Care Home: Gatehouse Cottages Care Home

What the care home does well Relatives and friends are welcome to visit anytime. The home helps people to stay in contact with their families and some people have regular visits back home.If people are unhappy about something at the home the manager will look into this and try and put things right.People have good opportunities to have their say about how the home is run. What has improved since the last inspection? The manager has completed his registration with CQC.There are more nurses working in the home who are trained to look after people with learning disability.The home has had a lot of redecoration and some new furniture provided.The meals for people have improved especially the choices at breakfast time.The staff working in the home have had more specialised training, guidance and supervision to help people living in the home.Staff follow instructions from other professionals to make sure they are looking after people properly.The care plans are kept up to date so they tell staff what people need and want, they also say more about what people are like.Staff keep better records about people`s health such as appointments with the dentist and hospital. When serious things in the home have happened the home tells CQC and other organisations about them. This makes sure that people are kept safe. More activities have been offered to suit everyone living in the home, more tripsPage 12 of 41Care Homes for Adults (18-65 years)out have been arranged. The home is kept clean and tidy; the staff know how important it is to wash their hands regularly and to wear their aprons and gloves to keep people safe. What the care home could do better: The manager needs to check if there are enough staff working each day to look after everyone properly.Some of the people who live at the home need to be able to go out for trips and activities more often. Key inspection report Care homes for adults (18-65 years) Name: Address: Gatehouse Cottages Care Home Stallingborough Road Immingham Grimsby North East Lincs DN41 8BP 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: Jane Lyons Date: 0 5 0 5 2 0 1 0 This report is a review of the 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 stars – excellent  2 stars – good  1 star – adequate  0 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. They reflect the things that people have said are important to them: 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 41 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 41 Information about the care home Name of care home: Address: Gatehouse Cottages Care Home Stallingborough Road Immingham Grimsby North East Lincs DN41 8BP 01469574010 01469574005 gatehouse.cottages@craegmoor.co.uk www.craegmoor.co.uk Health & Care Services (UK) Ltd Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mr Keith Laurence Bush Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 27 20 0 0 care home 27 learning disability physical disability Additional conditions: The maximum number of service users who can be accommodated is: 27 The registered person may provide the following category of service only: Care Home with Nursing, Code N. To service users of the following gender: Either. Whose primary care needs on admission to the home are within the following category: Learning Disability, Code LD, maximum number of places 27 Physical Disability, Code PD, maximum number of places 20 Date of last inspection 2 9 0 9 2 0 0 9 Care Homes for Adults (18-65 years) Page 4 of 41 A bit about the care home Gatehouse is a care home for adults with a learning disability aged between 18 and 65. It provides care support for up to 27 people, some have complex needs. Gatehouse Cottages is in the country and is a few miles from Immingham. It is in a quiet area with only one other house nearby. You can get to the care home by bus or by the care homes own mini- bus. Rooms are in 3 buildings. No one has their own toilet and bathroom. 2 of the rooms are shared bedrooms. The care home has many things that people can use to support them in their daily life. There is space to park in front of the care home. There is a private garden behind the home and a large sensory garden. When this report was written, it Care Homes for Adults (18-65 years) Page 5 of 41 cost from 500 pounds and 1185 pounds a week to live there. If people want extra services like hairdressing and private care for their feet, they could pay a bit more. Care Homes for Adults (18-65 years) Page 6 of 41 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 health care support Concerns, complaints and protection Environment Staffing Conduct and management of the home Care Homes for Adults (18-65 years) Page 7 of 41 How we did our inspection: This is what the inspector did when they were at the care home The inspector wanted to see how well the home was doing as there had been some problems at the last visit in January about how the home was looking after people and keeping them safe. After the visit in January, CQC had sent the owner of the home a special letter about the improvements they needed to make. Before the visit, the home sent us lots of information about how they run the home and about things that were affecting the health and happiness of the people living there. The inspector used this information to plan her visit. The main inspector was Jane Lyons, another inspector Terri Martin visited the home as well. The inspectors spent 1 day in May at the home. The inspectors did not tell the manager that CQC were visiting. Care Homes for Adults (18-65 years) Page 8 of 41 The inspectors talked with professionals such as social workers and speech therapists who visit the home to help with peoples care. They also telephoned some of the relatives to talk about the home. The inspector used their answers to write some of this report. The inspectors spoke with some of the people living at the home, staff and the manager. Some of the people living there found it hard to talk. So the inspectors spent some time watching how they were being cared for. The inspectors looked at papers about how the home works and cares for people. The inspectors found that nearly all the problems had been sorted out and gave the home 2 stars. This means the people who live in the home get good services. Care Homes for Adults (18-65 years) Page 9 of 41 What the care home does well Relatives and friends are welcome to visit anytime. The home helps people to stay in contact with their families and some people have regular visits back home. If people are unhappy about something at the home the manager will look into this and try and put things right. People have good opportunities to have their say about how the home is run. Care Homes for Adults (18-65 years) Page 10 of 41 What has got better from the last inspection The manager has completed his registration with CQC. There are more nurses working in the home who are trained to look after people with learning disability. The home has had a lot of redecoration and some new furniture provided. The meals for people have improved especially the choices at breakfast time. Care Homes for Adults (18-65 years) Page 11 of 41 The staff working in the home have had more specialised training, guidance and supervision to help people living in the home. Staff follow instructions from other professionals to make sure they are looking after people properly. The care plans are kept up to date so they tell staff what people need and want, they also say more about what people are like. Staff keep better records about peoples health such as appointments with the dentist and hospital. When serious things in the home have happened the home tells CQC and other organisations about them. This makes sure that people are kept safe. More activities have been offered to suit everyone living in the home, more trips Page 12 of 41 Care Homes for Adults (18-65 years) out have been arranged. The home is kept clean and tidy; the staff know how important it is to wash their hands regularly and to wear their aprons and gloves to keep people safe. What the care home could do better The manager needs to check if there are enough staff working each day to look after everyone properly. Some of the people who live at the home need to be able to go out for trips and activities more often. Care Homes for Adults (18-65 years) Page 13 of 41 If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Jane Lyons St Nicholas Building St Nicholas Street Newcastle upon Tyne Tyne and Wear NE1 1NB 01912333300 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 14 of 41 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and health care 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 15 of 41 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. Although the assessment process could not be fully tested out, as there had not been any admissions since the last inspection, assessments have been reviewed so that peoples needs are accurately recorded. People who use the service have an agreed contract with the service so their rights are protected. Evidence: Discussion with people who use the service, relatives, the manager and staff and viewing of files and documents show that people have satisfactory assessments of need in place and those needs are now better met. Five care files were case tracked as part of the inspection, and a number of other files were sampled. All contained assessments of need and care plans completed by the local authority. The home added to these with their own assessments and risk assessments, and also obtained assessments completed by other health professionals. The information was used to provide plans of care for people. Assessments for those people living in the home had been reviewed and updated to reflect changes in need. The documentation covers a range of areas such as health, personal, social and psychological needs, the Care Homes for Adults (18-65 years) Page 16 of 41 Evidence: assessments were detailed and included a lot of person centred information about how people choose to have their care. There was good evidence that the manager or qualified staff were now carrying out reassessment visits when people who use the service had been admitted to hospital, this will ensure that the home can continue to meet their needs. There have been no new admissions to the home since the last key inspection in September 2009, the local placing authority had continued to suspend admissions until improvements with the homes action plan in relation to previous safeguarding investigations had been fully met. Following this visit, we received confirmation that the placing authority had lifted the suspension on placements given the improvements to the quality of service provision and more positive outcomes for the people who use the service. All files seen contained an up to date copy of the homes statement of terms and conditions which had been signed by the individuals representative.The document contained clear and accurate information about the service at Gatehouse including information about the fee levels. Care Homes for Adults (18-65 years) Page 17 of 41 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. Improvements have been made to care planning and management of risk to ensure peoples needs are met safely and in a way they have chosen. Evidence: We looked care files from all areas of the service during the visit and found that the progress noted at the random inspection on the 28th January had continued. The care files were more organised and easier to read. Each care file had a signature of the person or their representative to evidence that they had seen the care file and agreed with the contents. Improvements were noted in the content of the care files, they stated what the individual was able to do for themselves and the tasks that were required by staff to ensure needs were met. The care plans were person centred and written in the first person, for example I like, I dont like etc. The plans in the main facility reflected the high physical needs of the individuals whereas the plans for people in the other facilities were aimed at promoting peoples independence and maintaining good mental health. In particular we noted improvements with the plans for people who were receiving specialist input from Care Homes for Adults (18-65 years) Page 18 of 41 Evidence: the community health and social care teams, these improvements are covered in more detail in section 4 of this report. At our last visit in January we found some inconsistencies in the evaluation and review of care plans however there was good evidence of improvements in this area, peoples care plans and risk assessments had been reviewed regularly and updated when their needs had changed or further information had been obtained. The staff complete daily records of care, the manager told us that he had introduced a new document in symbol format to prompt staff on the different areas on which to record, such as activities, nutrition, personal care etc. At the time of the visit , these records had been in use for three weeks; we saw that they varied in quality, some staff clearly described the support people had received and were able to describe how the person had spent their day and what they had enjoyed doing whilst others were more minimal. The manager confirmed that he had carried out a review of the these records and identified areas for improvement which he was addressing through further changes to the document format and individual support for staff. In discussions people told us that they could make some decisions about the things that they do each day, the times of rising and retiring, occupations, friends and family they visited or who visited them. One individual told us sometimes I like to get up a bit later than the others and thats OK, I like spending time in my room, listening to music. We looked at paperwork which guided staff in the management of risk or behaviour. Improvements continue with the risk assessment documents, those seen gave a clear indication of the level of risk and made it clear what action staff should take to reduce or manage the risk with certain activities. Behaviour management plans were detailed and directed staff on actions to take to diffuse situations, what techniques they were to use and how to communicate etc. At the last visit in January we found some inconsistencies in the frequency of the review of the risk assessments and behaviour management plans, at this visit, we saw improvements in this area and risk assessments had been kept under regular review and the associated plans updated where necessary. Records show that formal annual care reviews have been held for individuals in the service, where the care manager, the individual where possible, the relatives and named nurse/ manager of the service have met and discussed all aspects of the individuals current needs. The manager has now implemented a programme whereby all individuals have their care reviewed every six months. All relatives we spoke with confirmed that reviews are held regularly, the meetings are well structured and they have opportunities to discuss any issues or concerns they may have. Care Homes for Adults (18-65 years) Page 19 of 41 Evidence: Care Homes for Adults (18-65 years) Page 20 of 41 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 using the service have more opportunities to access a variety of leisure activities in the home and in the community and spend their time in a meaningful way. They are supported to maintain relationships with their friends and family. People have more choices at mealtimes and their nutritional needs are more safely met. Evidence: Staff told us that the routines of the home were planned around the individuals needs and wishes, those who reside in the main facility are reliant on staff and family members recognising and identifying their likes and dislikes. Individuals who reside in the Lodge and Studio flat have more opportunities to make decisions and exercise choices. The majority of people who use the service have complex or significant needs and require a high level of support from the staff team, therefore few of the individuals would be able to participate in work or college placements, however the manager continues to look into suitable work and college placements for some individuals. A small number of individuals are able to access day services in the community. Care Homes for Adults (18-65 years) Page 21 of 41 Evidence: In discussion staff displayed a good knowledge of individuals needs, likes, dislikes, family support and records contained information on peoples religious observances. At present none of the individuals access any religious services. People have their social and lifestyle needs identified in their care plans, progress noted at the last inspection has continuedl, there was good evidence that people with very complex needs have more detailed plans in place. Following the last inspection the manager has reviewed the activity provision in the main facility; the two activity co-ordinators have areas of delegated responsibility i.e one is responsible for managing external activities and the other for in- house activities. New weekly activity programmes in symbol format have been produced for each person which details their activities such as shopping for food supplies, lunches out, discos, swimming,ice skating, hydrotherapy sessions, cycling, massage, music therapy, personal shopping, audio tapes and quiet time in room etc. Care staff are allocated each day to a specific role within supporting activities. Activity records to support the programme have improved and evidence that people are participating in a more varied range of activities on a more regular basis. However there could still be improvements made especially in the main facility where the frequency of some individuals access to some of the activities varied greatly. We discussed activity support with the staff, relatives and people who use the service, comments include: It is much better than before, but we could do a lot more if we had more staff on duty, people in the main facility would benefit so much, one of the care staff drives the new vehicle, hes always taking people out and about now , weve noticed an improvement, my daughter does more activities and the activity coordinators are great and organise a lot of things for people to do, but they could do more if the staffing levels were higher . Evidence from this visit is that there has been improvement for people over the last few months in respect of their lifestyle, access to the community and personal fulfillment, however to sustain and build on these improvements staffing levels must be reviewed. People who reside in the Lodge and Studio have support plans which identify needs in relation life skills; activity plans include money skills, hygiene, shopping, cleaning, laundry, food management etc. Progress continues with the development of effective communication plans for people with complex needs in this area. The manager showed us some new documentation which is in symbol format, that he plans to put in place soon. Staff are accessing specialist training in this area, four staff had completed training in Intensive Interaction Therapy earlier in the year and their progress is being closely monitored by the SALT team, further courses have been arranged for more staff to commence in May. We observed during the day that the atmosphere was much calmer than on the previous Care Homes for Adults (18-65 years) Page 22 of 41 Evidence: visit, people were more settled and using more of the communal facilities rather than congregating at the staff desk in the hallway. Staff were seen to be supporting small groups of individuals in different areas of the home and also providing one- to one support, people were observed enjoying music therapy sessions and walks around the grounds and time in the sensory garden. It was especially pleasing to hear one of the staff describe how much an individual had enjoyed a visit to the sensory garden a few days previously, he described how he had picked flowers and held them up for her to smell and that she had responded with smiles and giggles. The home welcomes visitors and has close links with family members. Some of the people who live at the home go out regularly with their relatives and also go home for visits and overnight stays. Relatives we spoke with told us that the home supported them well, and provided transport for these visits home where possible. The home provides a communication book for staff and relatives to use, one relative mentioned that she would like more information to be recorded about aspects of care support, this was passed on to the manager. Progress has continued with arranging holidays for people this year. Four people had just returned from a four night stay at Butlins in Skegness, comments from individuals and staff show that everyone enjoyed themselves.The activity co-ordinators confirmed that people who reside in all areas of the home were being supported to choose where they would like to go and special trips out would be provided as an alternative if they chose not to go on holiday. A shortage of drivers for the homes two minibuses had been described at the last two inspections, this had limited peoples access to the local community. There was good evidence at this visit that the transport arrangements at the home had improved. One of the mini- buses has been exchanged for a people carrier which more staff can drive and there is another staff member applying to drive the mini- bus. Before we visited the home we spoke with the speech and language therapy team who provide support to some of the individuals in the home. They told us that the cook had worked very positively with them to improve the content and format of the menus in the main facility, they said she was very enthusiastic about her work and knew peoples dietary needs and preferences well. Menus are provided in a pictoral format, we saw staff using these when discussing with individuals their choice of meals. Significant improvements have been made to the choice of meals provided at breakfast time. The cooks hours have been reviewed and she starts her shift earlier to prepare the breakfast meals. People can now have a choice of a cooked meal such as eggs, porridge or toast, there is also a variety of cereals available. We observed people being supported by staff to choose what meal they wanted. In the Lodge and Studio areas people are more able to be involved in menu planning, shopping and meal preparation. They told us that they enjoyed the meals. Care Homes for Adults (18-65 years) Page 23 of 41 Evidence: Care Homes for Adults (18-65 years) Page 24 of 41 Personal and health care 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. Peoples health needs are being met and guidance from health care professionals is being followed more consistently by staff to ensure people with more complex needs are receiving the support they need. Medications are well managed. Evidence: We examined a number of care files in detail during the day to check how peoples health care needs were identified and addressed. There was evidence that these individuals had access to a range of health and social care professionals, for example G.Ps, psychiatrists, speech and language therapists and physiotherapists. Some of these professionals have carried out assessments and provided reports which detail specific support an individual may require, we saw that improvements had been made to the updating of care plans following such consultation. We spoke with a speech and language therapist who told us that systems to update the documentation and care support had improved, she is now asked to verify plans that have been reviewed to include her guidance. From observation and discussions with staff and management there is more evidence to show that staff are more consistently following the plans and senior staff are supervising staff and observing their practice more, however continued staff changes affect this area. Care Homes for Adults (18-65 years) Page 25 of 41 Evidence: It is clear that the home has developed more positive working relations with the community support team and are accessing their support more when concerns have been identified. For example referrals have been made to the dietician, psychiatrist, seating specialist and intensive support team. We discussed one individuals care needs with the staff and manager, there are current issues, due to changes in staff and transport which are affecting this persons behaviour and choices in lifestyle. Whilst it is positive the home have made a referral to the community team for assessment, the individuals care plan should now be reviewed to describe the current care support needed rather than waiting for the assessment report, further changes could be made at that time if necessary. Systems to support the accuracy and consistency with the recording of peoples weights have been put in place. Records are well maintained and new weighing scales have been provided, this equipment allows people in their wheelchairs to be weighed so people with complex mobility needs can be more closely monitored. All the care files seen contained an up to date Heath Action Plan, these included records of annual health checks, medication reviews, immunisation records, illnesses, dental and optical checks. This record focuses specifically on health issues and details when appointments have been made with the range of health care specialists involved in the persons care. It will ensure health is monitored and any issues dealt with at an early stage. Hospital Passport documents had also been updated and more clearly described the individuals current needs and care support. Whilst all the records had been dated and signed, there was no review date identified which needs to be considered. At the last visit we found that some progress had been made towards improving the systems for percutaneous enteric gastric (PEG)feeding in the home but there were still some inconsistencies in record keeping and staff hygiene practice. At this visit we saw further improvements. With the exception of one newly recruited nurse all the other qualified staff have received training in this area and their competency has been assessed. During the visit we observed a staff member administer a bolus feed and medications, which was carried out safely. Storage has improved and the feeds and lines are kept in the medication room. Recording was accurate, although the home now maintains three separate sets of records, one in the P.E.G. file, one in the care plan and one with the medication charts. We advised that one set of records would be more practical and safe. People living in the home and their relatives told us that staff are helpful, friendly and polite. Some comments included The staff are always very helpful and work extremely hard, they look after my daughter very well, she is always dressed nicely and they always let me know about any illnesses or changes and I like it here, the staff are nice to me and help me if I need it. At the last visit we saw very positive improvements with the storage of medications in the main facility, a new medication storage room had been provided. None of the people who Care Homes for Adults (18-65 years) Page 26 of 41 Evidence: live at the home self- medicate, all the medication is handled on their behalf by the nursing staff. We saw medication is handled safely and people are protected by the procedures in place. Care Homes for Adults (18-65 years) Page 27 of 41 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. Complaints were taken seriously and people were provided with information on how to make a complaint. The home has more robust systems in place to protect people from abuse. Evidence: The home has a complaints policy and procedure which was displayed. The home has also produced the complaints procedure in symbol format and copies were seen in peoples files. People spoken with during the visit told us that they knew who to speak to if they were not happy and how to make a complaint. The home had not received any complaints since the last key inspection visit. At the visit in January we found that the manager had not looked into concerns raised by an outreach worker regarding standards of hygiene and personal care provision. There was good evidence in the complaint records that these concerns had been formally addressed and the complainant was satisfied with the outcome. When we spoke with relatives, two of them told us about concerns which they had raised with staff about standards of personal care and standards of ironing, these issues were passed onto the manager who had not previously been informed of them. The management of concerns in the home should be reviewed and systems put in place so that staff are reporting issues to the management team who can ensure they have been dealt with effectively. Care Homes for Adults (18-65 years) Page 28 of 41 Evidence: The home has a multi agency policy and procedure for the prevention of abuse. All staff undertake mandatory training, records showed this was up to date. At the last visit we had concerns that the home was not reporting serious incidents to the appropriate agencies including the safeguarding team and CQC. There was good evidence of improvements in this area; two serious incidents had been reported and managed appropriately; due the escalating behaviours of one individual more appropriate placement has been found. We also saw that the manager had made good progress with the auditing of incidents in the home. Records are collated and reviewed at least monthly, the manager confirmed that a referral to the psychiatrist had been made for one individual as a consequence. Records show that staff are up to date with training in the management of challenging behaviours. Care Homes for Adults (18-65 years) Page 29 of 41 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. Improvements have been noted in the environment since the last inspection. Continuing progression with the homes redecoration and refurbishment plan would further improve the environment for those who live there. Evidence: The accommodation comprises of three separate units, there is a purpose built ground floor main facility, the first floor of this is the Studio which has three bedrooms and there is a separate three bedroom house nearby which is called the Lodge. During the visit we looked round all areas of the service. At the last key inspection in September 2009, we identified many areas of the facilities which required improvement. Following this visit the management produced a detailed maintenance programme with dates for completion, the programme included all the repairs, decoration and refurbishment needed. At the visit in January we saw that this programme had commenced and works to box in exposed pipe work in the Lodge and Studio areas, provide a new medication room and therapy room, provide a washbasin in the laundry and decorate the Studio had been completed. At that visit we were concerned that the recreation room in The Lodge was still not fit for use and the porch was in a state of disrepair, we advised that improvement works in The Lodge be made a priority within the programme. Care Homes for Adults (18-65 years) Page 30 of 41 Evidence: At this visit we saw that some progress had been made to improving the facilities in the Lodge. The porch area has been cleaned, tidied and repairs have been carried out to the windows. A decision has been made by the management to provide a ground floor bedroom for one of the people who live there, who has mobility problems and is finding the stairs increasingly hard to manage. We spoke with this individual who told us that she was excited about her new room. The plan is to change the use of a number of the rooms to accommodate this provision, this will also provide another individual with a larger bedroom upstairs. The recreation room is now situated next to the kitchen, a desk and computer had been provided, staff told us that individuals now used the facility. However delays with contractors has meant that the staff continue to use the recreation room for their office and until redecoration of the new bedroom is complete the staff facilities cant move upstairs. During the visit the manager confirmed that works to fit carpets would take place the following day and completion of the programme in the Lodge would be a priority. Progress has been made with redecoration of other areas in the main facility. New furniture and carpets were scheduled for delivery the following week. Relatives we spoke with told us that they we pleased with the improvements to the facilities however some were concerned with the delays, one commented they promised a lot of new furniture but we are still waiting. All areas seen were clean, tidy and no mal odours were noted. At the last visit in January we were concerned about some of the infection control measures in place, following this visit the manager accessed support from the infection control nurse with the community health team who has visited the home and provided staff with leaflets about effective infection control measures. Records showed that staff have accessed infection control training. During the day we saw good hygiene practices being followed, staff confirmed that they had satisfactory supplies of protective clothing. All bedrooms seen throughout the service were personalised to suit the individual, many contained personal items such as posters, pictures, mobiles, music systems, T.V.s and sensory equipment. Some people were pleased to show us their rooms. Discussions with staff and records of unit meetings demonstrate that people were consulted about choices of colour and decor . When we spoke with relatives, two of them told us about their concerns around the standard of laundry, we passed these on to the manager to look into. Results of recent surveys from relatives had identified this as an issue and the manager has developed an action plan to address the problems. During the visit we observed that people were well dressed and their clothes were nicely laundered however checks in the laundry room revealed that the iron was missing. The manager confirmed that consistent improvements need to be made in this area to properly promote peoples dignity. Care Homes for Adults (18-65 years) Page 31 of 41 Evidence: Arrangements for access to and from the building are suitable for the people living at the home, all the doors to the main facility are alarmed. The garden areas are well maintained, the plants and shrubs in the sensory garden are maturing and it was positive to see people spending time in the garden and enjoying themselves. Overall there have been positive improvements to the facilities, people now live in a safer, more pleasant and more homely environment but there is still some way to go. Care Homes for Adults (18-65 years) Page 32 of 41 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 may not be cared for by staff in sufficient numbers to meet their developing social needs and lifestyle choices. Improvements have been noted in staff training and supervision. These need to continue as planned to ensure that staff are equipped with the skills and knowledge they need to meet peoples needs. People are protected by the companys recruitment and selection practices. Evidence: At the previous inspection a recommendation was made to review the staffing hours in the home to ensure there were enough staff rostered to meet peoples dependency needs. We did not see any evidence that this had been formally carried out and since the reduction in occupancy (of one person), the staffing levels in the main facility have actually been reduced. Staff told us they felt overstretched at times, the levels of support with personal care and feeding that some individuals needed impacted on the time they could spend on activities and one to one support. They also said that they had been short staffed on some shifts when cover for staff sickness could not be arranged. Comments included we could do so much more with people if we had more staff and it is always busy and we are short again today. The manager confirmed that the home had experienced some difficulties in covering short notice sickness for both care and qualified staff. It is important that staffing levels are reviewed to ensure enough staff are provided Care Homes for Adults (18-65 years) Page 33 of 41 Evidence: to maintain the improved standards of care for people and to build on improvements to the quality of their lifestyle. More effort must be made to provide cover for staff sickness. Good progress has been made towards recruiting nursing staff with a learning disability qualification, two of the three new nurses employed in January remain in post. Information provided in the AQQA details that staff turnover for the last twelve months is high with twenty staff having left. Turnover for the last few months has settled somewhat but remains of concern with qualified and experienced care staff having left the home in recent weeks. Comments from relatives and health professionals include we are always seeing new faces, there are still a lot of staff changes, it would be nice if staff stayed, staff turnover continues and this impacts on the consistency of care for some individuals, especially around behaviour management and there have been staff changes but some of the staff have been there for years and Im reassured they know the care my daughter needs. The manager confirmed that staff retention policies had been reviewed; pay scales had been increased for all grades of care and nursing staff. The home also employs a range of support staff including an administrator, housekeeper, cook and maintenance person; it was very pleasing to see how these staff members had developed very positive rapports with the people who use the service. There is a balance of male and female staff working at the home. People spoken with liked the staff that supported them. Comments were the staff are nice to me and they are good, I like them. During the visit staff were observed interacting with people and this was carried out in a caring and sensitive way, ensuring that the people were given choices and consulted about everyday events occurring within the home. People who use the service are protected through robust recruitment procedures. Staff recruitment records sampled during the visit were well maintained and up to date, they contain appropriate information and all required checks are completed prior to new staff starting in post. The home has a corporate induction programme which all new staff undertake, this ensures they know the home and their responsibilities, the programme incorporates the common induction standards. The manager told us that there had been delays with a number of the new staff starting this programme, due to administration issues which he was following up. In January the home had recruited a newly qualified learning disability nurse, it is important that newly qualified staff complete a preceptorship programme to ensure they are appropriately supported in their new role. The company does not provide one, there were delays whilst the manager developed a programme, however this has now been completed. Page 34 of 41 Care Homes for Adults (18-65 years) Evidence: NVQ training continues 57 of the care staff have achieved level 2 or 3 in care. Since the last key inspection in September 2009 good progress has been made towards providing staff with the right skills to support people with complex physical and learning disability needs. Courses in Autism, communication, eating and drinking , person centred planning and PEG feeds have been provided. Some of the care staff are currently involved in a specialist communication training programme which is geared to supporting people with very complex communication needs; feedback from the speech and language therapy team indicate that staff have been supported with implementing this therapy. There is an annual training plan in place and records seen and discussions with staff show that they are up to date with safe working practice training which includes: fire safety, moving/ handling, first aid, food hygiene and infection control. At the last key inspection in September 2009 care staff were not receiving any formal one to one supervision with their line manager, when we visited in January senior staff had accessed training courses on how to provide formal supervision. The supervision programme has now started, it is being co-ordinated by the homes administrator who has developed a supervision plan for the year. Records show that the majority of staff have now received an appraisal and at least two formal supervision sessions, this programme needs to continue so that staff receive a minimum of six supervision sessions per year. Care Homes for Adults (18-65 years) Page 35 of 41 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. There have been improvements noted in the way the home is managed. People who use the service are involved in the running of the home as much as possible, their views and the views of others are used to inform the day to day functioning of the home. Peoples health and safety is promoted and protected as far as reasonably possible by the policies and procedures at the home and the training of staff. Evidence: The manager Keith Bush has been in post for almost a year, he recently completed his registration with CQC. He is a registered nurse with learning disability qualification and has previous management experience, he has recently enrolled on the managers leadership and management award. Staff described the manager as supportive. Comments from relatives and health care professionals include he is approachable and tries to sort things out, Keith has made a lot of improvements, and this is the best it has been for a long time, I hope he can keep the standards up. The manager told us that he is well supported by the senior management team and has Care Homes for Adults (18-65 years) Page 36 of 41 Evidence: access to supervision, advice and support from them as required. He confirmed that senior management visited the home regularly and have supported the staff team to make the necessary improvement work to the service. We have been encouraged by the improvements made to the management and recording systems in the home, in particular recruitment, care planning, training and supervision. The home continues to be much calmer and more organised than on the last key inspection. The home has a developed quality assurance system for monitoring the care and support offered to people and this includes a system of audits and surveys. Regular audits are carried out on care records, medication records, incident records and facilities. In recent weeks relatives have been asked to complete surveys, the questions cover all aspects of the service and some of the responses have been mixed. The manager has developed an action plan with timescales to address the deficiencies identified. Records show people who use the service and their relatives have access to regular meetings. Corporate policies and procedures are in place. The home undergoes an external audit from the company usually annually, however due to concerns identified about the service in 2009, these have taken place more regularly and results show a steady improvement. The home is a safe place for people to live in and staff to work in. Fire equipment is checked routinely and gas and electrical equipment serviced. Staff participate in mandatory training and have policies and procedures to guide their practice. Integral bed rails are provided with the profile style beds, there were no other bed rails in use at the home. Care Homes for Adults (18-65 years) Page 37 of 41 Are there any outstanding requirements from the last inspection? Yes  No  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 38 of 41 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 Description 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 Description Timescale for action 1 33 18 A review of the staffing levels 30/05/2010 must take place to ensure that there are sufficient staff working in all three areas of the service to meet the needs of all the people living there. This will ensure peoples needs are being met, the improvements to their quality of lifestyles can be maintained and further developed and staff do not feel overstretched. 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 6 Continue to improve the quality of the daily records which will better evidence the care people have received and how they have been occupied. Page 39 of 41 Care Homes for Adults (18-65 years) 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 2 14 Continue to develop the activity programme both inside and outside the home to ensure all people who use the service have regular opportunities to take part in a variety of activities they enjoy. Update the identified individuals care plan to ensure it reflects their current needs and care support, further changes can be made following the MDT assessment if required. Put in place a more robust system to manage concerns raised, this will better ensure issues have been dealt with effectively. The provider should ensure that the programme of renewals continues as planned. Ensure effective systems are in place to cover staff sickness, so staffing rotas are properly maintained at all times. Ensure newly recruited care and qualified staff commence their induction/ preceptorship programmes following employment to ensure they are fully supported and equipped for their new role. Continue with the supervision programme to ensure all care staff receive at least six formal sessions per year. 3 18 4 22 5 6 24 33 7 35 8 36 Care Homes for Adults (18-65 years) Page 40 of 41 Helpline: Telephone: 03000 616161 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. © 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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