Care Home: Esther Care Home Ltd

What the care home does well All the written and verbal feedback received from the people who use the service, their relatives, professional representatives and staff who work there was extremely complimentary and positive. Typical comments included, all `the staff are great`, ` I like my key worker`, `we`ve been very impressed with the attitude of all the staff who work`, `staff are very good at promoting our `clients` independence`, and `the whole place looks and feels more homely since the it was redecorated - we especially like the new look games room and kitchen facilities.` All the staff on duty during this visit, which included a new member of staff and the manager, were all observed taking there time to listen too and act upon what the people who use the service said. E.g. Service users who asked to phone a relative, go to the park, have a cup of tea, watch a film, and help prepare the evening meal were all actively encouraged and supported by staff to do so. Staff were also seen encouraging people to do as much for themselves as they were doing and this was always done in a very kind, respectful and professional manner. It was clear from all the practises observed that staff are familiar with the needs, wishes, and preferences of all the people who use the service and are able to communicate with them freely using individuals preferred method of verbal and non-verbal communication. The atmosphere in the home remained extremely friendly and relaxed throughout the course of this afternoon and early evening site visit. What has improved since the last inspection? The owner/manager has made a number of significant improvements to the home in the past year and has addressed all the outstanding requirements and good practise recommendations made in the homes last inspection report. Firstly, people who use the service have far greater opportunities to attend more interesting and stimulating community-based activities, especially in the evenings and at weekends. The newly redecorated games room has also been supplied with a new table football and various art materials and resources. As recommended in the services last report the manager has significantly improved the interior by: fitting new wooden flooring and carpeting in all the communal areas; installing new units, work-surfaces, oven and fridge in the kitchen; fitting a new bath suite and shower seat in the first floor bathroom; decorating a bedroom and all the communal areas; and suppling the lounge and entrance hall with all manner of ornaments, pictures, and house plants. All the homes staff now receive a minimum level of initial and refresher training that they need to perform their duties, which includes safeguarding vulnerable adults, fire safety, basic food hygiene, moving and handling, infection control, safe medication handling, person centred care planning and dementia training. The recommendation we made that manager should increase the number of supervision sessions her staff receive each year has also been implemented. As a result of all the aforementioned improvements to staff training and supervision the people who use the service can be sure they will be supported by suitably qualified and competent staff who have theright knowledge and skills to meet their individual needs and wishes. In addition to addressing all these staffing requirements and recommendations the manager has also recruited a number of new highly motivated, suitably qualified and experienced staff in the past year who she is able to share the responsibility of running the home with. The manager now ensures all the home staff participate in at least one fire drill every six months, they all receive fire safety instruction and the homes fire risk assessment of the building is reviewed on an annual basis. Finally, the temperature of hot water used in baths is now maintained at a safe level to minimise the risk of people who use the service being scalded. What the care home could do better: All the positive comments made above notwithstanding their remains a number of good practise recommendations the manager should consider implementing in order to further improve the lives of the people who use the service: Firstly, people using the service should be able to manage their own medication if they wish in order to promote their choice and independence providing all the risks associated with this activity are thoroughly assessed and managed. The proprietor should establish a time specific action plan setting out how she intends to re-landscape the rear garden and make it accessible to all the people who use the service. The manager should keep an up to date record of her staff teams training needs and strengths. This will enable her and anyone authorised to inspect this record to determine whether or not the homes staff team are suitably qualified and competent to perform their support worker duties. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Esther Care Home Ltd 15 Russell Hill Purley Surrey CR8 2JB     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: Lee Willis     Date: 0 8 0 6 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 32 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (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 32 Information about the care home Name of care home: Address: Esther Care Home Ltd 15 Russell Hill Purley Surrey CR8 2JB 02086685667 02087630875 esthercarehomes@hotmail.com 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) : Kalyani Kalaiyalagan,Sathiavathy Jeyarany Nesarajah care home 8 Number of places (if applicable): Under 65 Over 65 0 learning disability Additional conditions: 8 The maximum number of service users who can be accommodated is: 8 The registered person may provide the following category of service only: Care Home Only (CRH - PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Learning disability - Code LD Date of last inspection Brief description of the care home Esther Care is a privately run care home that provides personal support for up to 8 generally older adults (i.e. 40 and over) with moderate to severe learning disabilities. One person currently residing at the home is a permanent wheelchair user. Mrs Kalyani Kalaiyalagan, who co-owns the service with her mother Sathiavathy, remains the registered manager and continues to be in operational day-to-day control of the home. This detached Victorian property is perched on top of a hill in a quiet residential suburb in Purley. The home is within easy walking distance of the centre of Purley, which is well served by a wide variety of local shops, cafes; take aways, pubs, and banks. The home is also relatively close to a number of main line bus routes and a local train station, which has good links to Croydon and the surrounding areas. This detached Care Homes for Adults (18-65 years) Page 4 of 32 Brief description of the care home property comprises of 8 single occupancy bedrooms, of which three have en-suite facilities. Communal areas include an open plan lounge/dining area; a well resourced games/activities room; newly fitted kitchen and bathroom; entrance hall, walk-in larder; laundry room; cellar, and first floor office. The rear garden is well maintained and contains a wide variety of well-established trees and shrubs, although the lawn is not particularly accessible as it lies on a steep slope. People who use the service are offered copies of the homes Statement of Purpose and Residents Guide. Care Homes for Adults (18-65 years) Page 5 of 32 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 outcomes experienced by the people who live at Esthercare has significantly improved since this service was last inspected just over a year ago. Consequently, we have increased its star rating from a 1 to a 2 star good performing residential care home. From all the available evidence we gathered during this key inspection it was clear the service now has more strengths than areas of weakness. There are no longer any major shortfalls relating to lack of staff training and poor fire safety arrangements, which were the most significant areas identified for improvement at the last key inspection. Nonetheless, although National Minimum Standards under key outcome groups are generally met, there remains scope for further improvement in a number of Care Homes for Adults (18-65 years) Page 6 of 32 important areas of practise (See the summary section entitled - what the service could do better). We are nevertheless confident the manager and her relatively new staff team will continue to recognise and rectify all the minor shortfalls identified in this report. We spent 4 hours at the service. During this afternoon visit we met all six of the people who currently reside at Esthercare, the owner/manager, two care managers who were visiting their client at the time, and two support workers - which included the homes relatively new senior staff member. We also looked at various records and documents including, the care plan for the homes most recent admission. The remainder of the visit was spent during the premises. Four of our satisfaction surveys we also returned to us. 50 were completed by relatives on behalf of their loved one who used the service and the rest came from staff who worked there. Finally, the manager completed and returned our Annual Quality Assurance Assessment (AQAA) when we asked for it. This self-assessment document tells what the providers think they do well, what has improved since the homes last inspection, and what the manager thinks they could do better. What the care home does well: What has improved since the last inspection? The owner/manager has made a number of significant improvements to the home in the past year and has addressed all the outstanding requirements and good practise recommendations made in the homes last inspection report. Firstly, people who use the service have far greater opportunities to attend more interesting and stimulating community-based activities, especially in the evenings and at weekends. The newly redecorated games room has also been supplied with a new table football and various art materials and resources. As recommended in the services last report the manager has significantly improved the interior by: fitting new wooden flooring and carpeting in all the communal areas; installing new units, work-surfaces, oven and fridge in the kitchen; fitting a new bath suite and shower seat in the first floor bathroom; decorating a bedroom and all the communal areas; and suppling the lounge and entrance hall with all manner of ornaments, pictures, and house plants. All the homes staff now receive a minimum level of initial and refresher training that they need to perform their duties, which includes safeguarding vulnerable adults, fire safety, basic food hygiene, moving and handling, infection control, safe medication handling, person centred care planning and dementia training. The recommendation we made that manager should increase the number of supervision sessions her staff receive each year has also been implemented. As a result of all the aforementioned improvements to staff training and supervision the people who use the service can be sure they will be supported by suitably qualified and competent staff who have the Care Homes for Adults (18-65 years) Page 8 of 32 right knowledge and skills to meet their individual needs and wishes. In addition to addressing all these staffing requirements and recommendations the manager has also recruited a number of new highly motivated, suitably qualified and experienced staff in the past year who she is able to share the responsibility of running the home with. The manager now ensures all the home staff participate in at least one fire drill every six months, they all receive fire safety instruction and the homes fire risk assessment of the building is reviewed on an annual basis. Finally, the temperature of hot water used in baths is now maintained at a safe level to minimise the risk of people who use the service being scalded. 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 –0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 32 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 32 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 use this service are provided with all the information they need in order to help them make an informed decision about whether or not the home would be right for them. Peoples needs and preferences are fully assessed prior to admission so the individual, their representatives, and the home can be sure the placement is appropriate for them. Evidence: All the family members who completed our surveys on behalf of their loved ones told us they had received enough information about the home before deciding if it was the right place for their relative. One person wrote - we got all the details we needed. The AQAA states that none of the services placements have broken down and that one new referral had been accepted in the past 12 months. The manager told us this referral was made in an emergency and therefore contrary to good practice they were Care Homes for Adults (18-65 years) Page 11 of 32 Evidence: not given any opportunity to visit the home before moving in. However, the manager was able to produce a very thorough assessment of the new service users needs which covered every aspect of the individuals life, including their cultural and spiritual wishes. The manager demonstrated a good understanding of what constitute bet practice regarding new admissions and was very clear that she would not accept any new referrals unless she believed they would be compatible with all the people who had resided at Esthercare for many years. AQAA states a copy of the CQCs latest inspection report is always made available to all new and existing people who use the service. During a tour of the premises we noted a copy of the homes most recent inspection report conspicuously displayed on an information board in the entrance hall. Care Homes for Adults (18-65 years) Page 12 of 32 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans have been made more person centered and better reflect what is important to the individual, what their capabilities are, and what support they require to achieve their personal aspirations. Suitable arrangements are in place that enable the people who use the service to be consulted, have their views acted upon, and generally participate in all aspects of life in their home. The people who use the service are kept safe by the homes arrangements for assessing and managing identified risks, while their rights to make informed choices and to live their life as independently as possible is not restricted unnecessarily. Evidence: Manager stated in AQAA that as a result of listening to people who use the service they have made care plans more user friendly and accessible. Documentary evidence was Care Homes for Adults (18-65 years) Page 13 of 32 Evidence: or not produced on request to demonstrated this improvement had been achieved. The care plan that had been developed for the services most recent admission was very person centered and covered every aspect of this individuals unique personal, social and health care needs, preferences, goals, which also included all the support they required to have them met. The plan was written in plain language and illustrated with all manner of easy to read pictures and symbols to enable it to understood by the service user. The two staff who completed our surveys told us they were always given up to date information about the needs of the people they supported, and that care plans were very good. A relatively new member of staff spoken with at length told us they thought the care plan format used by the home was very clear and easy to use. The manager wrote in the AQAA that the service is now much better a regularly reviewing and updating care plans and keeping more in depth information about what the people who use the service do each day in their daily records. Documentary evidence was produced on request that showed us two care plans selected at random had each been reviewed in the past year and up dated accordingly to reflect any changes in need. Two care managers who were visiting the service at the time of this inspection told us they were impressed with the homes new approach to care planning and the way staff met the service users needs and wishes. Daily diary notes written by staff regarding what people who use the service had been doing each day also contained a lot of detailed information that showed us the needs identified in service suers care plans were being met. The manager and staff on duty at the time of this visit were observed on numerous occasions taking their time to listen to the people who use the service and where appropriate interpret non verbal queues and signed communication. Staff met clearly had a good understanding of the preferred communication methods of the people they supported. Easy to read pictorial information about how to make a complain, meal choices, and what activities were available in the local community were also conspicuously displayed throughout the home. We agree with the managers comments that weekly one to one meetings between the people who use the service and their designated key workers is a far more affective way of enabling individuals to express their views that group forums. Written evidence was produced ion request that showed us staff now record the outcome of the weekly sessions they have with the people they key work. The two care managers met told us they had been impressed with the way staff never miss an opportunity to promote service suers independence. A relatively new manager Care Homes for Adults (18-65 years) Page 14 of 32 Evidence: of staff told us they believed that was what the home was best at and the manager confirmed that promoting independent living was an area the service had significantly improved in the past year. It was evident in care plans viewed that the service is committed to promoting independent living and we observed staff on several occasions actively encourage and support the service users to do more for themselves. e.g. staff verbally prompted service suers to help prepare the evening meal, clear away dirty plates and cups, and go out clothes and food shopping. Care Homes for Adults (18-65 years) Page 15 of 32 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. The range of age appropriate and stimulating social, leisure, and recreational activities the people who use the service can choose to engage in both within the home and the wider community has significantly improved in the past year, although the manager acknowledges their remains scope for further improvement. Excellent arrangements are in place to enable the families of people who use the service to continue their involvement in the lives of their loved ones. Dietary needs and tastes are well catered ensuring all the people who use the service are provided with daily variation, choice, and nutritionally well-balanced meals, which they are now being actively encouraged and supported to help staff shop for and prepare. Care Homes for Adults (18-65 years) Page 16 of 32 Evidence: Daily diary notes and care plans viewed revealed that people who choice to practise a religion are actively encouraged and supported to do so by staff who regularly accompany individuals to various places of worship, including Churchs and a Hindu Temple. Information about up and coming events at a local Hindu temple is conspicuously displayed on the entrance hall notice board and a member of staff informally interviewed told us people who used the service were supported to be active members of various religious communities in the area. One relative who returned our survey about the home told us their loved one could mostly do what they wanted during the day, evenings and at weekends. Typical written feedback from relatives included, i am happy with the decisions staff make every day on behalf of my love one, and my relative goes swimming, horse riding and dancing, all of which they love, as it helps them with their confidence, fitness, and socialising. The homes manager and other staff met all told us that as required in the services last report the people who live there have far greater opportunities to engage in local community based activities than before. The two visiting care managers also told us the person they represented was enjoying a wide variety of meaningful and stimulating recreational activities within the local community. Activity records kept in respect of two people who use the service revealed that in the past six months these individuals had participated in all manner of community based social activities, which included shopping trips, meals out, visiting a local park, and trips to the local cinema. One person who uses the service told us their key worker had come with them to see a film at the local cinema, which they had enjoyed. Another service user told us they were looking forward to going on holiday next month. The variety of in-house activities the people whop use the service has also improved in the past year. Staff met told us people who use the service enjoy playing table tennis and football, drawing, playing catch, watching films and dancing. The large games room, which has recently been redecorated, contained a wide variety of stimulating leisure resources and equipment, including a table tennis table, table football, puzzles, books, board games, a music centre with lots of CDs. during this visit several people who use the service returned home from a shopping trip with staff, went out to the local park, watched a film in the main lounge, listened to music in the games room, and played catch with staff. It was also positively noted that a lot of the art work made by the people who use the service was displayed on a large notice board in the new games room. The homes visitors book and daily diary notes revealed that the families of people who use the service are actively encouraged to visit their loves ones whenever they like Care Homes for Adults (18-65 years) Page 17 of 32 Evidence: and to join in day trips and other activities. Records showed one family member spends a lot of their weekends visiting their loved one at the home. During this visit a service user requested to speak to their relative on the telephone, which staff immediately facilitated. The manager told us staff always accompanying one service user when they visit their family as agreed in their care plan. During a tour of the premises staff were always observed knocking on bedrooms doors to seek the permission of the service user to enter before doing so. One person who uses the service told us they had been provided to a key to their bedroom, which they always leave in the lock. Manager wrote in AQAA that as a result of listening to the people who use the service she had made the menus more user friendly. A pictorial version of the menus were produced on request. Two people who use the service told us they liked the food staff made for them and could choose to eat something else if they didnt like what was being prepared on the day. As previously mentioned in this report the service is now much better at encouraging the people who use the service to buy and prepare the ingredients for their meals. Staff maintain excellent records of the actually food the people who use the service choose to eat at mealtimes, which revealed the service still has a curry night every Monday to cater for the taste of a number of people who live their. The kitchen was found to be well stocked with a wide variety of fresh fruit, vegetables and salads. A member of staff told us they, with the help of a service user, were preparing pork pies, boiled potatoes and salad for that days evening meal. One service user met was clearly aware that this was going to be the evening meal, and told us they were looking forward to it. This individual also told us they could help themselves to fresh fruit from a bowl in the lounge whenever they liked and that the kitchen door was never locked. Care Homes for Adults (18-65 years) Page 18 of 32 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. Suitably robust arrangements are in place to ensure the people who use the service receive personal support in the way they prefer and require, and that their unique emotional and physical health care needs are continually recognised and met. Overall, the homes medication handling practises are sufficiently robust to keep the people who use the service safe, although more could be done to enable them to take far more responsibility for administering their own medication. This will promote the rights of people ho use the service to live their lifes as independently as possible. Evidence: All six people who currently use the service were suitably dressed in well-maintained clothes that were appropriate for the time of year. Two people who use the service told us they could get up and go to bed when they want, and always chose what they wore each day. The two visiting care managers told us the staff had actively encouraged the person they represented to go shopping with them to enable them to buy their own clothing. A manual handling assessments was made available on request in respect of the Care Homes for Adults (18-65 years) Page 19 of 32 Evidence: homes only permanent wheelchair user. Staff maintain good records of all the appointments the people who use the service kept with various health care professionals. including GPs, dentists, community base nurses ect... One care plan examined in depth contained detailed information about this individuals health care needs, dietary requirements, weight, medication regime, and the outcome of all their medical appointments. These records indicated advice is sought from external health care professionals as and when required. None of the people who use the service have been admitted to casualty in the past year. Furthermore, all the accidents people who use the service were involved in, which resulted in a number of minor injuries being sustained largely as a result of a fall, had been appropriate dealt with by suitably trained staff ion duty at the time. No recording errors were noted on any of the medication administration records (MAR) sheets used in the past month. As stated in the AQAA we noted that no Controlled Drugs were currently stored in the homes lockable medication cabinet. Documentary evidence was produced on request that confirmed what the manager wrote in the AQAA that sufficient numbers of the homes staff, including new members, had completed the Royal Pharmaceutical Society of Great Britains approved training in the safe handling of medication a social care setting. A new member of staff told us they had received this training and demonstrated a good knowledge of safe medication handling practises. The manager told us that none of the people who use the service are currently willing or capable of self medicating. We recommend peoples willingness and ability to take a degree of control for their medication is reassessed and the outcome of this exercise is acted upon and included in everybodys care plan. Care Homes for Adults (18-65 years) Page 20 of 32 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The homes arrangements for dealing with concerns and complaints are sufficiently robust and understood by staff to ensure people who use the service feel listened too and safe. Since the last inspection all the homes staff have up dated their safeguarding training and suitable arrangements are in place to protect the people who use the service from harm and abuse. Evidence: Both the relatives who completed our surveys on behalf of their loved ones ticked the yes box in response to the question - Do you know who to speak to if you are unhappy and how to make a complaint? One relative wrote - there loved one would speak to their key worker or the homes manager if they were worried about something. As previously mentioned in this report an easy to read pictorial version of the homes complaints procedure is conspicuously displayed throughout the home which all the people who use the service have access too. Homes complaints record revealed six concerns had been made by one individual on Care Homes for Adults (18-65 years) Page 21 of 32 Evidence: behalf of a person who uses the service. The manager told us that all six complaints had been taken seriously and the complainant notified about the outcome of the homes internal enquiry within 28 days. All these matters have been resolved to the complainants satisfaction. Both the support workers who completed our surveys told us they knew what to do if a service user and/or their representatives had a concern about the home, and were confident the ways information about people who used the service was passed between staff and the proprietor always worked well. The home has made one safeguarding referral to the Local Authority in the past year following a disclosure made by one person who uses the service. The matter was dealt with by the manager and staff at the home in a very prompt, open, and professional manner. Records showed us that in line with agreed safeguarding protocols both the local authorities safeguarding team and the CQC were notified without delay about the allegation of abuse made. The allegation was fully investigated and although the outcome was inconclusive the home has established appropriate risk management strategy to minimise the likelihood of a similar allegation and/or incident reoccurring in the future. This specific risk assessment is contained in the individuals care plan. As recommended in the homes last report the services Protection of Vulnerable Adults (POVA) policy has been amended to include more information about how to refer unfit staff for possible inclusion on the POVA list. As required in the homes last report all its staff have now received safeguarding adults training. Staff spoken with demonstrated a good understanding of the homes safeguarding procedures and were very clear what constituted abuse, and who they needed to notify if they suspected to witnessed abuse within the home. The manager told us that arrangements have also been made for her staff team to attend a Deprivation of Liberty course on 16th June 2009. Care Homes for Adults (18-65 years) Page 22 of 32 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The interior decoration of all the communal areas and facilities in the kitchen and a first floor bathroom have all been significantly improved in the past 12 month ensuring the people who use the service live in a much more homely and comfortable environment. The homes arrangements for controlling infection are sufficiently robust to ensure the people who use the service also live in a very clean and safe environment. Evidence: The manager wrote in the AQAA that in the last 12 months the homes environment has been improved with the fitting of new wooden flooring throughout the entire ground floor, laying of a lighter coloured carpet on the stairs upper landings, and repainting of all the communal areas, including the entrance hall and games room. Furthermore, as required the in the homes last report the AQAA states the kitchen and first floor bathroom have both been fully modernised, and bedroom number 7 redecorated. We confirmed all these improvements had been made to the environment during an Care Homes for Adults (18-65 years) Page 23 of 32 Evidence: extensive tour of the building. Overall, the place looks and feels much brighter, spacious and modern. One person who uses the service told us they liked the new look of their home and thought the new look games room was great. Staff met were particularly pleased about the introduction of the new oven and fridge in the kitchen and shower seat in the first floor bathroom, which enabled them to perform their jobs more easily. The environment also looks a lot more homely with all manner of ornaments, plants, pictures, and photographs of the people who live their hung and displayed on various walls and shelves in communal areas, which included the main lounge, entrance hall, and games room. The manager acknowledges in the AQAA that the garden is not particularly accessible to the people who use the service and writes, - she plans to develop the area further to include more shrubs and generally make it easier to access. We recommend the owner/manager establishes a time specific action plan setting out how she intends to redevelop the rear garden to make it accessible to everyone. Both the relatives who completed our surveys told us the home was always kept fresh and clean. The manager confirmed in the AQAA that the home has an action plan to deliver best practise in the prevention and control of infection and that all six members of its permanent staff team have received infection control training. Documentary evidence was produced on request to show sufficient numbers of staff had received this training. The home looked spotlessly clean during a tour. Sufficient number of latex gloves, toilet tissue and supplies of soap were all found in the homes toilets and bathrooms. Care Homes for Adults (18-65 years) Page 24 of 32 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. People who use the service have safe and appropriate support as there are enough competent, qualified staff on duty at all times. Peoples needs are also met because staff get the right training, supervision and support they need from the management team to carry out their duties effectively. Evidence: Both the relatives of service users who returned our surveys ticked the always box in response to the question - Do staff treat you well, and listen and act upon what you say? one relative wrote - from my observations - staff treat my love one well. Both the care managers met told us they had been impressed with the positive attitude and professionalism of all the staff they had met when visiting the home. Both the support workers and the manager who were all on duty at the time of this inspection were observed interacting with all the people who currently reside at the home in a very caring, respectful, and professional manner. Typical comments made by two people who use the service included, -I like staff and my key worker, and staff listen to me and take me out shopping and to the cinema. Care Homes for Adults (18-65 years) Page 25 of 32 Evidence: Having two staff on duty on the late shift was sufficient to met both the personal and social needs and wishes of the people who use the service, while performing daily routines of running the home, such a cooking and cleaning. During this visit one member of staff went out to the park with two people who use the service, while the other stayed at home supporting the remaining residents to prepare that evenings meal. The manager confirmed that there are always three staff on duty in the morning, at least two at weekends, and in the evenings. At night the service operates an on call system whereby a designated person can reach the home within 20 minutes to support the waking night staff in the event of an emergency. The manager assured us the on call system works well. In the past year the manager has recruited three new members of staff to fill the majority of its vacant positions. Consequently, the service is no longer reliant on temporary agency staff who were not so familiar with the service users needs and preferences. This recruitment drive has also ensured that the age, gender, and ethnic mix of the current staff team is far more reflective of that of the people who use the service. The manager told us she believed employing the right people to be carers was the cornerstone of delivering good outcomes for them. It was evident from the high number of professional qualifications held by all three of the homes most recently recruited staff that the manager was totally committed to employing very experienced and competent staff. The personal files for each member of staff employed since the homes last inspection included: a full employment history; details and evidence of registration with a professional bodies; photographic proof of identity; up to date and satisfactory Criminal Records Bureau (CRB) and Protection of Vulnerable Adults (POVA) register checks; two written references from previous employers within the care sector; and Home Office approved work visas/permits. All the staff who returned our surveys told us their induction had covered everything they need to know about their job before they started. Staff training records revealed that the vast majority of the homes current staff team had either achieved a National Vocational Qualification Level 2 or above in care or had already been awarded a professional qualification that was at least equivalent to an NVQ2 or above in care (i.e. Held a recognised nursing qualification). Furthermore, as required in the homes last inspection report sufficient numbers of its staff team had now received training in moving and handling and basic food hygiene. Records also revealed that sufficient numbers to cover each shift were suitably qualified to administer first aid. Other specialist training a number of the homes staff team had attended in the past year, included person centred care planning, continue promotion and working with people Care Homes for Adults (18-65 years) Page 26 of 32 Evidence: with dementia. The manager conceded that she had not kept her assessment of all her staff teams training strengths and needs up to date, which we strongly recommend she maintains. All the written feedback from staff indicated that the manager regularly meets with them to give them support and discuss their work related performance. One member of staff wrote - the manager is always ready to listen to any queries we have and we can talk to her at anytime about our work. The manager wrote in the AQAA that as recommended in the services last report the number of supervision staff receive has improved in the past year. Documentary evidence in the form of supervision notes for three staff selected at random were produced on request which confirmed progress had been made in this area. Records kept on the staff files for each of the homes most recent recruits showed that they were having one to one supervision with the manager at least once every two months. One member of staff told us - they found the sessions very useful and a good way of getting the training you needed arranged. In addition to these monthly meetings the manager told us she had introduced more in depth quarterly supervision, which focused on an individuals overall performance and training needs. The manager told us she has arranged for the new senior member of staff to receive training in staff supervision. Minutes of staff meetings revealed they were now being held on a monthly basis. These meetings were all well attended by staff and had covered a wide variety of relevant topics, including safeguarding, record keeping, and requirements identified in our last inspection report. Care Homes for Adults (18-65 years) Page 27 of 32 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 relatively well run by a competent owner/manager who has recently recruited a lot of highly motivated, qualified and experienced staff she can delegate more responsibility too for running the service in her absence. The homes fire safety arrangements have significantly improved in the past year to ensure all the people who use the service are not being placed at unnecessary risk of harm. All the homes other health and safety arrangements are also sufficiently robust to keep the people who live there safe. Evidence: The owner/manager was able to demonstrate she has the knowledge and skills to effectively run a residential care service for adults with learning disabilities and has a clear vision for the service. In the past year the manager has recruited a number of highly qualified and experienced staff she is now able to share the responsibility for running the home with them. This new approach of delegating more responsibility to senior staff represents a significant improvement in the way the service is managed. Care Homes for Adults (18-65 years) Page 28 of 32 Evidence: As required in the homes last inspection report the manager has taken appropriate action to address all the major fire safety breaches identified at that time. The fire risk assessment of the building has now been established, and all staff have participated in at least two fire drills in the past 6 months and received fire safety training. A new member of staff demonstrated a good understanding of what to do in the event of the homes fire alarms being activated and was very clear where all the homes fire exits and assembly points where. This individual also confirmed that they had participated in a fire drill approximately every three months since their appointment in 2008. The homes other fire records also revealed its alarm system continues to be checked on a weekly basis and all the homes fire detection and fire fighting equipment is tested on an annual basis by a suitably qualified engineer. As stated in the AQAA the manager was able to produce up to date Certificates of worthiness to show that suitably qualified engineers had also tested the homes gas installations, water heating systems (legionella), and portable electrical appliances in the past year. During a tour of the kitchen it was noted that all items of food kept there were correctly stored in line with basic food hygiene, including items taken out of their original packaging, which were correctly labelled and dated. The home has recently been awarded five stars from the local Environmental Health authority for maintaining excellent standard of hygiene in the home. As required in the homes last report records revealed that hot water used in all the homes baths is being maintained at a safe level (i.e. between 38 and 41 degrees Celsius). The temperature of hot water emanating from the homes new bath on the first floor was found to be a safe 39 degrees Celsius when tested at 14.45. Care Homes for Adults (18-65 years) Page 29 of 32 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 30 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 20 People using the service should be able to manage their own medication if they wish in order to promote their choice and independence providing all the risks associated with this activity are thoroughly assessed and managed. The proprietor should establish a time specific action plan setting out how she intends to re landscape the rear garden and make it accessible to all the people who use the service. The manager should keep the record of her staff teams training needs and strengths up to date. This will enable her and anyone authorised to inspect this record to determine whether or not the homes staff team are suitably qualified and competent to perform their support worker duties. 2 28 3 35 Care Homes for Adults (18-65 years) Page 31 of 32 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. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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