Care Home: Gonville Road (33)

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What the care home does well This small service offers people a homely and family style environment. The home is comfortably furnished and decorated and bedrooms reflect the individuality and choice of the people who stay there. A new en suite shower has been built for one person and was near completion at the time of our visit. The owners and staff work hard to meet the needs of the people they support and encourage individuals to achieve their personal ambitions. They are approachable, have a caring attitude and respect the views of the people living in the home. People using the service are provided with a range of stimulating and varied activities to meet both their needs and social interests. This extends to both within the home and the local community. Surveys provided by the home to people using the service were complimentary and responses all ranged from ‘very’ to ‘quite’ satisfied. The home is managed by a committed and knowledgeable manager, who knows each person`s assessed needs and individuality. The owners showed good knowledge about the people they look after but record keeping must improve to reflect the service`s good intentions for providing care.Gonville Road (33)DS0000028514.V377795.R01.S.docVersion 5.3 What has improved since the last inspection? Information has been updated so that people have the necessary details about the home and the additional respite care services it offers. Needs assessments have been completed for the two people who use the service for short term stays as well as medication administration charts. The care plan for one person now covers all aspects of their health, personal and social care needs in ways that give ownership to them. This person centred approach now needs to be applied for other people who use the service. Progress has been made with regards to training and development for staff. Both the owners and staff have attended further training to keep their knowledge and skills up to date in meeting the needs of people using the service and to understand new legislation. Training has included safeguarding, the Mental Capacity Act and DoLS (Deprivation of Liberty Safeguards). They have also updated key health and safety training in fire safety, infection control, moving and handling and first aid. The small staff team now benefit from regular supervision that supports individuals to do their jobs well and reflect upon their performance and practice. The staff recruitment processes have been strengthened to ensure that the people using the service are safeguarded from possible harm and poor practice. The quality assurance process has improved since we last visited. People using the service and their relatives have been given questionnaires to seek their views about the home. All gave complimentary feedback. What the care home could do better: Whilst we have assessed that the home has made progress, there are some areas that still need development in relation to care planning, risk taking and record keeping for people who use the service. In addition, four issues remain outstanding from our last inspection and must be prioritised. We have therefore extended this requirement for a final time and may consider taking enforcement action if there is another failure to comply. When someone moves in, a review must be carried out after the introductory period to ensure that a person is happy with the services and that the home is suitable to meet their individual needs. Any person using the service must have an up to date plan of care so that staff have clear guidance on how to meet their care needs effectively and promote their health and welfare. Staff also need written guidance on how to support people`s needs whilst managing any risks. This will make sure people are safe and individual needs are met. Risk assessments must therefore be developed. Each person, including those who stay on a short term basis must have an up to date and relevant contract so that they have accurate information about how much they will pay and what the home provides for the money. The home needs to keep better records to show that the people using the service for short term care get the individual care they need and are safe.Gonville Road (33)DS0000028514.V377795.R01.S.docVersion 5.3We have also identified that the following areas require improvement. Risk assessments for people must be kept under regular review so that staff have the most up to date guidance on what action to take to support their needs and promote their safety and independence. The manager needs to obtain a copy of the latest local authority guidance on safeguarding vulnerable adults and use it in conjunction with the home’s own policy. This is so that staff know how they should respond in line with the correct procedures for protecting people. Although the Quality Assurance process has developed, an annual plan is now needed that outlines the expected aims and objectives for improving the services and that reflects the views of people living in the home and their representatives. This needs to be completed once a year and reviewed annually after that. To enhance the running of the service and safeguard the interests of the people who use it, record keeping needs to improve and be kept in good order. This will also enable better accessibility to records for the staff and other professionals. Risk assessments concerning the premises and safe working practices need review and further detail. Information is also needed concerning access to the laundry area as such restrictions could be construed that people are not fully able to exercise their rights within the home. Any risks must be recorded to ensure that the rights of people using the service are considered and protected. Key inspection report CARE HOME ADULTS 18-65 Gonville Road (33) Bovell`s Lodge 33 Gonville Road Thornton Heath Surrey CR7 6DE Lead Inspector Claire Taylor Key Unannounced Inspection 24th September 2009 10:45 Gonville Road (33) DS0000028514.V377795.R01.S.doc Version 5.3 Page 1 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. 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 home adults 18-65 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. Gonville Road (33) DS0000028514.V377795.R01.S.doc Version 5.3 Page 2 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 Gonville Road (33) DS0000028514.V377795.R01.S.doc Version 5.3 Page 3 SERVICE INFORMATION Name of service Gonville Road (33) Address Bovell`s Lodge 33 Gonville Road Thornton Heath Surrey CR7 6DE 020 8683 4802 T/F 020 8683 4802 wilfredbovell@yahoo.co.uk Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Wilfred Bovell Barbara Ellaine Bovell Mr W Bovell Care Home 3 Category(ies) of Learning disability (3) registration, with number of places Gonville Road (33) DS0000028514.V377795.R01.S.doc Version 5.3 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 25th September 2008 Brief Description of the Service: Bovells Lodge is a small care home for up to three adults who have a learning disability. The home is situated in a residential area of Thornton Heath with good access to local transport links and amenities. There are three good- sized single bedrooms on the first floor, communal lounge, open plan dining / kitchen area, laundry and office. There is a garden to the rear of the home with paved area. The registered owner is also the manager and is very involved with the day to day running of the service. The property is also the private residence of the owners. At the time of this inspection one person was living permanently in the home and two other people were using the service for short term stays. The weekly fees for a place at the home start at £1096.00 and were correct at the time of this inspection. Additional charges are payable for holidays, some activities and personal items such as toiletries. Any extras would be discussed prior to admission. Copies of the homes Statement of Purpose and Service User Guide can be obtained directly from the home. Gonville Road (33) DS0000028514.V377795.R01.S.doc Version 5.3 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This key inspection visit was unannounced and lasted four and a half hours. We met with the one person who has lived at the home for many years and the manager/owner Mr Bovell assisted us with the inspection. Two other people use the service periodically for short term or respite care breaks but were not staying when we visited. We looked at various records in relation to peoples care, staffing and the way the home was being run. We also looked around the building and checked to see that the environment was safe. Prior to the visit, the home returned its Annual Quality Assurance Assessment (AQAA) when we asked for it. This is a self-assessment that must be completed once a year. It is used to tell us about the services provided, how well outcomes are being met for people using the service and any planned developments. Some details from the AQAA are included in this report. Following the homes last key inspection in September 2008, we asked the provider to complete an improvement plan which is used to tell us how the home will meet the required improvements. We received a response within the correct timescale and checked that the plan had been actioned as part of this inspection. We did not receive any comment cards back on this occasion but we spoke with the person who lives in the home and a new part time member of staff to ask for their views about the service. What the service does well: This small service offers people a homely and family style environment. The home is comfortably furnished and decorated and bedrooms reflect the individuality and choice of the people who stay there. A new en suite shower has been built for one person and was near completion at the time of our visit. The owners and staff work hard to meet the needs of the people they support and encourage individuals to achieve their personal ambitions. They are approachable, have a caring attitude and respect the views of the people living in the home. People using the service are provided with a range of stimulating and varied activities to meet both their needs and social interests. This extends to both within the home and the local community. Surveys provided by the home to people using the service were complimentary and responses all ranged from ‘very’ to ‘quite’ satisfied. The home is managed by a committed and knowledgeable manager, who knows each persons assessed needs and individuality. The owners showed good knowledge about the people they look after but record keeping must improve to reflect the services good intentions for providing care. Gonville Road (33) DS0000028514.V377795.R01.S.doc Version 5.3 Page 6 What has improved since the last inspection? What they could do better: Whilst we have assessed that the home has made progress, there are some areas that still need development in relation to care planning, risk taking and record keeping for people who use the service. In addition, four issues remain outstanding from our last inspection and must be prioritised. We have therefore extended this requirement for a final time and may consider taking enforcement action if there is another failure to comply. When someone moves in, a review must be carried out after the introductory period to ensure that a person is happy with the services and that the home is suitable to meet their individual needs. Any person using the service must have an up to date plan of care so that staff have clear guidance on how to meet their care needs effectively and promote their health and welfare. Staff also need written guidance on how to support peoples needs whilst managing any risks. This will make sure people are safe and individual needs are met. Risk assessments must therefore be developed. Each person, including those who stay on a short term basis must have an up to date and relevant contract so that they have accurate information about how much they will pay and what the home provides for the money. The home needs to keep better records to show that the people using the service for short term care get the individual care they need and are safe. Gonville Road (33) DS0000028514.V377795.R01.S.doc Version 5.3 Page 7 We have also identified that the following areas require improvement. Risk assessments for people must be kept under regular review so that staff have the most up to date guidance on what action to take to support their needs and promote their safety and independence. The manager needs to obtain a copy of the latest local authority guidance on safeguarding vulnerable adults and use it in conjunction with the home’s own policy. This is so that staff know how they should respond in line with the correct procedures for protecting people. Although the Quality Assurance process has developed, an annual plan is now needed that outlines the expected aims and objectives for improving the services and that reflects the views of people living in the home and their representatives. This needs to be completed once a year and reviewed annually after that. To enhance the running of the service and safeguard the interests of the people who use it, record keeping needs to improve and be kept in good order. This will also enable better accessibility to records for the staff and other professionals. Risk assessments concerning the premises and safe working practices need review and further detail. Information is also needed concerning access to the laundry area as such restrictions could be construed that people are not fully able to exercise their rights within the home. Any risks must be recorded to ensure that the rights of people using the service are considered and protected. 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. Gonville Road (33) DS0000028514.V377795.R01.S.doc Version 5.3 Page 8 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Gonville Road (33) DS0000028514.V377795.R01.S.doc Version 5.3 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,4 and 5 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People’s needs are more fully assessed prior to moving in although the admission process should be arranged in a more planned way. This will ensure that each person’s needs are understood and can be met. Up to date contracts are needed so that people have accurate information about the facilities and services they can expect to receive. EVIDENCE: At our last inspection, we required for the Statement of Purpose to be rewritten as it was unclear as to the range of needs that the home could accommodate, namely the provision of respite care services. The manager reviewed the document as well as the Service User Guide in January 2009 and sent us a copy. Both were clear and reflected all the required information to ensure that people or their relatives know about the service and facilities available to them. The statement of purpose included information about respite care arrangements that the home offers. As previously required, the manager had completed needs assessments for the two people staying periodically for respite care. In addition, he had obtained copies of the summary and care plans from the assessments carried out through care management arrangements. This means that staff now have up to date information about Gonville Road (33) DS0000028514.V377795.R01.S.doc Version 5.3 Page 10 each person’s care needs and how to support them. Although there were no records of a review meeting for the two respite care people, the placing authority carried out a placement review in April this year. The manager is reminded however that the home must undertake a review after the introductory period to ensure that the person is happy with the services and that the home is suitable to meet their individual needs. We previously required the home to improve upon its contracts as one was out of date and did not reflect accurate details about the service being provided or the costs involved. There were also no contracts for the two people who stay on a shortterm basis. The manager conceded that he had not revised the contract or provided a written statement of terms and conditions for the two people using the service for respite care. People and/or their representatives must have clear information about the obligations of the provider and the persons responsibilities when using the service. Full details about any extra costs needs to be included so that people have accurate information about any additional services they can expect to pay for. Gonville Road (33) DS0000028514.V377795.R01.S.doc Version 5.3 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The care planning and risk management process still needs improvement, as it does not give assurance that all people’s needs are being fully met. People using the service are consulted and given opportunities to influence how the home is run. EVIDENCE: The AQAA stated, “All residents have a care plan which reflects their individual care and social needs. From these individualised care programmes are agreed to deliver the best possible outcomes for the service user.” We saw that not all people using the service had an up to date care plan that reflected their needs and goals. Overall, we saw very limited information about the two people who use the service on a short-term basis which does not give assurance that their needs are being met. The home has worked well however to develop one care plan for the person who lives permanently at Gonville Rd. The manager has Gonville Road (33) DS0000028514.V377795.R01.S.doc Version 5.3 Page 12 used more person centred approaches and written a plan of care and support that recognises the person’s individuality and their preference for the delivery of care. The person centred plan had been reviewed in September this year and gave good information about individual needs, any changes and the necessary support that staff should provide. The plan also emphasised the individuality of the person and reflected their qualities and personality. Individual diaries are used daily and records seen were thorough, relevant, and also gave a sense of that person’s experience of their day. Similar care plans must be developed for people who use the service short term however. This will enable staff who are not familiar with the person to deliver consistent person centred care. Through daily records and on discussion with the person we met, we saw that their choices are respected and they are very involved with making decisions about their lifestyle and way of life in the home. We saw that they are fully involved in the daily routines and encouraged to be independent wherever possible. Risk assessments seen within the personal file of one person had not been reviewed or updated for over a year. In addition, risk plans had not been developed for the other two people who use the service to fully safeguard them from potential harm. We required this to be done at our last inspection and may take enforcement action in the future if there is a continued failure to comply. Through discussion, we recognised that the owner and staff clearly know how to support the needs of each person but record keeping must improve to reflect the good provision of care. Planned improvements on the AQAA told us, “We intend to embed the mental Capacity Act safeguards into the home and embrace the legal frame work to protect both our service users and our staff.” Gonville Road (33) DS0000028514.V377795.R01.S.doc Version 5.3 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): This is what people staying in this care home experience: 12, 13, 14, 15, 16 and 17 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service make choices about their lifestyle and are provided with a range of activities to enhance their lives and meet their needs and interests. People are supported to keep in touch with their families and friends and maintain relationships that are important to them. Meals are nutritional and take into account peoples individual preferences and choices. EVIDENCE: The AQAA told us, “Service users have enjoyed their trips to the seaside and other places of interests.” We looked at records related to one person’s lifestyle. Written in a person centred way, the plan included lots of detail about their interests and how best to support them. There were sections to tell staff what the person liked or disliked as well as their favourite interests and hobbies. We met with the person who spoke enthusiastically about all the Gonville Road (33) DS0000028514.V377795.R01.S.doc Version 5.3 Page 14 different activities and outings they took part in. They included karate, judo session, church visits, trips to Brighton, college and a recent summer holiday to Blackpool. This corresponded with the persons care plan. The person living permanently in the home also goes to a day care placement two days a week and attends an adult education college. Other community activities include shopping, eating out, walks and meeting friends at a weekly social club. The manager advised that the other two people who come to stay attend a day care centre in Lambeth during weekdays. The care plan included details about the person’s social network and who is important in their lives. As discussed earlier in the report however, similar records must be kept for the two people who stay short term. Families are involved and the staff support people to keep contact with those that are close to them. One person is assisted to telephone their relative regularly. Records showed that family, friends and guests are welcome at the home and that the manager maintains good communication links with peoples respective families or representatives. Due to the small size of the home, there were no specific menus. We saw that daily records are kept of what is eaten so that the staff can monitor each persons food intake and ensure a nutritional diet. These showed that people are offered a varied and balanced diet that also takes into account individual choice and any cultural preferences. Meals are home cooked and the person we spoke to confirmed that they enjoyed the food. We saw that people can eat at flexible times which fit in with their daily routines and lifestyles. A choice of meal is provided and people are consulted about what they would like to eat. Gonville Road (33) DS0000028514.V377795.R01.S.doc Version 5.3 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Promotion of health is generally well observed although healthcare plans must be developed for people who stay short term. Without the right support, this could lead to peoples individual health needs not being met. Medication practices have improved to ensure people’s health and well being. EVIDENCE: Records and observations showed that staff respect peoples choices and know their preferred routines. Based on the written records we saw for the one person living permanently in the home, people generally receive appropriate support to access the health services they require. Their care plan outlined the support they may need for health check-ups and health screening. Any specific healthcare needs, such as epilepsy, were also recorded. Written in a more person centred way, the plan provided staff with clear details on how the individual liked to be supported with their personal care and what staff must do to ensure their health and well being. The person is fully supported to access Gonville Road (33) DS0000028514.V377795.R01.S.doc Version 5.3 Page 16 relevant specialist services on a routine basis. Individual records show involvement with a number of healthcare professionals including GP, Consultant and dentist. Staff keep a detailed record of all appointments, outcomes and any follow up action required. We saw that the person had recently visited their GP for a general health check. As highlighted at our last inspection similar records must be kept for the two people who use the service on a short stay basis. This is so that staff have written guidance about the specific health and personal care support each individual requires. Without such information, their healthcare needs may not be met. The home has a suitable policy on the management of medication. People who use the service need full support to take their own medication and this was reflected in the one care plan we saw. In response to our last inspection, administration charts were in place for the two respite care users. We further suggest that the manager writes medication profiles for each person so that staff know what their medication is for and the reasons for its use. Records were accurate for the receipt and disposal of medication and sampled administration charts were signed and accounted for. All medicines were stored appropriately in a locked cabinet in the kitchen. An improvement on the AQAA stated, “We had members of staff trained in medication giving.” Records confirmed that staff had refreshed their medication training. Gonville Road (33) DS0000028514.V377795.R01.S.doc Version 5.3 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Good practices and policies are in place to enable concerns to be raised and responded to. Improvements have ensured that people are more fully protected and staff have a better understanding of safeguarding although the home must obtain up to date policy guidance from the local authority. EVIDENCE: The home has a complaints procedure that is also produced in pictorial format to assist people in their understanding and communication. The procedure is displayed in the office area. Due to the home’s small size, informal concerns raised by individuals are addressed through discussion with staff on a day- today basis. The person we spoke to knew who to talk to if they were unhappy or wanted to complain. We have received no complaints or safeguarding alerts about this home in the last 12 months. Records showed that all staff apart from the newest member have undertaken recent training in safeguarding vulnerable adults through the local authority of Croydon. We saw a policy on abuse but there was no up to date local authority guidelines for safeguarding. The home must have a policy that includes multi agency procedures so that staff are aware of the correct guidance and know how to refer concerns of this nature to the local social services department. The AQAA stated, “We will work with our umbrella body to introduce the Independent Safeguarding Authority arrangements. We will ensure that any complaints are recognised even if not formally made.” Gonville Road (33) DS0000028514.V377795.R01.S.doc Version 5.3 Page 18 The one person living in the home needs full support with their finances and the manager is the designated appointee. Appropriate documentation was in place with regard to income/expenditure made on peoples behalf as well as policies to safeguard their personal interests. We saw that accurate records are kept of all financial transactions and daily checks are made to ensure that these are correct. Personal expenditure sheets were sampled and balanced correctly with cash amounts held in the home. These systems help to ensure that peoples financial interests are safeguarded. Gonville Road (33) DS0000028514.V377795.R01.S.doc Version 5.3 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 24, 26 and 30 People using the 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 live in a comfortable, homely and generally safe environment. Bedrooms are designed and furnished to meet peoples individual needs, personal preferences and interests. The premises are clean, hygienic and kept in a good state of repair. EVIDENCE: For what the service does well, the manager wrote on the AQAA, “The home is kept clean, hygienic and free from offensive odours by good practice within the care staff team, and a skilled housekeeping team. The home has an ongoing rolling programme of decoration. Prior to new residents being admitted to the home, their room is redecorated. Where possible they will be able to choose the colour of their room.” Some home improvements have been carried out since our last inspection such as redecoration and the owner was in the process of completing an en suite Gonville Road (33) DS0000028514.V377795.R01.S.doc Version 5.3 Page 20 shower room for the person who lives permanently at the home. This person showed us their bedroom which had been furnished to meet their needs and lifestyle. The room was personalised with things that were important to them such as their TV with “Sky” system, music stereo and laptop. They said they had everything they needed and were looking forward to having their own shower room. The owner and staff have completed training on infection control. The home was clean and tidy with good hygiene practices in place and suitable hand washing facilities available. The laundry facilities are located in the conservatory area which was full of items such as wooden flooring planks, building materials and other storage items. The manager reported that the room was not accessible to people using the service. This could be construed that people are not fully able to exercise their rights within the home if certain areas are not accessible to them. The manager must therefore complete a risk assessment concerning the use of the conservatory and laundry room. Planned improvements on the AQAA stated, “Adding en-suit to two rooms and completing the laminated floor in the passage downstairs and the dining room.” Gonville Road (33) DS0000028514.V377795.R01.S.doc Version 5.3 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 and 36 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Increased training and regular supervision for staff has resulted in a more skilled workforce to meet peoples individual and collective needs. Improved recruitment practices have meant that people are more fully protected from unsuitable workers. EVIDENCE: This is a small care home and the size of the staff team reflected the needs of the people who were using the service. The owner/ manager and his wife provide most of the care and support with two other staff employed on a part time basis. Staff allocation was between one and two staff during the day and evening. The owners, Mr and Mrs Bovell, live at the property and are available on call during the night. The person we spoke to confirmed that they were treated well and liked going out with the staff. The homes recruitment procedures are appropriate and practices have improved to ensure that staff are vetted correctly before they begin work. We looked at two staff files which included the most recent employee. Files contained the necessary information Gonville Road (33) DS0000028514.V377795.R01.S.doc Version 5.3 Page 22 and confirmed that staff had undergone appropriate checks such as a CRB disclosure and check against the Protection of Vulnerable Adults register. As previously required, we saw that the newest staff member’s full employment history had been explored and recorded. In addition the manager had revised the job application to ensure that any future employees are required to declare their full work history before any consideration of appointment. This ensures that people using the service are further protected from unsuitable workers. We looked at training certificates for two staff. The newest staff member had only started work in the last two weeks and there were plans for them to attend training courses. Since our last inspection, some of the recent raining has included food safety, first aid, safeguarding, managing violence, the Mental Capacity Act and fire safety. The manager explained that most of the training is accessed through the local authority of Croydon. One of the part time staff had also completed their NVQ level 2 qualification in care. Staff have therefore refreshed their skills and knowledge to ensure that they are up to date with current practice and legislation. In response to our last inspection, records showed that staff had received regular supervision with the manager every two to three months. The home also used a DVD training pack on supervision and appraisal in September this year. Staff answered questions and completed a self assessment to check their learning and understanding. Gonville Road (33) DS0000028514.V377795.R01.S.doc Version 5.3 Page 23 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 41 and 42 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager, also one of the homeowners, has good experience and professional qualifications to run the home. There are arrangements for monitoring the quality of care provided although an overall plan is needed to show how any outcomes are acted upon. Record keeping still needs to improve so that the rights of people using the service are better safeguarded and to provide more accessibility for the staff. The environment is generally safe for people and staff although premises risk assessments must be reviewed to further safeguard people from harm. EVIDENCE: Gonville Road (33) DS0000028514.V377795.R01.S.doc Version 5.3 Page 24 Mr Bovell, the registered manager, has many years experience working with adults with learning disabilities and has achieved a relevant management qualification and an NVQ level 4 qualification in management and care. Since our last inspection he has updated training in safeguarding, fire safety, moving and handling, medication and infection control. The manager and his wife who also works in the home attended training on the Mental Capacity Act and DoLS (Deprivation of Liberty Safeguards). This is new legislation that came into force earlier this year. Although the manager had sent out questionnaires to people using the service, an overall annual plan now needs to be written up. This should identify the strengths and weaknesses in the service and show how the home plans to make improvements over the forthcoming year. It should be based upon the views of people using the service, their relatives and other relevant parties and should reflect a cycle of planning; action and review of care practices. The manager had acknowledged this on the AQAA and wrote, “Self audit needs to improve and we will concentrate on this in the next year.” Appropriate policies, procedures and records required for legislation are in place although they were randomly filed around the office and the owner spent unnecessary time locating some of them. We have suggested better organisation at previous inspections and following our last visit, we made a requirement that the administration and record keeping systems be improved upon. This will ensure that people’s rights and best interests are safeguarded and enable easier access to the necessary files and records for staff and other relevant professionals. Records are maintained of all accidents and incidents at the home. The completed AQAA stated that all relevant safety checks were upto-date. We confirmed this when we checked the homes servicing and maintenance records including gas and electrical safety. Records showed that equipment had been regularly tested to make sure it was safe to use. Fire drills and checks had been carried out at regular intervals. We saw that the risk assessment for the premises was in need of review as it had not been done since June 2008. In addition, the provider was building a new en suite shower adjacent to one person’s bedroom and this needs to be risk assessed for potential hazards and safety. As previously required, key health and safety training for staff had been completed. Certificates showed that training undertaken since the last inspection has included food safety, first aid, moving and handling and fire safety. Planned improvements on the AQAA stated, “We intend to ensure that our staff are sent on the appropriate and relevant courses.” Gonville Road (33) DS0000028514.V377795.R01.S.doc Version 5.3 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 X 4 2 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 2 25 X 26 3 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 3 X 3 X 2 X 2 2 X Version 5.3 Page 26 Gonville Road (33) DS0000028514.V377795.R01.S.doc Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA4 Regulation Requirement Timescale for action 31/12/09 12(2)14(1)(d) Following a trial stay or settling in period, a review meeting is held to ensure that the person is happy in the home and that it is suitable to meet their individual needs. Previous timescale of 31/12/08 not met, warning letter sent. Failure to comply with requirements will lead to enforcement action being considered by CQC Each person needs an up to date and completed contract so that they or their representative are given full information about the services that are being arranged and what the home provides for the money. Previous timescale of 31/01/09 not met, warning letter sent. Failure to comply with requirements will lead to enforcement action being considered by CQC 2. YA5 5 (1)(c)(3) 31/12/09 Gonville Road (33) DS0000028514.V377795.R01.S.doc Version 5.3 Page 27 3. YA6 15 The two people who stay in 31/12/09 the home on a respite basis must have a written plan of care and support. This is to ensure that staff have clear guidance on how to meet their care needs effectively and promote their health and welfare. Previous timescale of 30/11/08 not met, warning letter sent. Failure to comply with requirements will lead to enforcement action being considered by CQC 4. YA9 13(4b) Risk assessments must be written for the two people who stay in the home on a respite basis. This is to ensure that staff have clear guidance on what action to take to support their needs and promote their safety and independence. Previous timescale of 30/11/08 not met, warning letter sent. Failure to comply with requirements will lead to enforcement action being considered by CQC 31/12/09 5. YA9 13(4b) Risk assessments must be regularly reviewed for people who use the service so that staff have the most up to date guidance on what action to take to support their needs and promote their safety and independence. The two people who stay in the home on a respite basis must have a written plan of DS0000028514.V377795.R01.S.doc 31/12/09 6. YA19 12(1) 31/12/09 Gonville Road (33) Version 5.3 Page 28 support concerning their healthcare needs.This is so that staff have clear guidance on how to meet and support their specific needs. 7. YA23 13(6) The home must obtain a copy of the latest local authority(Croydon) procedures on safeguarding vulnerable adults and use it in conjunction with their own safeguarding policy. So that staff are aware of the correct procedures for responding to safeguarding incidents. Access to the laundry room/ conservatory area must be risk assessed to ensure that the rights of people using the service are considered and protected. An annual quality assurance plan must be written up that reviews the provision of services and is based upon outcomes for the people using it. This is so that measures can be taken to make improvements for the benefit of people who live and work in the home. 31/01/10 8. YA24 12(3)(4 a) 13(4) 31/01/10 9. YA39 24(1) 31/10/09 10. YA41 17(2, 3 & All records relating to people 4)Schedules 3 who use the service and for &4 the purposes of running the home must be kept in good order. So that their rights and best interests are more fully safeguarded and that records are readily accessible to all staff. 01/03/10 Gonville Road (33) DS0000028514.V377795.R01.S.doc Version 5.3 Page 29 11. YA42 13(4) Due to the building works taking place in the home, the provider must complete a suitable risk assessment to ensure peoples safety and protect them from avoidable harm. The risk assessment for the premises must be reviewed to ensure that health and safety practices are up to date and the environment is safe for people living and working in the home. 31/12/09 12. YA42 13(4) 31/12/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA1 Good Practice Recommendations The user guide for the home should be made available in other formats such as large print or pictures so that it is more accessible to people who wish to use the service. Repeated from last two inspections. 2. YA6 Person centred plans should be developed for all people using the service and all staff should complete training in person centred care. This will enhance people’s involvement and contribution to their plan of care and ensure staff are familiar with current good practice and developments. Repeated from last inspection in September 2008. 3. YA20 Medication profiles are written for people who stay short term so that staff know what their medication is for and the reasons for its use. Gonville Road (33) DS0000028514.V377795.R01.S.doc Version 5.3 Page 30 4. YA35 That the manager develops a planned programme of training and development to show where refresher training is due. This will help ensure that staff update their skills and knowledge at the required intervals. Repeated from last inspection in September 2008. 5. YA41 The home’s administration systems should be improved upon so that staff have access to the required information that is clearly filed and readily available. Gonville Road (33) DS0000028514.V377795.R01.S.doc Version 5.3 Page 31 Care Quality Commission Care Quality Commission Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: 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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