Care Home: Harper House

What the care home does well People told us they are happy in the home and make daily decisions about what they do and who they see. Professionals and relatives spoke highly of the home and that they are kept closely informed of any changes as well as progress: "...x...is happy in the family environment..."; "...anxieties are reduced...plenty of opportunities to get out and about...supported to be an individual, people follow their own interests, style of clothing..."; "we are working with the home to further develop his plans and communication skills"; "...service excels in keeping everyone in the multidisciplinary team up to date"; "there seems to be really good communication in place..." People living in the home have excellent relationships with staff and managers. Staff know a lot about each and the detailed care plans in place. Respectful and dignified care is provided with people`s daily consent, the way they want. Support is flexible, maximises independence and people continue to learn, develop and stay healthy. Emotional wellbeing has improved, and behaviour management uses best practice. People living at Harper House have complex needs and some decisions are made in their best interests with multi-professional teams. There is good access to healthcare, and a consistent approach is shared between Harper House, transport and day services. There is safe medication management. People experience good outcomes in most regards. The home encourages suggestions in a number of ways so that the service can act, continue to learn and develop. Information about the home and for people living there is produced in a user friendly way, or it is explained. Concerns are taken seriously and acted upon inside and outside of the home. There are competent staff and managers with excellent qualifications and additional training to understand people`s conditions, meet their needs and encourage personal development. People take part in the running of the home and selection of staff. It is welcoming and clean, and generally well maintained. There are high quality standards which are spot checked, and clear development plans for the service and staff. We complimented staff practice and management on our visit. What has improved since the last inspection? Harper House are now providing more activities during weekdays as services in the community have closed. People choose the gender of staff they want to support them with personal care. There are now more reviews so that care changes quickly when necessary, and choices people make are now recorded. Since the last inspection, managers and staff have undertaken qualifications about learning disabilities, meeting a requirement. More staff now have NVQ qualifications in care, and two managers completed the Registered Managers Award. Staff training in equality and diversity was arranged with Solihull College. New furniture was provided in two bedrooms, which people helped to choose. The garden was landscaped, fencing improved, and a new minibus was purchased.Policies, procedures and forms have been updated and a checklist was introduced to ensure record keeping is up to date. There are new monthly audits in place to check service quality, health and safety. What the care home could do better: Goal planning needs to be clear in records and care plan evaluations. More opportunities for exercise would promote mobility, coordination, wellbeing and healthy living. Minor improvements to the medication system would improve protection for people in the home and public safety. Action was quickly taken to concerns we raised about environmental hazards so that accidents could be prevented. Risk management and essential repairs needs to be timely in future. A plan to improve the premises should be progressed so that a person living in the home has more independence and safety. Facilities and furnishings need review to fully promote privacy, dignity and diversity. People are safe and well cared for, however they are living with health and safety controls, occasional aggression and damage to the home`s property. We recommend criticial evaluation with people about their experience in the home utilising independent facilitation so that the service development plan can take steps for peer appropriate facilities and outcomes that fully promote people`s rights. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Harper House Harper House 2 Cathcart Road Stourbridge West Midlands DY8 3YZ     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: Tina Smith     Date: 1 8 0 3 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 36 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 36 Information about the care home Name of care home: Address: Harper House 2 Cathcart Road Harper House Stourbridge West Midlands DY8 3YZ 01384441469 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Miss Gail Louise Harper care home 5 Number of places (if applicable): Under 65 Over 65 0 learning disability Additional conditions: 5 The maximum number of service users who can be accommodated is: 5 The registered person may provide the following category of service only: Care Home Only (Code PC); To service users of the following gender: Either; Whose primary care needs on admission to the home are within the following categories: Learning disability (LD) 5 Date of last inspection Brief description of the care home Harper House is in a residential area of Stourbridge, close to public transport and local amenities. Car parking is available on the road. Accommodation and care is provided for a maximum of five younger adults with learning disabilities. There is a lounge and dining room on the ground floor, kitchen, office at the back and an enclosed garden with a separate smoking room. One single bedroom and two shared bedrooms are on the first floor, along with a communal bathroom and shower. Fees range upwards from £535.95 per week, depending upon support needs, as in the service user guide. Additional charges apply to: private health and dental care, hairdressing, dry cleaning, entrance fees for outings and activities, and public transport. This was correct at the time of our visit. Enquiries should be made at the home about up to date fees. Care Homes for Adults (18-65 years) Page 4 of 36 Care Homes for Adults (18-65 years) Page 5 of 36 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 peterchart Concerns, complaints and protection Environment Staffing Conduct and management of the home Poor Adequate Good Excellent How we did our inspection: The last key inspection was held on 16/02/07. Prior to our visit the home supplied information to us each year from their legally required Annual Quality Assurance Assessment (AQAA). The AQAA provides information about what has improved and is planned for the future, and current information about running the home. The AQAA arrived on time, had all the information we asked for, and the self assessment quality was generally good. Information from this and from other sources was also used when forming judgments on the quality of the service. The home sends us notifications, and we receive reports from other sources. We received 17 out of 19 surveys sent to people, relatives, other professionals and staff. People had help from others outside of the home to complete them, which is good practice. Care Homes for Adults (18-65 years) Page 6 of 36 One inspector visited the home over one day, 08:00 to 17:30 so that the morning and afternoon routine could be observed. The home was not informed that we would be visiting. People showed us around the home, we spoke to two people privately and examined their records closely, and observed medication administration. Records about three other people were sampled along with records about the running of the home: two staff files, communication records, staff training chart, cleaning schedule, contractor certificates and management spot checks, service user meeting minutes, medication records, and legally required certificates. We also saw the homes published information. The deputy manager was present throughout the day, and the manager was present for part of the day. We discussed our findings with these managers and a representative from Head Office. There was one requirement from the previous inspection which was fully met. As a result of our visit, no immediate requirements were made because people were safe. We agreed additional information to be sent and action that would be taken within 48 hours, which managers fully met. One requirement and a list of recommendations are at the end of this report and we have confidence that this will be acted upon so that Harper House and peoples outcomes will continue to improve. What the care home does well: What has improved since the last inspection? Harper House are now providing more activities during weekdays as services in the community have closed. People choose the gender of staff they want to support them with personal care. There are now more reviews so that care changes quickly when necessary, and choices people make are now recorded. Since the last inspection, managers and staff have undertaken qualifications about learning disabilities, meeting a requirement. More staff now have NVQ qualifications in care, and two managers completed the Registered Managers Award. Staff training in equality and diversity was arranged with Solihull College. New furniture was provided in two bedrooms, which people helped to choose. The garden was landscaped, fencing improved, and a new minibus was purchased. Care Homes for Adults (18-65 years) Page 8 of 36 Policies, procedures and forms have been updated and a checklist was introduced to ensure record keeping is up to date. There are new monthly audits in place to check service quality, health and safety. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 36 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 36 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have the information they need to make decisions about the home. Thorough assessments and reviews ensure peoples needs are met. Evidence: Five people have lived in the home over 12 months, funded by the council. There have been no admissions or discharges since the last inspection, and there are no vacancies. All five care records had a thorough assessment that made use of information from the person, their families, social services and health professionals and previous placements, all pre-dating current management. Care records show that there are monthly care plan reviews, and a process of regular placement reviews. We were told that everyone was reviewed last year to assess if people could move onto supported living, but it was decided by the council that all were best placed at Harper House. People told us in surveys that they had enough information, wanted to come to live in the home and are happy there. There is a service user guide and statement of purpose Care Homes for Adults (18-65 years) Page 11 of 36 Evidence: with user friendly information for people and their families to learn about the home, services included in the fee and philosophy of care. The guide explains what would happen if a vacancy arose. People could visit gradually to get to know others living there and staff, while the home assess needs and decide if personsonalities are compatible, which is good practice. Everyone living in the home has family who are in regular contact, and one person has an advocate to support them in expressing their views. Management are aware of the role of statutory advocates, should they be needed for best interest decisions about admissions, care and discharges. Care Homes for Adults (18-65 years) Page 12 of 36 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. People, representatives and professionals take part in care planning or make best interest decisions together. Staff have clear guidelines and responsive communication systems to support people the way they want and need. Independence is promoted by people taking part in the running of the home and in their care. Evidence: People make decisions about their lives or best interest decisions are made with other professionals, people and their representatives. Some people can communicate choices and staff prepare picture/photo diaries with others so that choices can be expressed and likes and dislikes can be reviewed. There are regular meetings with key workers, and with everyone living in the home to plan food, outings and holidays. An advocate is helping one person to seek alternatives after their day centre closed. There are meetings with other services so that care is consistent - for example, at the home, on transport and at day services, which is good practice. Care Homes for Adults (18-65 years) Page 13 of 36 Evidence: Care plans are detailed so that staff know how people want to be supported, safely with equipment as necessary. There are individual guidelines about personal care, health and wellbeing, nutrition, behaviour, manual handling, medication and activity plans. On our visit four people went out to day services and one person went shopping with staff. Peoples rights are protected by staff supporting risk taking and trying new things for personal development. For example, one person told us that they like to visit second hand shops to buy music. Staff help them budget by providing money in daily amounts, which they can manage independently. Staff also divide up tobacco for their pipe which they find helpful. Two relatives manage peoples money, and three have council appointees. Social services told us that the home work well and consult appropriately when helping people to make purchasing decisions. Accounts are audited monthly and we were told they are usually kept on the premises but an audit was underway on our visit. Records requested were sent after our visit, and we saw up to date and appropriate accounts that tallied. Spending decisions matched peoples needs and lifestyle, and the terms and conditions of the service. Records are securely kept for confidentiality. Care plans are signed and people have access to user friendly care plans, and these are explained. These are reviewed monthly, and guidelines are reviewed at least six monthly or when there are changes. Annual reviews take place with funding authorities. Goal planning with people could improve, as this is not clear in care records. Activities are tried to promote personal development, such as cooking, and there is a chore rota about daily living tasks. We saw very plans and guidelines drawn up from thorough assessments and consultations in accordance with mental capacity law. Changing abilities and conditions and risks are monitored and recorded, along with peoples daily choices. Staff understand their legal roles and peoples rights. Multi-professional decisions are usually made with peoples consent about medication, health and wellbeing. One person told us that their doctor changed their epilepsy medication and they now feel it is working. We saw behaviour plans using least restrictive alternatives and distraction techniques that avoid the need for restraint. This shows that best practice is known and used. The staffing level and skill mix meets peoples needs, including at peak times and when people need individual support. There are good assessments and care plans about personal safety and dignity inside and outside of the home, during transport, on holidays and at night time. This includes for example, prompting continence, mobility, road safety awareness, and contingencies if people become anxious or for emergencies. Care Homes for Adults (18-65 years) Page 14 of 36 Care Homes for Adults (18-65 years) Page 15 of 36 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are treated as individuals, and there are appropriate opportunities for personal development, worship and activities in the home and community. Relationships with family and friends are maintained according to peoples wishes. Personal tastes in food and dietary needs are met, and there is a healthy diet. Evidence: There are flexible routines to match peoples patterns; some people with autistic conditions need structure to their day. People go to bed when they want to, and some people said this was about 10 or 11 pm. Each person has their own activity plan, reviewed 6 monthly. Staffing and mealtimes at the home are based around these plans and individual needs. Four people told us that they can do what they want to each day, including weekends. Care Homes for Adults (18-65 years) Page 16 of 36 Evidence: Everyone has opportunities to learn and use practical life and social skills, at day services and in the home and community. People take part in their own care and in the running of the home according to their ability and mood. For example, some people keep their room clean and tidy, make their bed, and help to prepare food. On our visit, one person prepared drinks and took out the rubbish for collection. Another person did not want to take over hovering from staff when this was offered, so staff completed the task. This shows us that people have choice. The chore rota makes sure opportunities continue to be offered which maximises independence, although some people have limited attention spans. There are age, peer and culturally appropriate activities and use of community facilities such as attending religious services, walks in parks, cinemas, shopping and meals out. Public transport is used after risk assessment and training, and everyone has a bus pass. Everyone currently needs staff escorts to go out. Sometimes the homes minibus is used. Shopping trips are taken individually to buy what people want. Holidays are usually taken together for five days plus outings, but some people respond better to day trips and this is planned for. Each person has their own interests and people told us they enjoy going to the day centre to see my boyfriend; looking around shops and smoking my pipe in the garden; getting people drinks and helping around the house.; listening to music in my room. One person does exercises in their room. The home continue to want to expand activities, but no one wants to go swimming. We recommend other opportunities for exercise are explored to promote healthy lifestyles and to retain mobility as people grow older. Religion is noted in each care record, and people choose whether and how they want to worship. All five people have relatives they see regularly, and one relative sings religious songs with people on occasions, which we are told they enjoy. People told us about visits by their family, and a lunch date with their friend the day of our visit. Staff help families to keep in touch, and there is a phone so that people can talk privately. A relative said the home will phone if they have concerns and will take advise from professionals. We saw staff appropriately manage displays of affection to eachother on our visit, which shows us that people have support to lead responsible lives. Menus are planned for the month at resident meetings, where it is also checked that they like the food. All staff prepare food and one person told us that they like to help prepare jelly. Staff have tried to involve others in making sandwiches. At meal times, people have the support they need and meals are staggered or served in two rooms so that people have a calm atmosphere which is conducive to eating well and without interference from each other. This is best practice. No one has special dietary needs or Care Homes for Adults (18-65 years) Page 17 of 36 Evidence: diabetes. Drinks and healthy snacks such as fresh fruit are available day and night. Food on offer is nutritious and varied, and there are occasional meals out. People like curry, have pizza nights, and cinema nights where a DVD is hired and staff make popcorn. Government advice about healthy eating is promoted for peoples health, such as whole grains and oily fish. Care Homes for Adults (18-65 years) Page 18 of 36 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. Personal care and health needs are met in the way people prefer, with dignity and risks managed, however opportunities for privacy can be improved. Screening to prevent falls and malnutrition is needed. The medication system is managed by competent staff and regular checks ensure this protects people. Evidence: On our visit people had good personal hygiene. Their appearance and clothing was appropriate for the temperature, their age, culture and tastes and surveys from professionals praised this. We saw a quality audit about oral and nail care, and changing bedding, showing us that management check quality of care and outcomes for people regularly. Minutes of a residents meeting show that the arrangements for showering were changed at someones request. Staff accurately told us about peoples health and personal care needs, risks, what people prefer (such as baths or showers) and how care is safely provided. Assessments note abilities to self care, such as brushing teeth. Staff prompt or assist with personal care as needed according to peoples cooperation and mood, recorded Care Homes for Adults (18-65 years) Page 19 of 36 Evidence: daily. People have choice of male or female staff to help with personal care. Respect and dignity is shown by discreet prompting to use the toilet and washing of hands, encouraging people to choose their daily clothing, and staff knocking on bedroom doors before entering. However rooms are shared and peer appropriate facilities could improve so that dignity and privacy is fully respected (see environment). There are a variety of risk assessments which are signed by staff to show they have been read. However there are key risks regarding falls and malnutrition that are not yet assessed for prevention. There are people unsteady on their feet and with poor coordination in the home, and on our visit we pointed out that people helping to provide drinks led to spills that were not noticed or immediately cleared up, which could result in falls. Exercise and tasks that improve coordination and balance could be further researched and encouraged. Nutritional needs are assessed, people are regularly weighed and we were told that no one is losing weight. Some people have food and fluid intake charts and records show that specialists are involved when necessary. However malnutrition risk is not assessed, so best practice is not fully in use. We were told that nutrition training is planned and in response to our query about why a purchased tool is not in use, managers said this will be followed up after the inspection. We noted that government advice about healthy eating of roughage was followed and resulted in improvement so that a person no longer needs weekly enemas, which is a good outcome. Staff have additional training to understand peoples conditions, such as epilepsy. One persons condition is now under control after seizure monitoring and medication change. Records are kept of visits by health and social care specialists, and their advice is incorporated into care plans. There are a range of health specialists supporting people and the home, including psychiatry, community nurses, dieticians. The home attends appointments to support people, and all annual health, dental and sensory checks are up to date. There are excellent communication systems amongst staff and with other professionals and consistent approaches so that people have seamless services. This means that changes in peoples conditions, behaviour and moods are noticed and acted upon quickly. Records show that peoples health, wellbeing and behaviour has improved and plans are regularly revised. There are guidelines about peoples conditions and medication, including allergies, contra-indications for diet and exposure to sunlight, signs to watch for and detailed guidance for actions to be taken. We saw up to date monitoring records about personal hygiene, menstruation, epilepsy, emotional and psychological wellbeing, personal safety, and behaviour - self harm, obsessions, and aggression. Care Homes for Adults (18-65 years) Page 20 of 36 Evidence: Two people have limited communication, and others have anxieties or become unsettled at times. Staff have detailed guidelines to recognise signs of distress or discomfort and a checklist to work through that is personal to the individual. Diversion is used to manage behaviour, or monitoring charts and praise. This was drawn up with other professionals, is good practice and is closely monitored. Some people have psychotropic and occasional use medication, under regular review with health specialists. Medication guidelines and protocols for chemical restraint are reviewed six monthly. This is helping the people concerned to live a life with more quality. Side effects are well researched and monitored closely to note patterns - by the home and with specialists, such as incidents following depot injections. One person has a liquid medication prescribed so that it is absorbed more quickly. Aggressive incidents are always analysed. Guidelines ensure that people are protected, and incidents we discussed concerned damage to property or verbal aggression to staff, and specialists are actively involved. On our visit people appeared to get on well together, affection was shown, and each others habits and repetitive speech are tolerated. We were told about some love/hate relationships and we saw that people responded well to staff and sought their help, for example to change batteries or to explain things affecting their day. No one self manages medication. People usually have choice to refuse, which is recorded and discussed with doctors if it often occurs. We were notified of one incident regarding forced administration of medication. This is was appropriately reported and managed through the homes adult protection procedures and council protocol, with no lasting effect on the person concerned. It could not have been foreseen. We observed two staff witnessing and administering medication safely, and confirmed through records that competence is determined by regular observation. Staff have accredited training and regular updates. The medication system has regular internal checks and external audits by the homes pharmacist, for peoples protection. There is good key security and a system to check medication when it is received and disposed of. Minor improvements were discussed with management. New prescriptions mid month are not added with existing stock on the medication administration record (MAR) so that they are easily auditable. Temperatures are not taken where medication is stored to ensure it remains stable for peoples health, although it was not excessively warm. We asked managers to identify Schedule 2 drugs with an appropriate clinician and to review medication storage arrangements as there is no controlled drugs cabinet or register. Medication is well managed and recorded so people have medication as their doctor intends. Reviews note improvements in depression and reducing frequency of aggression. Care Homes for Adults (18-65 years) Page 21 of 36 Care Homes for Adults (18-65 years) Page 22 of 36 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People know who they can report a concern to inside and outside of the service, and staff are trained to recognise and report distress or abuse in line with the homes policy, national guidance and local protocols. People can have confidence any concerns will be taken seriously and acted upon. Evidence: People and relatives all told us they would talk to staff and managers if they were unhappy or had a concern and had confidence that appropriate action would be taken. Staff have guidelines to notice and act upon signs of distress or discomfort in people with limited communication, which is good practice. A professional said, Harper House have always worked in a professional manner with the multidisciplinary team to resolve issues for the benefit of client. Complaints and protection policies are robust, linked to council processes, and they are in keeping with national guidance. There are accurate contact details so that a concern can be reported inside or outside of the home, which is good practice. However details of making a complaint to the local council would be more accessible if presented in an Easy Read style. There have been no complaints in the past year. Recognising abuse and raising a concern was discussed in a residents meeting. This is excellent practice so that people are aware of their rights, that they can say no if Care Homes for Adults (18-65 years) Page 23 of 36 Evidence: someones behaviour is bothering them and report it. On our visit a manager asked someone if they minded being kissed on the head by another service user, as well as explaining that this was not behaviour that they have to accept. The other person has a behaviour management plan that we saw is being followed for their social skill development. Safeguarding is taken seriously and there is a whistle blowing policy that is used by staff who have acted responsibly in the past year. Staff have training and excellent knowledge to recognize and report abuse and poor practice. The home worked well with other agencies under the local adult protection protocol regarding one incident that is near conclusion. The home took immediate action so that people were safe and there were no ill effects, however it was an incident of significant risk about the way medication was administered. We were informed that a staff member will be dismissed and reported to the Independent Safeguarding Authority to protect other adults in the care sector, as is their legal duty. The incident could not have been forseen and the worker was appropriately trained but had not followed the homes best practice procedures. Learning was shared with staff to prevent recurrence. The home has other protective policies which we sampled and found to be in keeping with the law, national guidance and best practice. This includes restraint and managing challenging behaviour, money and belongings. Peoples financial interests are protected, and their property so that it wont go missing or be disposed of without their involvement. The home is preparing for enactment of a new law on 01/04/09 about Deprivation of Liberty Safeguards, and managers have attended council training. On our visit we found that people who need controls on their movement and personal security have assessments and best interests decisions recorded about this, with consultation in keeping with the Mental Capacity Act and peoples rights. This includes protection from wandering, road safety and checks at night, to manage behaviour and aggression, health and wellbeing. We advised that a new policy and access to national and local forms should be developed and used when necessary, due to the nature of peoples complex conditions. Care Homes for Adults (18-65 years) Page 24 of 36 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 adequate 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 homely, clean and secure environment. Facilities could improve to promote independence and privacy, and checks could improve safety. There are best practice measures for food hygiene and to prevent the spread of infection. Evidence: The home is in a residential area, and is an ordinary house that does not stand out in the neighbourhood. It is comfortable, homely and has a welcoming atmosphere. The home and enclosed garden are secure and doors are alarmed so people do not wander into the road. There is a shed in the garden that has been made into a smoking room, which is used by one person. The home itself is a smoke free environment so that other peoples health is protected. Most communal areas downstairs are accessible to wheelchair users, such as the lounge and dining room, although there is a narrow hallway to the laundry and office. There is sufficient storage for one persons wheelchair, which is usually used outside the home. The person told us they are pleased with their new wheelchair. There is no stair lift, and they wear calipers and negotiate stairs slowly with a staff escort. They have poor short term memory and are easily distracted. A staff escort is also needed if they leave their upstairs bedroom. We were told that this was reviewed with a Care Homes for Adults (18-65 years) Page 25 of 36 Evidence: specialist; however we observed risk to the person and to staff if they lost footing or balance. Managers said an extension has been planned that would give this person more independence and safer mobility, as their room and an assisted bathroom would be on the ground floor. Management are also considering a loft extension to provide more single bedrooms. Detailed manual handling and transport assessments show staff how to help people safely in the home and in the minibus, or using public or other transport. The premises are maintained and refurbished through contractors and work by the deputy manager, who is currently painting some of the rooms. There are window locks and low surface radiators, to prevent falls and burns. Contractor certificates and monthly safety checks were sampled and were satisfactory. The water is tested to prevent bacteria, and while we were in the home the hot water was tested at our request and found to be in the safe range to prevent scalds. Health and safety checks did not act upon environmental hazards known to management that we saw in the house and garden and the refurbishment plan is not prioritizing health and safety. For example, we were told that no one uses the bathtub which had broken tiles, and that people prefer the shower. The bathroom is due to be completely refurbished but no date was planned. There was a broken bathtub board that people unsteady on their feet could have fallen against and become injured. We negotiated a timescale for essential repairs, which the home confirmed were completed early and within 48 hours of our visit. A broken chair out front was collected by the dustmen on our visit. We queried a stack of broken furniture in the garden, as this presented risk of falls or use as weapons if someone became aggressive. Management confirmed that this was removed within 24 hours of our visit. Repairs are not always timely and at present there is damage caused by service users on occasion. The large screen TV in the lounge has been broken and will be replaced with one inset in the wall. We queried a broken wardrobe door, and were told that there is sturdier furniture on order and wardrobe door locks so that peoples belongings will not be disturbed. Each person has lockable space for small amounts of money or valuables. There are two shared bedrooms for four men and we were told that they do not mind the lack of privacy screens. Apparently two men pulled down a room divider, so these were removed for health and safety, and signed waivers were in care records. We queried why there was no toilet paper in a communal bathroom and were told that one person stuffs the rolls down the loo causing blockages and now people must ask for Care Homes for Adults (18-65 years) Page 26 of 36 Evidence: toilet paper. This does not proactively promote dignity and privacy (see management). We were shown around the building by people living in the home. Bedrooms suit gender, ages, culture and lifestyle. Each room has a battery charger showing that portable music equipment is regularly used. We were told that people chose the colour schemes and bedding, however we queried this and were told that the men all chose the same bedding. We think individuality could be more proactively encouraged. In contrast, the female service user has a single bedroom filled to the brim with mementoes, and she clearly chose the colour scheme and bedding. There is sufficient storage space for personal belongings, and we saw that people have more than ample clothing. Photographs of family and friends are on display. The home is clean and smells fresh; surveys told us it is always this way. Staff are clear on the cleaning schedules. Best practice measures for infection control and food safety are in place for peoples health, and all staff are trained in these areas. An Environmental Health Report made only one recommendation about kitchen tiles, which we saw was acted upon. The kitchen was clean and safe, and a locked pantry secures cutlery and crockery. There are daily checks on essential food stocks so that the home does not run out - particularly of drinks, due to obsessive behaviour. Care Homes for Adults (18-65 years) Page 27 of 36 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Competent and consistent staff have the right attitude, training and supervision to support people with complex needs. Robust recruitment checks ensure staff are safe to work in the home. Evidence: During the past year management introduced higher quality standards. A large number of staff left for various reasons and were replaced. There are currently ten permanent staff. Rotas are arranged so that staff with appropriate skills meets peoples needs day and night. There are usually two staff on shift including one qualified in first aid so that lives can be saved in an emergency. There are two staff at night, one sleeping and one waking and managers are on-call for support. Temporary staff, when necessary, are consistent so that peoples needs are known. The manager is planning their supervision. The workforce is diverse so that people can have gender choice for help with personal care. Staff are recruited with the right attitude, and people meet them and take part in the selection process, which is good practice. Three people told us that staff treat them well. Relatives and professionals told us that staff have the right skills and experience and the service provided meets their expectations. Most staff said that there are Care Homes for Adults (18-65 years) Page 28 of 36 Evidence: always enough staff, that they are kept informed about people and read their care plans. Staff were knowledgeable about people, policies and procedures. They learn together as a team as well as through training. Sampled records show that robust recruitment checks made with police, government lists, and previous employers before staff start work so that people are protected. There is an induction to safe working practices and code of conduct expected by the home, followed by a longer induction and a training programme that meets Skills for Care standards. We saw an excellent checklist about this which shows us that staff are effectively supported and managed within timescales so that people are protected from inexperience and lack of knowledge. Management value and invest in staff training and support. Since the last inspection, staff were trained in a learning disabilities qualification, and the home have steadily increased the number of staff with NVQ qualifications in care. There are excellent opportunities for additional qualifications and training by various training providers that exceeds basic mandatory training and refreshers so that peoples conditions, equality and diversity are understood. A professional told us that staff also regularly undertake challenging behaviour training with our team. Managers keep staff up to date about new ways of working. There is a policy about supervision, which we confirmed is two monthly, and a three stage appraisal process that includes observation. Systems are in place to check quality, which informs continuous staff development. This ensures that staff effectively monitor peoples health and wellbeing and recognise when to seek specialist advice. Care Homes for Adults (18-65 years) Page 29 of 36 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well run with audits, spot checks and peoples views used to maintain high quality standards and satisfaction. There are organised systems, up to date policies and safe working practices. The service development plan and risk management needs to critically evaluate the prevention of accidents and promotion of peoples rights. Evidence: The home has a qualified and experienced manager and deputy, and support from Head Office, including an administrator shared between the homes. This family-run home took ownership in 2004, inheriting staff and people living there. On our visit we saw people of varying abilities, all with complex needs and the home are providing good outcomes and quality of life. We received very high praise from professionals and relatives, and about staff and managers. There are good relationships between people, staff and managers. The home responds quickly and effectively to requests and any concerns noticed or reported. This was Care Homes for Adults (18-65 years) Page 30 of 36 Evidence: evident from surveys, our observations and records seen on and after our visit. The AQAA was returned on time. It had all the information we requested and provided a reasonable self assessment. The homes certificates are up to date and on display Both managers have care, management and learning disability qualifications appropriate to their roles and for the service provided, and the manager is registered with the Commission. Our last inspection report was acted upon and shared with people. From discussions we found that managers provide leadership and have kept staff up to date with new laws and ways of working, such as person-centred care. Policies and procedures we sampled are up to date and use best practice including restraint, adult protection and peoples access to records. Best practice was also evident in infection control and food safety measures we saw. Managers are choosy when recruiting staff to promote peoples rights. People are involved in the selection process, and also share their views about existing staff. There is a clear recruitment strategy so that the workforce is diverse to benefit people. Staff are highly valued and equal opportunity is promoted, for instance by arranging audio training materials for staff with dyslexia. There is regular staff supervision, and appraisal is a three-stage process. Staff and managers have enthusiasm to try new ideas. They work well with other agencies to provide seamless services and a consistent approach which has improved outcomes for people. There are good staffing levels, organized systems, safe working practices and the home is smoothly run. Competence and quality standards are kept up by unannounced checks. Updating records improved since a checklist was introduced. People have excellent access to records that are put into an appropriate format or are explained. The fire risk assessment and evacuation plan, and the homes risk assessment are kept up to date, and comply with other regulators. The premises, however are not maintained to the high standard the AQAA told us about and in this regard management need a more responsive and analytical approach to service development and environmental health and safety so that people are fully protected and their rights are promoted by facilities, furnishings and timely repairs. The home needs to find practicable alternatives so that one persons rights and risk management do not override the rights of others for dignity and privacy. People accommodated in the home should have facilities to fully promote independence and safe mobility. Environmental hazards need to be acted upon when they arise. There are appropriate contractors, and in other respects there are regular and effective health and safety checks. There are a number of ways in which effective management practice sustained high Care Homes for Adults (18-65 years) Page 31 of 36 Evidence: quality standards since the last inspection. Periodic reviews of incidents and accidents identify patterns that are acted upon or learned from. Audits are discussed in supervision, appraisals and staff meetings. Peoples views are sought in a variety of ways that influence the running of the home, the service and facilities. However there is significant aggression and damage to property, and we would expect the extent to which this affects peoples lives to be critically evaluated with them and their representatives. There are a control measures that directly affect privacy and dignity, such as having to ask for toilet paper and waivers we saw about dividers in shared rooms. We recommend that independent support, facilitation or observation is used to critically examine peoples experience in the home as individuals have limited experience of alternatives to draw upon, and some have limited communication and significant mental impairment. The extension plan will improve facilities for current residents but it has not been progressed since a planning application was rejected two years ago. Staff support is appropriately provided, however risk is posed to the person and staff. The person concerned cannot afford to lose their mobility, through accidental injury. Ground floor accommodation would greatly improve their independence, freedom of movement and safety and free up a single bedroom. Managers say they intend to see this through, as well as the refurbishment plan. The provision of single rooms for everyone in the home would better meet public expectations and privacy. Staff have a health and safety culture that balances risk taking and independence with personal safety, and people are safeguarded when necessary. The homes personcentred and professional approach to seamless services has been praised by other professionals to have made a difference to the lives of people living at Harper House. Care Homes for Adults (18-65 years) Page 32 of 36 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 33 of 36 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 1 20 13 13(2): The quantity of all medicines received midmonth, and any balances must be added on the medication administration record for accurate audits. This is so that audits demonstrate that medicines are administered as prescribed, and all medication in the home is accounted for. 18/08/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 6 Goal-planning should be clear in care records, and periodic care plan evaluations should assess whether tasks have been appropriate to meeting the goals people seek. Opportunities for exercise should be explored for each person so that their mobility and health is promoted, and coordination can be further developed. It is recommended that the pharmacist is consulted to avoid NHS wasteage by returning unused PRN medication Page 34 of 36 2 13 3 20 Care Homes for Adults (18-65 years) monthly that is still within its shelf life date. 4 20 The purchase of a thermometer is advised and daiily recorded checks to ensure that medicines are stored in accordance with their product licence to maintain their stability for peoples health. For best practice and public safety, Schedule 2 Drugs should be stored in an appropriate controlled drugs cabinet and a controlled drugs register with numbered pages used in addition to the MAR. It is recommended that the complaints policy provides an Easy Read summary to making complaints to the council, in keeping with the homes own accessible policy. A new policy about Deprivation of Liberty Safeguards will be needed from 01/04/09, with access to national and local forms so that the homes new legal duties and peoples rights are understood; exercised when necessary. It is recommended that facilities in shared bedrooms and waivers regarding room dividers are reviewed so that privacy and dignity are promoted. When bedding needs replacement, it is recommended that the men are encouraged separately to choose bedding that reflects their own interests and preferences to promote diversity and independence. The plan for an extension should be progressed so that facilities provide greater independence and safer mobility for a person living in the home. Risk management should ensure that environmental hazards are noted and responded to in a timely way to prevent accidents. It is recommended that independent facilitation is used to critically evaluate the effect on peoples lives of aggression/damage, and control measures for health and safety, so that steps can be taken to further promote the rights of all people living in the home (as discussed in the report). 5 20 6 22 7 23 8 24 9 26 10 42 11 42 12 42 Care Homes for Adults (18-65 years) Page 35 of 36 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. 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