Care Home: Goddards The

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What the care home does well People have a full care needs assessment prior to their admission to the home and then have a gradual introduction to the home to help them decide if they would like to live or have respite care there. Care plans are a personalised record of each individuals strengths and needs and the support that is needed from staff to maintain or promote independence. Person centred plans include thorough risk assessments that support responsible risk taking and a record of how decisions have been made with the person concerned. People`s health care needs are met, including the provision of annual health checks, six monthly medication reviews and nutritional screening. Health care professionals are consulted and advice is taken and followed by staff. This promotes the health and wellbeing of the people living at the home. Independence is promoted for people living at the home; one person is considered independent enough to move out of the home into supported housing. Medication policies and procedures are robust and staff practices ensure that people receive their medication safely and as required; one person is being supported to be able to manage their own medication. Meal provision is good and is based on the expressed likes and dislikes of the people living at the home. Special diets are catered for, such as weight reducing diets and `soft` diets. People have a full programme of activities that includes adult education classes, attendance at day centres, taking part in social clubs and classes and in-house activities. Some people belong to the local walking group and have helped with voluntary activities within the local community. People are encouraged to have appropriate friendships and relationships and this includes being assisted to keep in touch with family and friends. People tell us that they know who to speak to if they have any concerns and that they know how to make a complaint. Most staff have attended training on safeguarding adults from abuse and this helps them to recognise poor practice and abusive situations. The home is clean, comfortable and homely - it is well maintained and people are able to personalise their own rooms. Staff are well trained and qualified - this results in a staff group that have the knowledge and skills to support the people living at the home. There is also a low staff turnover and this means that staff know the service users very well and are able to communicate well with them (and vice versa). The home is managed by a skilled, qualified and experienced manager who ensures that the home keeps up to date with new concepts and changes in legislation. This enables people living at the home to receive the best possible care. People living at the home and others are consulted about the quality of care that is provided. This enables people to express their views and to affect the way in which the home is operated. What has improved since the last inspection? Care records are now well organised so that information held within them is easy to find. This enables staff to access up to date information about people living at the home. Criminal Record Bureau (CRB) checks are now carried out on ancillary staff as well as care staff. This ensures that everyone working at the home is considered safe to work with vulnerable people. What the care home could do better: The Care Quality Commission should be notified of any safeguarding alerts sent to the local authority so that we have information about all incidents at the home that may affect the well-being of the people who live there. We recommend that a receipt should be given to people when they hand money to staff at the home for safekeeping, to protect all parties concerned from any misunderstandings. Any handwritten entries made on medication administration records should be checked and signed by two staff to reduce the risk of errors being made. Key inspection report Care homes for adults (18-65 years) Name: Address: Goddards The Goole Road West Cowick Goole East Yorkshire DN14 9DJ     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Diane Wilkinson     Date: 0 9 1 0 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 33 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 33 Information about the care home Name of care home: Address: Goddards The Goole Road West Cowick Goole East Yorkshire DN14 9DJ 01405860247 01405869981 goddardscare@btinternet.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mr Trevor Anthony Womersley,Mrs Jayne Womersley care home 11 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 11 The registered person may provide the following category of service only: Care home only - Code PC, to service users of the following gender: Either, whose primary care needs on admission to the home are within the following category: Learning disability Code LD Date of last inspection Brief description of the care home The Goddards is a privately owned care home that is situated on the main road between the towns of Goole and Snaith, in the hamlet of West Cowick. The property is a large Grade 11 listed Edwardian house built in extensive grounds and the registered provider and manager live in a separate property within the grounds. There is car parking to the front of the house. The home provides care and accommodation for 11 people with a mild to moderate learning disability, both male and female. There is a mix of single and shared Care Homes for Adults (18-65 years) Page 4 of 33 Over 65 0 11 Brief description of the care home bedrooms and two bedrooms have en-suite facilities. Shared areas within the home are spacious and comfortably furnished, and the large gardens have been provided with seating and sports/leisure equipment. Care Homes for Adults (18-65 years) Page 5 of 33 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This inspection report is based on information received by the Care Quality Commission (CQC) since the last Key Inspection of the home on the 10th October 2006, including information gathered during a site visit to the home. The unannounced site visit was undertaken by one inspector over one day. It began at 10.15 am and ended at 3.30 pm. On the day of the site visit the inspector spoke on a one to one basis with three people living at the home, a relative, staff, the registered manager and the registered provider. Inspection of the premises and close examination of a range of documentation, including two care plans, were also undertaken. The registered manager submitted information about the service prior to the site visit by completing and returning an Annual Quality Assurance Assessment (AQAA) form. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. Care Homes for Adults (18-65 years) Page 6 of 33 As part of the inspection process we sent survey forms to some residents, staff and health and social care professionals. Six were returned by residents, four were returned by staff and three were returned by health and social care professionals. Responses in surveys and comments from discussions with people living at the home, staff and relatives on the day of the site visit were positive, for example, I like living here and Skilled staff group - low staff turnover has meant staff have an excellent knowledge about and relationships with service users. The registered manager told us that the current fee for residential care is from £406.04 to £768.75 per week. At the end of this site visit, feedback was given to the registered manager and registered provider on our findings, including recommendations that would be made in the key inspection report. We have reviewed our practice when making requirements to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations - but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. Care Homes for Adults (18-65 years) Page 7 of 33 What the care home does well: People have a full care needs assessment prior to their admission to the home and then have a gradual introduction to the home to help them decide if they would like to live or have respite care there. Care plans are a personalised record of each individuals strengths and needs and the support that is needed from staff to maintain or promote independence. Person centred plans include thorough risk assessments that support responsible risk taking and a record of how decisions have been made with the person concerned. Peoples health care needs are met, including the provision of annual health checks, six monthly medication reviews and nutritional screening. Health care professionals are consulted and advice is taken and followed by staff. This promotes the health and wellbeing of the people living at the home. Independence is promoted for people living at the home; one person is considered independent enough to move out of the home into supported housing. Medication policies and procedures are robust and staff practices ensure that people receive their medication safely and as required; one person is being supported to be able to manage their own medication. Meal provision is good and is based on the expressed likes and dislikes of the people living at the home. Special diets are catered for, such as weight reducing diets and soft diets. People have a full programme of activities that includes adult education classes, attendance at day centres, taking part in social clubs and classes and in-house activities. Some people belong to the local walking group and have helped with voluntary activities within the local community. People are encouraged to have appropriate friendships and relationships and this includes being assisted to keep in touch with family and friends. People tell us that they know who to speak to if they have any concerns and that they know how to make a complaint. Most staff have attended training on safeguarding adults from abuse and this helps them to recognise poor practice and abusive situations. The home is clean, comfortable and homely - it is well maintained and people are able to personalise their own rooms. Staff are well trained and qualified - this results in a staff group that have the knowledge and skills to support the people living at the home. There is also a low staff turnover and this means that staff know the service users very well and are able to communicate well with them (and vice versa). The home is managed by a skilled, qualified and experienced manager who ensures Care Homes for Adults (18-65 years) Page 8 of 33 that the home keeps up to date with new concepts and changes in legislation. This enables people living at the home to receive the best possible care. People living at the home and others are consulted about the quality of care that is provided. This enables people to express their views and to affect the way in which the home is operated. What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 33 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 33 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. We looked at outcomes for Standard 2. People have a thorough care needs assessment prior to their admission to the home and are encouraged to visit the home and to have a gradual introduction as part of their decision making process. Evidence: The home has detailed information available for prospective service users and their relatives about the care and services on offer at the home. The manager told us in the AQAA form and we observed on the day of the site visit that the homes Service Users Guide has been redesigned into a more user friendly format to assist people in making a decision about admission to the home - this includes symbols and pictures. On the day of the site visit there was a someone who was interested in having respite care at the home visiting with their care manager. When we arrived, they were talking to people living at the home and staff about daily routines and activities at the home. We observed that they were made welcome by both residents and staff. The manager Care Homes for Adults (18-65 years) Page 11 of 33 Evidence: told us that she had arranged to visit this person at home to start the assessment process and that they had arranged for them to return to The Goddards a week later to have another look around the home. They had been given a copy of the new Service Users Guide. We looked at the records for two people living at the home. One of the assessment forms used by the home is written in the first person and asks questions such as, what do you like to be called?, do you prefer to have a bath or a shower?, do you like animals? and do you watch TV and what are your favourite TV programmes? People living at the home told us in surveys, I like living here, It is lovely and It is good. Assessment information gathered by the home includes details of all of the people involved in that persons care, a personal profile, appropriate risk assessments and any restrictions on choice and freedom that may be necessary. Input is sought from any health or social care professionals who are involved with the service user at their time of admission. The manager told us in the AQAA form that they intend to explore the availability of advocates to assist people with decision making when they are thinking about admission to the home. When the service is commissioned by a local authority, a copy of their community care assessment and care plan is obtained by the home. This information, along with the homes own care needs assessment, is used to develop an individual plan of care for the person concerned. Care Homes for Adults (18-65 years) Page 12 of 33 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. We looked at outcomes for Standards 6, 7 and 9. People are supported by staff to be independent and to make their own life choices. This is accompanied by good care planning systems and robust risk assessments. Evidence: We examined the care records for one person who lived at the home permanently and another who had regular respite care at the home. These included a range of documentation including a care needs assessment, a personal profile, a variety of risk assessments and a star profile - this is a social competence assessment. Care plans are very specific and are focused on the health, personal and social care needs and strengths of each individual. They include information about preferred daily living routines and about how any behaviours should be managed by staff. It is clear that health and social care professionals such as psychologists and nurses are Care Homes for Adults (18-65 years) Page 13 of 33 Evidence: contacted whenever staff have concerns about a persons health care needs or changing behaviours. Care plans clearly record the advice given by these professionals and there is evidence that this advice is followed as part of the day to day care package provided by staff. Any challenging behaviour displayed by people living at the home is recorded and monitored and the information is shared with health and social care professionals appropriately so that decisions can be made about future strategies for improving behaviours. The plan is drawn up with the involvement of the service user, their family and relevant agencies and/or specialists. Care plans are currently being redeveloped so that the information is more person centred. Headings used include personal care, communicaton, nutritional needs, social/recreational needs and behavioural needs. Each section is further expanded to give specific details such as hair washing needs and strengths, teeth cleaning needs and strengths, shaving needs and strenghs and so on. Care plans are accompanied by a variety of risk assessments that are specific to the needs of the individual and support risk taking and decision making. Areas include road safety, vulnerability and inappropriate behaviour We spoke to the parent of someone who has respite care at the home. They told us that their sons/daughters stays at the home have increased their independence and have introduced them to new activities, and have got them used to sharing with other people and being tolerant rather than having the one to one attention they receive at home. They felt that this should improve their chances of living in supported housing at some time in the future. Records evidenced that regular reviews of care plans take place - one of the care plans we saw had been reviewed every six months; these alternate between formal and informal reviews and records are kept with the individual care plan. Care plans are updated if new information or new strategies are identified as part of the review process. We saw that a lot of information is collated by the home in preparation for care reviews, such as photographs of people taking part in activities and details of how their leisure time is spent. Care plans include information about a persons capacity to make decisions and record how individual choices have been made. They record the level of risk that is involved in promoting a persons independence and how this should be managed. It is evident that people are allowed to take responsible risks - people go out into the community unaccompanied by staff (following a period of assessment and training to ensure that Care Homes for Adults (18-65 years) Page 14 of 33 Evidence: this is safe) and one person has become independent enough to move out of the care home into supported housing. Care Homes for Adults (18-65 years) Page 15 of 33 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. We looked at outcomes for Standards 12, 13, 15, 16 and 17. People living at the home enjoy a very fulfilling lifestyle, where independence and family and community contact is promoted. Evidence: The AQAA form includes information about group and individual leisure and educational activities undertaken by people living at the home. These include day centre attendance, taking part in music, drama and dance classes and attending adult education classes and art classes. Some of the art work completed by people living at the home was included in a local exhibition and people took part in a production of the Sound of Music, with one service user taking the lead role. The manager told us that one person attends two adult education classes and another person is attending taster sessions to help them decide which classes to take. Care Homes for Adults (18-65 years) Page 16 of 33 Evidence: Six people living at the home returned a survey and they all told us that they can do what they choose during the day, in the evenings and at weekends. Each care plan includes a form (a weekly programme of activities) that is entitled, How do you spend your week? This records a persons activities for the full week, am and pm and includes information about educational and social activities. The home is close to the town of Snaith and this gives people easy access to local facilities. People use public transport and the homes own mini-bus to access these services or services in other neighbouring areas, but Snaith is also within walking distance. People take part in the local community, for example, participating in bulb planting and litter picking locally. Three service users and the provider/manager were asked to officially open the Church Christmas fete and they were asked to contribute to a display for Snaith Heritage Day by putting on a display about food from different cultures. Some group activities take place such as barbeques at the home, a holiday to Caistor, taking part in a walking group and visits to the local social club. Other activities are undertaken by individuals such as watching Doncaster Rovers games, going to see the Tall Ships in Hull and visiting Whitby to see the Dracula Experience. Two people are having guitar lessons and others have had golf taster sessions at the local golf club. One person living at the home is American and the home make a point of celebrating Independence Day every 4th July by all service users enjoying coca cola and ice-cream. On the day of the site visit one service user was in the kitchen with the cook - they were making scones, which the inspector was allowed to sample. There is a computer in the lounge for people to access and other in-house activities include arts and crafts, movement to music and indoor games. We noted that there was a scary Haloween display in the entrance hall. The manager recorded in the AQAA form, We have passed on information that we have received about political parties to service users, prior to assisting them to vote. People are supported to keep in touch with family and friends and have opportunities to meet people and make friends outside of the home. On the day of the site visit people told us about their family contact and about their friends. One care plan that we saw recorded information about the telephone calls from their relatives during their respite stays at the home. Daily routines are flexible - we saw on the day of the site visit that people could spend time on their own or with others, that staff used their preferred name as recorded in Care Homes for Adults (18-65 years) Page 17 of 33 Evidence: their care plan and that staff interact well with service users. People have responsibility for some household tasks such as keeping their bedroom tidy, with help from their key worker. People living at the home told us that they like the meals that are provided. The manager recorded in the AQAA that the cook has regular meetings with service users so that they can help with menu planning. Service users suggest a list of meals and the cook prepares menus for 6 - 8 weeks based on this list. The cook has a book where she records the likes and dislikes of foods for both permanent and respite residents. The manager told us that some people like hot foods such as chilli but others dont, so on these occasions an alternative to the main meal is offered. The menu is not displayed but people are told each day what the meals are going to be. People have a light meal at lunchtime and the main meal in the evenings. We were told that the meal for the previous evening had been quiche, potato wedges and salad, but that some people chose beans instead of salad. The manager told us that two people are on weight watching diets so they only have things like chips and curry once a week. Two people are underweight so they are trying to encourage these people to eat more and another person is on a soft diet. The manager told us that they only use good quality foods - they purchase their vegetables from the local farmshop and their meat from the local butcher. Care Homes for Adults (18-65 years) Page 18 of 33 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. We looked at the outcomes for Standards 18, 19 and 20. Peoples health care needs are met, including consultation with health care professionals to ensure that their health and well being is promoted. Evidence: We saw information in care plans about a persons need for support with personal care; this is individual to the person concerned and is very detailed. Two of the health care professionals who commented on this aspect of care told us that the care service always respect the privacy and dignity of the people living at the home. People have a key worker and a co key worker so that there is consistency in offering assistance with personal care. We saw on the day of the site visit that people choose their own clothes and hairstyle and people told us about their trips out to buy clothes. We observed that people are given guidance and support regarding personal hygiene. There is a nutritional screening tool in use and we noted that people are weighed on a Care Homes for Adults (18-65 years) Page 19 of 33 Evidence: monthly basis and this is recorded, so that their weight can be monitored. Visits to GPs, dentists, opticians and other health care professionals are recorded in care plans. Each person has an annual health check; the manager told us that, this year, this took place at the same time as people were given their flu jab. In addition to this, the manager told us that a GP attends the home every six months to undertake a medication review for all people living at the home. Some people are receiving on-going support from psychologists to deal with particular behaviours and very detailed information has been provided for the individual concerned and for staff on how to manage these behaviours; this was recorded confidentially in the care plan we examined. We noted that the homes medication policy was reviewed in June 2009 and that it meets current requirements. We examined the recording and storage arrangements for medication administered by staff. Medication administration record (MAR) sheets include a photograph plus details of the persons GP, any allergies they have and details of individual medications. The MAR book included a list of all service users, the medication prescribed to them and guidelines for staff on the administration of as required (PRN) medication. There were no gaps in recording on MAR sheets but we recommended that any handwritten entries made on MAR sheets should be signed by two staff to reduce the risk of inaccurate entries being made. Medication is provided by the pharmacist in colour coded blister packs and some medication that cannot be stored with other medication is provided in separate blister packs. A returns book is used to record any unused medication that is returned to the pharmacist. Plans are currently in place for one person to move out of the home into supported housing. They are being supervised by staff so that they will be able to administer their own medication. Currently they are taking their own medication from the blister pack and signing their own MAR sheet, observed by staff. Staff that are responsible for the administration of medication have undertaken appropriate training and the manager told us that she monitors the medication system on a monthly basis to check that staff are following the homes policies and procedures. Care Homes for Adults (18-65 years) Page 20 of 33 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. We looked at outcomes for Standards 22 and 23. People living at the home are protected from abuse by the systems in place and staff training, and they tell us that they know who to speak to if they have any concerns or complaints Evidence: Six people living at the home returned a survey to us. They told us that they know who to speak to if they not happy; two people mentioned someone by name. They also told us that they know how to make a complaint. Three health and social care professionals told us that the home has always responded appropriately if anyone has raised concerns. There is a complaints policy and procedure in place and complaints information used at the home was updated in April 2009 and the manager told us that they regularly review the complaints procedure during house meetings. There have been no recorded complaints made to the home during the last three years although there is a system in place ready to record any complaints or concerns. There are risk assessments in place within individual care records to reduce the risks from people whose behaviour could cause possible harm to others and staff have Care Homes for Adults (18-65 years) Page 21 of 33 Evidence: attended training on how to manage challenging behaviours. The manager told us in the AQAA form that eleven staff have undertaken training on safeguarding adults from abuse, and that she has attended training on the Vetting and Barring scheme. The manager makes safeguarding referrals to the local authority appropriately and follows local protocols. We advised that the Care Quality Commission should be notified of any incidents that require referral to the local authority via a safeguarding alert so that we are made aware of all incidents at the home that may affect the well-being of the people who live there. Staff support residents to manage their monies and asssit them with budgeting; everyone living at the home has their own bank account and service users withdraw their own money using a cash card. Any money held on behalf of people living at the home is held safely and satisfactory financial records are kept. We recommend that a receipt is given to relatives when they hand money to the home for safekeeping to protect all parties concerned from any misunderstandings. Care Homes for Adults (18-65 years) Page 22 of 33 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. We looked at outcomes for Standards 24 and 30. The home provides a clean, comfortable and safe environment for the people who live there, and people are able to personalise their bedrooms. Evidence: The home is a large detached property that is situated in extensive grounds. It is maintained in a safe condition and is comfortable, bright, cheerful, clean and free from unpleasant odours. People who have a respite stay at the home are accommodated in dedicated bedrooms but they share communal accommodation with permanent residents. This is to enable them to develop social skills and become more independent by mixing with residents and taking part in activities and mealtimes with people who live at the home permanently. People have personalised their bedrooms to reflect their interests and personalities; the manager told us in the AQAA form that they have recently decorated one bedroom in Manchester United colours at the request of the service user. Since the last key Care Homes for Adults (18-65 years) Page 23 of 33 Evidence: inspection the kitchen, hall, corridors and staff toilet have been redecorated. The Coach House is now included within the homes overall registration. Two people moved into the Coach House in July 2007 when their current place of residence (The Cottage - the sister home of The Goddards) was flooded and had to be vacated. The Cottage was subsequently deregistered. There was one bathroom for the two bedrooms in the Coach House and this allowed one bedroom to have en-suite facilities. The CQC Registration team agreed to the other bedroom being used for a period of six months without being registered. They said that en-suite facilities should be installed and that the registered persons should submit a major variation following this six month period. When we visited the home we noted that the en-suite room had been built but that the toilet and basin had not been plumbed in. This was discussed with the registration team, the local area manager and the area manager and it was agreed that it would be in the service users best interests to remain in that bedroom and for en-suite facilities to be completed as soon as possible. The registered persons agreed to action this and to submit an application for a major variation immediately. We saw the laundry facilities at the home and noted that these were satisfactory. The manager told us in the AQAA form that they have started the renovation of the laundry room. The manager has undertaken a Train the Trainer course on infection control and has conducted an in-house training session for staff on this topic. We saw on the day of the site visit that staff follow good hygiene practices. The manager told us in the AQAA form that, at house meetings, she has encouraged people living at the home to consider infection control and effective hand washing. Care Homes for Adults (18-65 years) Page 24 of 33 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. We looked at the outcomes for Standards 32, 34 and 35. People are supported by well trained and skilled staff who have been recruited via a robust recruitment and selection process - they have a high level of knowledge about the needs of the service users, which helps to ensure that their assessed needs are met. Evidence: The manager recorded in the AQAA that they have fourteen members of care staff and that three of these have completed National Vocational Qualification (NVQ) Level 2 in Care; one person is currently working towards this award. In addition to this, one member of staff has achieved NVQ Level 3 in Care and a further three members of staff are working towards the Level 3 award. A male modern apprentice has been working at the home and they intend to employ him on a permanent basis when the modern apprenticeship comes to an end. Another male carer is also employed at the home so they are able to offer people living at the home a carer of the same gender if this is their wish. Care Homes for Adults (18-65 years) Page 25 of 33 Evidence: Training records held at the home evidence that staff have the knowledge of topics that enable them to offer appropriate care to people living at the home, such as challenging behaviour, epilepsy awareness, equality and diversity, first aid and the protection of vulnerable adults. On the day of the site visit we observed that staff communicate well with people living at the home and that they are comfortable with the service users. The manager told us in the AQAA form that they have a stable, motivated and knowledgeable staff team. We received three surveys from health and social care professionals. They all told us that the services managers and staff have the right skills and experience to support peoples social and health care needs. One person added, Skilled staff group - low staff turnover has meant staff have an excellent knowledge about and relationships with service users. We looked at the recruitment records for a new member of staff. These included an application form that recorded the persons qualifications, employment history, training undertaken and the names of two referees. People are also asked to sign a declaration stating that they have no criminal convictions. A job interview assessment form has been retained following the persons interview along with a copy of the questions asked and responses given. Two written references and a POVA first check had been obtained and were in place prior to the person commencing work at the home. The manager told us that this member of staff worked under supervision until CRB clearance was received a month later. Copies of the persons training certificates are retained by the home for future reference and to evidence that the person has undertaken the training recorded on their application form. Staff are supplied with a copy of the homes Business Aims and Objectives for the current year and are given information about the concept of key working and confidentiality. They also receive a copy of the General Social Care Council code of conduct and are asked questions about this as part of their induction training. Staff are issued with a contract of employment. Details of the persons induction training is recorded and we noted that people have one to one supervision with the manager following week 5 of their induction training their induction training is discussed and they are asked questions to verify that they have understood the training. The new member of staff attended safeguarding training a couple of months after they started work at the home and we saw evidence in their records that they had a learning and development review with the manager following this training to check out Care Homes for Adults (18-65 years) Page 26 of 33 Evidence: their level of understanding. This is good practice. The manager told us in the AQAA form that there is now a training record and a training plan in place at the home; the training plan focuses on the training needs of the staff group. The training record evidences that 8 staff have undertaken training on health and safety, all staff have done fire awareness, first aid, safeguarding adults from abuse and equality and diversity training, 12 staff have done training on food hygiene and epilepsy awareness and 9 staff have done training on infection control. The manager told us that all staff will be doing moving and handling training shortly via Selby College - they have agreed to facilitate two training sessions at The Goddards. Care Homes for Adults (18-65 years) Page 27 of 33 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. We looked at outcomes for Standards 37, 39 and 42. People who live at the home benefit from a well managed service where they are involved in decision making and quality improvements, and where proper attention is given to ensure their health, safety and well-being. Evidence: The manager is qualified, competent and experienced to run the home and meet its stated purpose. She has a BA Hons. in Psychology and Sociology and has achieved the Registered Managers award. However, the training company went into liquidation so she did not receive a certificate. She is therefore continuing with training at NVQ Level 4 by working towards the Leadership and Management award and NVQ Level 4 in Care. The manager is a member of the registered care homes association and has also been involved in a registered managers group as part of a Humber Leadership and Management group. This helps her to keep her practice up to date and she told us that Care Homes for Adults (18-65 years) Page 28 of 33 Evidence: this has led to her having a greater understanding of the personalisation agenda. She has recently attended training on the Mental Capacity Act, Deprivation of Liberty and Vetting and Barring and has done a Train the Trainer course on infection control so that she is able to provide in-house training to the staff group. There is a quality assurance system in place at the home and the home retained the Investors in People award when they were revisited in 2007. The manager told us in the AQAA form, In-house quality assurance surveys take place on an annual basis, culminating in an annual service review where planning and action for the subsequent year is formulated. Results are circulated to all parties involved. The manager told us that surveys are sent to people living at the home, parents/carers, respite service users and commissioners/other agencies. We saw the QA results for 2008 and noted that topics included in the surveys were personal care, staff, choice, keyworkers, dealing with concerns and activities. We also saw details of a specific quality assurance meeting that took place at the home in May 2009. House meetings and staff meetings are held and regular service user reviews also take place. This gives people the opportunity to express their views about the service provided by the home. We saw the minutes of the most recent house meeting - these evidenced that the topics discussed were privacy and confidentiality, suggestions for outings and activities, the new service user guide (this was shown to service users). They also announced the winner of the colouring competition with the title of Safe, clean hands. Minutes of these meetings are in symbol format so that they can be read by people living at the home. We examined a sample of health and safety documentation held at the home. The fire book includes a list of all service users and the locality of their bedroom. The homes fire safety policy was reviewed in June 2009 and the fire risk assessment was updated in November 2008. There are up to date test certificates in place for the fire alarm system, emergency lighting and fire fighting equipment. Staff take part in a fire drill every 1 or 2 months and service users have a monthly fire drill. Weekly fire tests take place consistently. We received some information (anonymously) a few weeks prior to the key inspection from someone who told us that the fire alarm had gone off early one morning and there was only one member of staff on duty to evacuate the building. The manager told us that there is a direct intercom into their home so they would know immediately if there was any kind of emergency and would go to the home straight away; they live in a property in the homes grounds and consider themselves to be sleep in staff. Care Homes for Adults (18-65 years) Page 29 of 33 Evidence: A portable appliance test took place in August 2009 and we noted that this included the testing of all appliances that belong to people living at the home as well as equipment belonging to the home. There are risk assessments in place for safe working practice topics, there are comprehensive health and safety policies and procedures in place and staff undertake training on health and safety topics. This helps to protect people living and working at the home from the risk of harm. Care Homes for Adults (18-65 years) Page 30 of 33 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 31 of 33 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 17 The home should consider displaying a daily menu to encourage people to check the meals on offer independently. Two people should sign hand written entries on medication administration records to reduce the risk of inaccurate information being recorded and to protect people from the risk of harm. We reminded the registered persons that the Care Quality Commission should be notified of any incidents at the home that require a referral to be made to the safeguarding adults team, to ensure that we are kept informed of all incidents that may affect the welfare of the people living at the home. We recommend that a receipt should be given to relatives when they hand money to the home for safe keeping to protect all parties concerned from any misunderstandings. Staff training in NVQ Level 2 in Care should continue so that 50 of the stafff group have achieved this award. 2 20 3 23 4 23 5 32 Care Homes for Adults (18-65 years) Page 32 of 33 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. 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