager the issue of ensuring that it is evident that residents who communicate any concerns about the service, and other issues, are listened to, and that concerns be managed in Care Homes for Adults (18-65 years) Page 20 of 31 Evidence: the same way as a significant complaint. The manager spoke of developing the systems in place with regard to responding to complaints and concerns. The AQAA told us that the home could ensure that the complaints procedure is discussed with the service users on a regular basis and that they are informed of how to access the procedure and to use it. We were told that the home has clear and robust policies and procedures with regard to the protection of people using the service. These include whistle blowing, counter bullying, staff code of conduct and safeguarding procedures. During the inspection, we were informed that the safeguarding procedure was accessible from a computer file. The home should have a easily accessible paper safeguarding procedure document that staff can look at, when the computer is down or when they do not have access to Essex Parks computer. Following the key inspection the manager provided us with an up to date safeguarding adults procedure. A staff member told us that safeguarding adults training is included in the staff induction programme. Staff who spoke to us knew how to respond to a suspicion or allegation of abuse. Records told us that staff had received safeguarding adults training. The manager confirmed that staff had understanding of the Mental Capacity Act 2005 and deprivation of liberty safeguards. Contacting the lead Local Authority with regard to consulting/liaison with them about possible individual assessment of deprivation of liberty safeguards was discussed with the manager. The AQAA told us that the home plans to ensure staff are fully trained in deprivation of liberty safeguards. Care plans include the area of staff guidance, and risk assessment in areas such as finance, as well as in regard to meeting the needs of service users who might challenge the service. 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. The layout of the home enables residents to live in a clean, safe, well maintained, and comfortable environment, which supports and encourages their independence. Residents bedrooms, meet their individual needs, and are individually personalised. Evidence: The inspection included a tour of the premises. The forecourt of the home is attractive, and tidy. We were told that since the previous inspection there had been significant improvements made to the decor of the home. These have included a new stair carpet, the replacement of flooring in several rooms including the dining area and lounge, new curtains in several rooms, and most furniture in the communal areas being replaced. We were told that a resident was having some new bedroom furniture. We saw the boxes containing it. Communal rooms have been repainted. The deputy manager told us that residents chose the colour scheme and wallpaper from looking in catalogues and visiting DIY retail shops. The home is well maintained, and is very clean, light, airy and homely. The manager told us that there were still some minor maintenance issues needing to be carried out, and he had ensured that a maintenance person would be coming to the home to fix these items during the week following this inspection. The maintenance requirements from the previous inspection were judged to have been met. The decor is bright and attractive. It was evident that significant attention had been made to ensure that the environment was attractive as possible for Care Homes for Adults (18-65 years) Page 22 of 31 Evidence: people using the service. Homely items including houseplants, photographs, music system, and a communal television are located in the home. Feedback from people using the service told us that the home is always fresh and clean. The home has an enclosed garden, which is well maintained. We were told that the garden is regularly used in the good weather by residents. A resident told us that she liked the flowers in the garden. We noted that garden furniture is accessible to people using the service and their visitors. Two people using the service kindly showed us their bedrooms. The bedrooms were individually personalised, with items that included their own television, music player, photographs and furniture. This residents told (or indicated) us that they were happy with their bedroom. The manager told us that all the residents bedrooms were individually decorated and personalised, and that any resident who is newly admitted to the home can choose the decor of their bedroom. The laundry facilities are located away from food storage, and food preparation areas. Disposable gloves were seen to be accessible to staff and to others. Residents were observed to help with putting clean laundry away. We were told by staff and from records that staff receive 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff in the home are trained, skilled and are in sufficient numbers to support the people using the service, and to support the smooth running of the service. People using the service are supported and protected by the care homes recruitment policy and procedure. Evidence: The staff rota was accessible. This told us that there are generally three staff working the morning shift, two in the evening, and one awake at night. In addition there may be the manager and/or the deputy manager on duty. We were told that there were sufficient staff on duty at all times to ensure that the varied needs of people using the service are met. The manager told us that since the previous inspection less agency staff are used, and that when they are needed, the home makes sure that if possible the agency staff know the home, and residents well so that there is always consistency of care for residents. We were told by management staff that staff meetings take place regularly. Staff spoke of knowing the residents well, and of working as a team in the home. Staff follow a daily shift planner with regard to their duties. Staff commented in feedback surveys that they look after the service users nicely and staff do their best to support residents to enable them to live a fulfilling life. Care Homes for Adults (18-65 years) Page 24 of 31 Evidence: The AQAA told us that all new employees undertake the Learning Disability Qualification level 2 as part of their induction. Records told us that staff have the opportunity to receive varied and appropriate training with regard to their roles and responsibilities. We were told that staff attend several training days (including refresher training) each year. The manager told us that most of the training, is carried out by Walsingham, and some training (ie further safeguarding training) is accessed locally from the Local authority. A staff member spoke of having attended varied training relevant to their role and responsibilities. Staff training records, confirmed that the training that staff have attended included health and safety, infection control, 1st Aid, moving and handling, fire safety, safeguarding adults, medication, risk assessment, and safe food handling training, and a variety of specialist training including epilepsy, disability equality, and management development. The deputy manager told us that staff had recently received epilepsy training. Staff feedback surveys informed us that they received good training, a comment included I am pleased with the training. The AQAA informed us that 2 members of the team is National Vocational Qualification(NVQ) level 2 qualified and that 7 members of staff are NVQ level3 qualified. Records, and staff told us that staff receive regular 1-1 staff supervision, and appraisal, to ensure that staff are supported in their role. Staff meetings also take place. Comments from staff feedback surveys told us that staff have regular supervision. A resident confirmed that he/she liked the staff and that they are approachable. The feedback from the two surveys completed (with support from staff) by people using the service told us that staff treat them well, and listen and act on what they say. Three staff personnel records were looked at. These confirmed that appropriate required checks including an enhanced Criminal Record Bureau check (a check to gain information as to whether a person has a criminal record) was carried out. Feedback from staff surveys told us that when they started their job at Essex Park the home carried out checks, such as CRB, and references, before they started work. We were also told that each staff member receives a job description when they start working in the home. The manager and deputy manager told us of the progress being made to ensure that residents are more involved in the process of recruiting staff. We were informed that residents spend time with staff candidates when they visit the home, and that Walsingham run courses for people using the service in interviewing techniques. 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 good 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, has effective quality assurance systems, which ensures that a quality service is provided to people using the service. So far as reasonably practicable the health, safety and welfare of people using the service is promoted and protected. Fire drills need to be carried out at regular intervals. Evidence: The manager told us that he had only been managing the care home for a month, and prior to that he was managed another service in the organisation. He told us that he is waiting to be enrolled in an NVQ level 4 in June 2010 and has has recently completed LMC level 4 award. The AQAA informed us that the manager is experienced in both residential and supporting living delivery models and that the manager enjoys managing people and ensures that his high value base is passed on to the team. The AQAA and management staff told us that there are plans to recruit a new team and management for Essex Park, and that existing staff will be supported to improve their performance to ensure the service users have the quality of life and Care Homes for Adults (18-65 years) Page 26 of 31 Evidence: enhanced independence that they deserve. The manager informed us that a new deputy manager had been appointed and would be replacing the present seconded deputy for the home. The AQAA told us that there is a homes business plan which works with the individuals goals aims and ambitions and that of the staff team. Records and the AQAA told us that the quality of the service is monitored closely. Records are up to date, health and safety checks are carried out. Policies and procedures had been reviewed in 2008. Following the key inspection the manager supplied us with documentation that told us that required monthly checks of the service had been carried out by a representative of the owner. The manager spoke of the telephone and email contact the he and other staff have with the relatives/friends of people using the service. It was noted that staff had signed as read some health and safety policies. The home has an up to date fire risk assessment, and regular required fire safety checks are carried out. Residents care plans included individual assessment with regard to managing each person in the event of a fire. According to records there had not been a fire drill since May 2009. This was discussed with the manager, who told us that a fire drill will be carried out as soon as possible. Following the inspection the manager told us that a fire drill had been carried out and that a further one had been planned to take place during the night shift. Records told us that temperatures of food which is cooked, reheated, and served are monitored as required. Up to date fridge/freezer records could not be located during the inspection. Accidents and incidents are recorded, and appropriate action taken in response to them. The employers liability insurance was seen to be up to date. Care Homes for Adults (18-65 years) Page 27 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 28 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 22 22 There needs to evidence that there is complaints record book. To ensure that it is evident that people who complain are listened to and that appropriate action is taken to resolve their complaint and/or concern. 01/08/2010 2 42 13 The temperature of the homes fridge and freezer needs to be monitored. To ensure that food is stored safely. 13/06/2010 3 42 23 The home must make 12/06/2010 arrangements to ensure that fire drills and practices are carried out at suitable intervals. To ensure that persons working in the home, and so far as practicable, residents are aware of the procedure to be followed in case of fire. Care Homes for Adults (18-65 years) Page 29 of 31 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 17 The home could consider displaying in picture or photograph format details of each meal. This could improve the accessibility of the information to residents who have difficulty in reading or understanding the written word. The home should ensure that meals eaten by people using the service are recorded. This provides evidence that residents dietary needs and preferences are being met by the home, and it can also be significant record if the home ever has to look into an issue such as a resident having a stomach upset etc. The home should have a easily accessible paper safeguarding procedure document that staff can look at when the computer is down or when they do not have access to Essex Parks computer. 2 17 3 23 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. © 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. 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