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Care Home: Granville Court 4

  • The Esplanade Hornsea East Yorkshire HU18 1NQ
  • Tel: 01964532160
  • Fax: 01964534495

4 Granville Court is a purpose built care home offering up to 20 placements to adults both under and over the age of 65 years (male and female) who have a learning disability. The home is situated in the seaside town of Hornsea and is positioned close to the sea front, the local shops and amenities. Accommodation at the home is in three small units, called bungalows, one of which is currently not being used. This means that currently there are 14 bedrooms available for use in the home. Each service user has a single room. The bungalows have a lounge/dining area and a small kitchen on each unit and service users have access to a large communal activity room and a 2 3 0 9 2 0 0 8 24 24 Over 65 20 20 smaller `snoozelem`. This is a room that contains specialist equipment for sensory stimulation. However this is currently not in use. The home has a spacious courtyard area with seating that is enclosed and secure with good access, including for people in wheelchairs or with mobility problems. A new sensory garden is in place. The home is owned by a multi agency organisation, which includes Social Services and the Local Health Authority, and is know as the Spice Trust Project. The registered provider is the East Riding of Yorkshire Council. The weekly fees are from 1418.00 to 1489.00 GBP depending on the funding source, with additional charges for items such as toiletries and hairdressing. This information was provided by the registered manager at the site visit (19/5/2009).

Residents Needs:
Learning disability, Physical disability

Previous Inspections

This may not be the latest inspection for this service as we are having techinical problems updating from CQC - please check directly on the regulators website for the most recent report; bestcarehome hopes to be back to regular updates shortly.

For extracts, read the latest CQC inspection for Granville Court 4.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Granville Court 4 The Esplanade Hornsea East Yorkshire HU18 1NQ     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Eileen Engelmann     Date: 1 9 0 5 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 30 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 30 Information about the care home Name of care home: Address: Granville Court 4 The Esplanade Hornsea East Yorkshire HU18 1NQ 01964532160 01964534495 moira.gillyon@eastriding.gov.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: East Riding of Yorkshire Council care home 20 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability physical disability Additional conditions: To offer respite care to service users aged 16 - 18 (those in transition from childrens services to adult services). Date of last inspection Brief description of the care home 4 Granville Court is a purpose built care home offering up to 20 placements to adults both under and over the age of 65 years (male and female) who have a learning disability. The home is situated in the seaside town of Hornsea and is positioned close to the sea front, the local shops and amenities. Accommodation at the home is in three small units, called bungalows, one of which is currently not being used. This means that currently there are 14 bedrooms available for use in the home. Each service user has a single room. The bungalows have a lounge/dining area and a small kitchen on each unit and service users have access to a large communal activity room and a 2 3 0 9 2 0 0 8 24 24 Over 65 20 20 Care Homes for Adults (18-65 years) Page 4 of 30 Brief description of the care home smaller snoozelem. This is a room that contains specialist equipment for sensory stimulation. However this is currently not in use. The home has a spacious courtyard area with seating that is enclosed and secure with good access, including for people in wheelchairs or with mobility problems. A new sensory garden is in place. The home is owned by a multi agency organisation, which includes Social Services and the Local Health Authority, and is know as the Spice Trust Project. The registered provider is the East Riding of Yorkshire Council. The weekly fees are from 1418.00 to 1489.00 GBP depending on the funding source, with additional charges for items such as toiletries and hairdressing. This information was provided by the registered manager at the site visit (19/5/2009). Care Homes for Adults (18-65 years) Page 5 of 30 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: Information has been gathered from a number of different sources over the past 23 months since the service had its last key visit on 7 June 2007, this has been analysed and used with information from this visit to reach the outcomes of this report. We completed an Annual Service Review (ASR) for Granville Court on 28 May 2008. We only do an annual service review for good or excellent services that have not had a key inspection in the last year. An ASR is part of our regulatory activity and is an assessment of our current knowledge of a service rather than an inspection. The published review is a result of the assessment and does not come from our power to enter and inspect a service. This unannounced visit took place with the manager, staff and people using the service. The visit included a tour of the premises, examination of staff and peoples Care Homes for Adults (18-65 years) Page 6 of 30 files, and records relating to the service. Time was spent in the lounge areas of the two bungalows being used, observing everyday life. Staff interactions with people using the service were positive with staff talking and interacting readily with individuals. People were relaxed in their home and appeared comfortable. Due to the specific communication needs of the people using the service, no formal discussions were held between them and the inspector. Informal chats with staff took place during this visit; their comments have been included in this report. Questionnaires were sent out to a selection of people living in the home and staff. Their written response to these was adequate. We received 5 from staff (50 ) and 1 from people using the service (10 ). The manager completed an Annual Quality Assurance Assessment and returned this to us within the given timescale. There was an additional unannounced visit in September 2008 when our Pharmacy inspector looked at medication practises and records because of a number of medication errors reported to us by the home. It was found at this visit that the staff used good medication practises when medication was given to people and the records kept were up to date. However the policy and procedures in place did not provide clear information for staff on current legislation and guidance in social care settings. A report was produced as part of this visit, which can be obtained by interested parties from the Care Quality Commission or from the manager of the home. 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. What the care home does well: 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 set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 30 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People undergo a full needs assessment and are given sufficient information about the home and its facilities prior to admission, to enable them to be confident that their needs can be met by the service. Evidence: Three peoples care and records were looked at as part of this visit, they each have been provided with a statement of terms and conditions/contract on admission and these are signed by the person or their representative. These documents give clear information about fees and extra charges in a large print and pictoral format, that is meaningful and appropriate for the people using the service. In each of the three care plans looked at during this visit there was a copy of the community care assessment and Local Authority care plan. The home also completes their assessment of need and from these a detailed and descriptive care plan is developed. Input from other professionals and/or family is also recorded and each plan is individualised to the person using the service. Care Homes for Adults (18-65 years) Page 10 of 30 Evidence: Information given to us in the Annual Quality Assurance Assessment (8/4/09) and through discussion with the manager is that wherever possible individuals thinking about moving into the home, are encouraged to visit the service on several occasions to meet the staff and other people living in the home, before making the decision to come in permanently. Where a person is unable to visit the home the manager or senior staff will meet with them before they are admitted so they see a familiar face when they come into the service. Information from the Annual Quality Assurance Assessment and discussion with the manager indicates that all of the people using the service are of White/British nationality. The home does accept people with specific cultural or diverse needs and everyone is assessed on an individual basis. Discussion with the manager indicated that the home looks after a number of people from the local community, although placements are open to individuals from all areas. Staff members on duty were knowledgeable about the needs of each person they looked after and had a good understanding of the care given on a daily basis. People using the service have serious communication problems, but we observed staff and individuals interacting in a positive manner and staff used a number of different techniques to ensure people were listened to and their choices acted on. Information from the training files indicates that the majority of staff are up to date with their basic mandatory safe working practice training, and have access to a range of more specialised subjects that link to the needs of people using the service. Staff who completed our surveys said that their training was good and that they felt they provided a high quality of care, which promoted peoples rights to individuality, privacy and dignity. Care Homes for Adults (18-65 years) Page 11 of 30 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. The care plan is person centred and focuses on the individuals strengths and personal preferences. It celebrates the individual, their life experiences and sets out in detail how all their current requirements and aspirations are to be met through positive individualised support. Evidence: Each individual using the service has a detailed, descriptive and person centred plan, which identifies their individual needs and abilities, choice and decisions and likes and dislikes. In addition to this information there are risk assessments to cover daily activities of life, behaviour management plans where a risk to the person or others has been identified, and clear information about health and input from professionals and the outcomes for people. All the information in the plans is presented in a large, clear print with pictures and photographs to back up the written element. Included in the care plans is a This is about me booklet which some people using the service have been actively involved in writing. The booklets contain the views, Care Homes for Adults (18-65 years) Page 12 of 30 Evidence: opinions and choices of each person about their care and how they wish to be looked after. If a person agrees or is unable to participate fully in the development of their This is about me booklet due to the level of their disability then staff ask people who know them well enough to contribute. People have Patient Passports that are taken with them if they are admitted to hospital; these contain up to date information about individuals and ensures that important information is passed to relevant health professionals involved in diagnosis and treatment of people using the service. Staff are monitoring and reviewing the care plans on a regular basis and work is progressing to ensure each plan is explained to the person concerned and that their signature/or their representatives signature is obtained to show they agree with the content. Reviews of care with the families, person living in the home and care co-ordinator from the local authority are taking place and minutes of these meetings are in the plans. The manager told us at this visit that no-one in the home is currently using an advocate, but the home has access to services in the community should the need arise. Minutes of Best Interest meetings are available in the care plans, these take place when informed choice cannot be made by the individual and includes the views of all those involved in the individuals care. In the last key inspection report of June 2007 a recommendation was made that The registered person should explore more methods of involving the service users in decision making in their home. The home has responded to this by introducing positive interaction groups as a means of individuals making choices on a day-to-day basis. Staff who have received training around positive interaction techniques take the lead in ensuring the groups take place and facilitiate the groups. Changes made in response to the groups include menus being reviewed and work is ongoing to produce pictoral menus to help people make greater choices. Staff enable people to take responsible risks in their every day lives and information within the care plans includes a number of risk assessments covering activities of daily living, use of equipment and personal safety information. Staff have had training around equality and diversity, Deprivation of Liberty, Mental Capacity Act and Protection of Adults from Abuse. This knowledge and information is used to ensure that peoples choices and human rights are maintained and that any limitations on facilities or personal choice are only made following assessment, best interest meetings, risk assessments and discussion with the person concerned or their Care Homes for Adults (18-65 years) Page 13 of 30 Evidence: representative. Care Homes for Adults (18-65 years) Page 14 of 30 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A range of activities within the home and community means that people that live in the home have the opportunity to maintain and develop their skills and participate in stimulating and motivating activities that meet their individual needs, wants and aspirations. Evidence: At the time of our visit (May 2009) there was no-one using the service who was attending any educational courses, due to their mental and physical disabilities. People are able to access a good range of social and leisure activities including trips out, shopping at the local community facilities, craft sessions at the local resource centre and events taking place in the local Floral Hall. The manager and staff told us two people living in the home are going on holiday to Blackpool the week following our visit and other holidays are being arranged, based on peoples wishes and abilities. Care Homes for Adults (18-65 years) Page 15 of 30 Evidence: The manager told us that increased staffing levels have meant that people are able to go out in a morning and an afternoon and each person was seen to have their own daily programme of leisure activities in their care plan. We observed that four individuals had chosen to go out of the home for a shopping trip and lunch in town, they arrived back after midday having clearly enjoyed their time outside of the service. There are regular music sessions taking place in the home and people can join in with their own instruments provided by the service; an organist visits the home on a weekly basis. The local community church visits once a month and school children doing their Lifestyle awards have created a raised garden bed in the grounds of the home. People living in the home are encouraged to maintain contact with family and friends, there is no restriction on visiting times and relatives/friends are invited to celebrate occassions such as birthdays and christmas parties in the home. Family contact and activities attended are clearly recorded in each persons care file, showing where and how individual choices and decisions are made by each person. People receive good support in the meeting of their dietary needs. We observed the lunch time meal which was relaxed and unrushed, with individuals being offered good support with eating their meals. Each bungalow has its own kitchen where snacks and drinks can be prepared throughout the day, we saw that one person had a choice of a hot meal and sandwiches as they were known not to be hungry at lunch time and may want something later on in the day. Information had been sought from other professionals to assist people with eating and drinking, and some had specialist support plans in place. Peoples dietary needs are assessed and if necessary records are kept of food and fluid taken by the individual. People are being weighed monthly, and the new overhead tracking system for hoisting has a capacity for weighing individuals so this should be carried out more effectively. Some individuals are being fed by a PEG system and their care is monitored closely by the community dietician; staff liaise with the dietician should any issues arise. The home was visited by the Environmental Health department in April 2009, the kitchens and its records were inspected and no problems were found. Care Homes for Adults (18-65 years) Page 16 of 30 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. Peoples personal and healthcare needs are met through good inter-agency working and by the staff having a sound knowledge of each individuals needs. Staff ensure that care is person led, personal support is flexible, consistent and is able to meet the changing needs of the people using the service. Evidence: It was apparent from discussions with the staff that they were knowledgeable about peoples preferences and likes/dislikes regarding their care. Choices and decisions are recorded in peoples This is about me booklets and within the care plans. Support with personal care and personal hygiene is provided in private, by one or two people depending on the need of the individual, by the same gender where possible if the person wishes. The home has recently fitted an over head tracking system for hoisting people in their bedrooms and bathrooms, which has made the task of moving individuals more effective and efficient for staff and more comfortable for individuals. Aids and equipment are provided following assessment by occupational therapists, physiotherapists and other health care professionals; people are reviewed regularly to meet any changes in need. Care Homes for Adults (18-65 years) Page 17 of 30 Evidence: People in the home are able to access health care through the local GP, dieticians, district nurses, epilepsy specialist nurse amongst others who provide support and advice for the staff when needed. Individuals have their Patient Passports to take to hospital if they need to be admitted; these contain up to date information about the person which ensures diagnosis and treatment is more efficient. For those people unable to give informed consent for treatment, a Best Interest meeting is held to ensure the best possible outcome for the individual. Minutes of these meetings are kept in each persons care plan. Where an individual requires specific care such as postural management or epilepsy management, a detailed plan of how this is to be achieved can be found in each persons care plan. Staff are able to liaise with the specialist services on a regular basis to ensure the plans are reviewed and amended as needs change. In September 2008 our pharmacy inspector visited the home to follow up a number of medication errors that we had been notified of through the Regulation 37 reports sent in by the manager of the home. A copy of the pharmacy inspectors report is available from the Care Quality Commission or from the manager of the home. Checks completed during this visit (May 2009) found that the manager has met all the recommendations made in this report. The pharmacy inspector found that the medication policy in the home did not provide clear information for staff on current legislation and guidance in social care settings. Checks at this visit found that the manager is working with the Trusts pharmacist to produce a stand alone policy for the home which will give the nurses more flexibility in how they work. Discussion with the manager indicated the home is considering changing the way they keep medications on the bungalows. At present the nurses have to fetch and carry medicines from each persons bedroom, where they are stored in a locked cabinet. This gives rise to greater opportunities for interruption and distraction, despite the use of the red warning aprons worn by the nurses during medication giving. The intention is to introduce a medication trolley and remove the bedroom cabinets, and this work is expected to be done by the end of July 2009. We found that the home has implemented changes to how they record medications in the MAR charts in line with the good practise advice given by our pharmacy inspector. Staff are now consistently recording medication brought forward from previous MAR charts, which makes auditing stock and checking medication is being administered correctly, much easier. Up to date management plans for the use of risperidone and midazalom are in place, and staff have obtained further information from the GP Care Homes for Adults (18-65 years) Page 18 of 30 Evidence: and/or community pharmacist about use of medications prescribed as required which do not have management plans in place. This makes sure that medication is given correctly. When an entry in the MAR chart requires amending due to changes asked for by the prescriber, two trained nurses do this and put their signatures onto the sheet against the amendment. This reduces the risk of mistakes being made as two people check the new instructions when medications or doses are changed. Other changes that have been made include oxygen cylinders being stored securely attached to a wall, and temperature checks being taken of fridges and room environments to ensure medicines are being stored securely at temperatures recommended by the manufacturer so that staff know they are safe to use. We found that medication records and stock levels were up to date and accurate and controlled drugs were stored securely and documented in a controlled drug register. Care Homes for Adults (18-65 years) Page 19 of 30 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a satisfactory complaints system with some evidence that peoples views are listened to and acted upon. Evidence: Checks of the records show that there have been no formal complaints made about the home or its service since the last key visit in June 2007. There are good complaints systems available and on display within the home, which support the people living in the home or their representatives to be able to raise any concerns and be confident that these will be dealt with appropriately. The complaints systems are made up of two complaints procedures. The first is a comprehensive policy, which has been developed by the Local Authority. The second is an easy read version, developed in the home, which allows for clear direction if anyone, in particular a person using the service, wishes to complain. Staff told us that should they raise a concern with the senior staff then this would be dealt with appropriately. The staff demonstrated a good awareness of the process to safeguard the people in the home from abuse. The staff training files we looked at indicate that some of staff have received training on protection of adults from abuse, most have attended Mental Capacity Act briefings and all have access to information on Deprivation of Liberty Safeguards. We recommended that all staff attend safeguarding of adults training and that this becomes part of the homes rolling programme of staff development/training. Care Homes for Adults (18-65 years) Page 20 of 30 Evidence: No referrals have been made under the Protection of Vulnerable Adults procedure since the last key inspection in June 2007. Appropriate policies and procedures are in place in relation to the protection of the people using the service. Care Homes for Adults (18-65 years) Page 21 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The environment provides people with safe, comfortable and homely surroundings in which to live, that meet their individual needs and lifestyles. Evidence: The home consists of three bungalows, one accommodating up to eight people and the other two accommodating six people each. At present one bungalow is closed and there are no plans to re-open this at the moment. People are provided with their own, single occupancy bedroom and those seen were individually decorated and fitted with appropriate furnishings. There is one communal bathroom on each bungalow and these are fitted with assisted baths. An overhead tracking system has been fitted to thirteen bedrooms and the two bathrooms, to aid staff when hoisting people to and from beds, chairs and into and out of the baths. It is expected that the tracking system will be extended into the lounge areas and the remaining bedroom by the end of September 2009. The premises were built in 1995 and are accessible to people in wheelchairs, those with walking frames or those more independantly mobile. There are level accesses and doorways are of a width to accommodate wheelchairs. The grounds of the home are user-friendly and have flat walkways, a sensory garden and raised bed areas where Care Homes for Adults (18-65 years) Page 22 of 30 Evidence: people can sit and spend time during the better weather. The home has an ongoing maintenance programme and recent upgrades have included new lounge furniture and carpets being fitted to the occupied bungalows, and apron and glove dispensers fitted to all bedrooms to improve infection control standards. Walking around the home we found that the bedrooms are in need of decorating and require new carpets fitting as those carpets seen were stained and worn; the lounge areas require decorating as do the corridors (paintwork is damaged from wheelchairs). The bathroom in Carlyle bungalow has had a water leak in the roof and the ceiling needs redecorating, the kitchen dishwasher on Carlyle is out of order and needs repairing as soon as possible. At our last visit to the home in June 2007 a recommendation was made that the registered person should be able to provide evidence that the home meets the Water Supply (Water Fittings) Regulations 1999. Reflecting a fully safe water system for people using the service. Checks at this visit found this has not been actioned and so it will remain a recommendation on this report. The laundry facilities for the home are sited in the main building, and there are effective systems in place for dealing with soiled or infected clothing/linen. Staff have received infection control training and there are good supplys of personal protection equipment such as aprons and gloves. Hand washing facilities are in all areas where soiled or infected laundry/clinical waste is handled and staff were observed following universal precautions whilst carrying out their duties. Care Homes for Adults (18-65 years) Page 23 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service have confidence in the staff that care for them. Rotas show that the home is staffed efficiently, with particular attention given to busy times of the day and changing needs of the people who use the service. Evidence: Observation of the interactions between staff and people using the service showed that staff are skilled in communicating and interpreting the needs of the people who live in the home. Those staff we spoke to were enthusiastic and motivated about their work and felt they achieved good levels of job satisfaction. At the last visit in June 2007 a requirement was made that the registered person must make sure that all staff are adequately trained, to ensure the needs of people using the service are met. Checks at this visit found the requirement has been met. The staff training information supplied to us during this visit shows that staff are attending mandatory training and some specialised subjects including dementia care, palliative care, enteral feeding, naso-gastric care, epilepsy, Mental Capacity Act and safeguarding of vulnerable adults. Evidence of the training completed is now provided in a print out from the East Riding of Yorkshire Council and this helps the manager audit and plan the training needs of the workforce. 54 of care staff have completed Care Homes for Adults (18-65 years) Page 24 of 30 Evidence: their NVQ 2 in care and new starters complete an induction which meets the criteria for Skills for Care. Each staff member has their own training file and knows what training they must attend each year. The employment records show that the manager is using a selective approach to recruitment; ensuring new staff have the right skills and attitude to meet the needs of people in the home. Checks of the staffing rotas and observation of the service showed that the home employs male and female care staff and all staff are currently of a white/british nationality. Staff from other countries and cultures have been employed in the past, but a lack of suitable applicants means there were none in post at the time of our visit. Staffing in the home has been increased over the past two years and in May 2009 there were three care staff to each bungalow during the daytime hours, plus one nurse who oversaw both units, and two care staff and one nurse on duty at night. At the time of our visit (May 2009) there were eleven people in residence (10 high dependancy and 1 medium) and no-one was receiving care payments for additional 11 funding. Using information about dependency levels provided by the manager at the this visit, checks against the Residential staffing forum guidelines for a learning disability home shows that the home is exceeding the minimum recommended staffing hours. The manager told us that the increase in staffing has meant a huge improvement in the quality of life for people living in the home, with more time available for taking people outside of the service and for 1-1 time with those who need more support. The home has a recruitment policy and procedure that the manager understands and uses when taking on new members of staff. Checks of three staff files showed that police (CRB) checks, written references, health checks and past work history are all obtained and satisfactory before the person starts work. Care Homes for Adults (18-65 years) Page 25 of 30 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management of the home is satisfactory overall and the home regularly reviews aspects of its performance through a good programme of audits and consultations, which includes seeking the views of people using the service, staff and relatives. Evidence: The registered manager is a first level nurse (Registered Nurse for Learning Disabilities) and has 32 years of experience in a managerial/supervisor position. The manager holds the NVQ 4 Registered Managers Award and regularly updates her skills and knowledge through training sessions pertinent to her role. The home does not have a formal quality assurance process in place, but does have a range of quality monitoring systems in use. Audits of the service are carried out by the council, health trust and includes financial and clinical audits. Policies and procedures within the home have been reviewed and updated to meet current legislation and good practice advice from the Department of Health, local/health authorities and specialist/professional organisations. The responsible Care Homes for Adults (18-65 years) Page 26 of 30 Evidence: individual does spot checks and completes the regulation 26 visits, this was a requirement in the June 2007 report and is now met. Feedback is sought from the people living in the home, staff, relatives and other stakeholders through regular satisfaction questionnaires, and the manager has produced a development report as part of this process to highlight where the service is going and/or indicate how the management team is addressing any shortfalls in the service. Meetings for people using this service are not the best way of finding out peoples view points, so the manager carrys out 1-1 talks with people instead. Staff have meetings with the manager and everyone is encouraged to join in with discussions and voice their opinions. Individuals are able to express ideas; criticisms and concerns without prejudice and the management team will take action where necessary to bring about positive change. Information from the manager indicates that none of the people living in the home are able to manage their own finances, instead they all have a family member or representative who handle their monies. People are able to have personal allowances kept for them by the service and the council audits the account books and does spot checks to ensure these are up to date and accurate. The home keeps individual accounts sheets for money transactions and receipts are stored for each person. Those monies checked by us during our visit were all in order. Maintenance certificates are in place and up to date for all the utilities and equipment within the building. Accident books are filled in appropriately and regulation 37 reports completed and sent on to the Commission where appropriate. Staff have received training in safe working practices and the manager has completed generic risk assessments for a safe environment within the home. Risk assessments were seen regarding fire, moving and handling and daily activities of living. Care Homes for Adults (18-65 years) Page 27 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 28 of 30 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 23 The manager should ensure that all staff receive training around safeguarding of adults from abuse, to ensure they have the knowledge and confidence to report or deal with any issues that may arise, and offer good support to people living in the home. The registered person should make sure that bedrooms, corridors, bathrooms and lounge areas are redecorated and new carpets fitted where those insitu are stained and worn. The registered person should be able to provide evidence that the home meets the Water Supply (Water Fittings) Regulations 1999. Reflecting a fully safe water system for people using the service. 2 24 3 30 Care Homes for Adults (18-65 years) Page 29 of 30 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 30 of 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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