Care Home: Heathside Neurodisabillity Unit

What the care home does well The residents receive personal support to meet their needs both physical and emotional. This is being done in a committed and caring manner. Staff are friendly and respectful of residents. Residents and family members commented that they feel safe and that staff understand them and are very helpful. Staff are well inducted and trained and the atmosphere in the home is relaxed and friendly. The home makes sure that all staff have been treated fairly during recruitment and that all their work histories and police checks are properly done before coming to work at the home. There is a range of health care professionals involved in helping the staff and in supporting the residents to overcome significant health care problems. Health care and health and safety are very well managed and protect residents and staff. The care planning and review meetings are regular at least every two months which is important as the nature of support is rehabilitation. Care plans regarding health care and risk assessments to protect residents are good. The building is fully wheelchair accessible with excellent bathroom and en suite facilities and is well decorated and clean with good natural light and is well maintained and safe. Specialist services such as Physiotherapy and Occupational Therapy are provided within the home and there is regular involvement from a range of health care professionals ensuring that good health care support is provided. The staff team is experienced and well trained with more than 70 percent having achieved NVQ qualifications. What has improved since the last inspection? The home now makes sure that all long term residents care plans include activities that they like to take part in. Activities include personal development and training opportunities for long term residents. The daily records kept by staff include details of social and leisure activities and details of residents mood and expressed interests. The homes contracts with residents include details of the fees to pay and details of termination notice and are signed by the residents to show that they have agreed and understood. Formal supervision for care staff and nursing staff has been improved so that all staff now have supervision should least six times a year. The home now employs an activities coordinator to improve the level of social and leisure care activities for residents. Key workers and other staff are now involved in care reviews and other meetings and are able to participate fully to represent the residents needs in these meetings. Some work has been done to redecorate various parts of the home with plans in place for further redecoration. The communications between staff and health professionals are now very good. What the care home could do better: There should be more focused advocacy for residents who experience delays in receiving specialist equipment such as wheelchairs and the management should review the reasons for any delays and tell the residents and equipment providers about these delays to improve this service. Community based activities need to be improved for residents especially for those in ling retm residence. The home should look to improving transport available so that outings can more easily happen. The home must ask residents whether they are getting food that they like and respond to their needs in this area. The smoking room should be examined to see whether there is too much furniture which gets in the way of wheelchairs and some should be removed if residents agree to this. The manager should check whether cleaning is always acrried out as fully as it should be. Key inspection report Care homes for adults (18-65 years) Name: Address: Heathside Neurodisabillity Unit Blackheath Brain Injury Rehabilitation Centre 80 Blackheath Hill London London SE10 8AD     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Sean Healy     Date: 0 9 1 2 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 35 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 35 Information about the care home Name of care home: Address: Heathside Neurodisabillity Unit Blackheath Brain Injury Rehabilitation Centre 80 Blackheath Hill London London SE10 8AD 02086924007 02086948316 andrea.walker@fshc.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Four Seasons Healthcare Properties (Frenchay) Limited care home 18 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 physical disability Additional conditions: The maximum number of service users who can be accommodated is: 18 The registered person may provide the following category of service only: Care home with nursing (CRH - N) to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Physical disability - Code PD Date of last inspection Brief description of the care home Heathside Neurodisability Unit is a care home with nursing, providing support, accommodation and rehabilitation for up to 18 residents. The home specialises in providing neuro disability rehabilitation. Although it is intended that residents stays at the home would be limited to the time needed for rehabilitation the homes practice is to allow some residents to stay until suitable alternative accommodation can be identified. To this end the services of a Community Liaison Officer is employed to identify move on accommodation and to help sort out funding and benefits issues. A number of residents have been at the unit for approximately seven years but in the Care Homes for Adults (18-65 years) Page 4 of 35 Over 65 0 18 Brief description of the care home last year six of these have been found alternative accomodation. The provider is a private company is called Four Seasons Healthcare Properties (Frenchay) Ltd. The responsible individual has regular contact with the unit. The home is supported by senior management links with another brain injury unit based on the same site which offers access to other health professionals such as Neuro psychology. The day to day management of the unit is delegated to a Registered Care Manager. This manager who is a trained nurse leads a team of 8 nursing staff and approximately 25 support staff. The home employs in house physiotherapy occupational therapy speech and language therapy services and access to a neuro psychologist from a neighbouring unit. The home employs a housekeeping team and a health and safety maintenance officer. The home is housed in purpose built modern premises. The home is spacious well lit and fully wheelchair accessible. It is comprised of 18 single bedrooms 15 of which have en suite shower and toilet facilities. These are fully accessible. There are also four other separate toilets one bathroom and one other shower room all of which are accessible. The home is located on Blackheath Hill South London Care Homes for Adults (18-65 years) Page 5 of 35 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The quality Rating for this service is 2 Star. This means that the people who use this service experience good quality outcomes. The inspection was unannounced and was conducted with the support of an Expert by Experience. The inspection was facilitated by the registered care manager supported by the clinical services manager. The process included interviews with six residents and feedback from eight families of the residents. 6 other residents also responded to the inspection surveys. Five residents assessment and care planning files were examined. One social worker and one visiting peg feed specialist and the activities coordinator and health and safety facilitator were also interviewed. Five staff completed inspection surveys and five other staff employment files were examined. The inspection included Care Homes for Adults (18-65 years) Page 6 of 35 a tour of the premises. Care Homes for Adults (18-65 years) Page 7 of 35 What the care home does well: What has improved since the last inspection? The home now makes sure that all long term residents care plans include activities that they like to take part in. Activities include personal development and training opportunities for long term residents. The daily records kept by staff include details of social and leisure activities and details of residents mood and expressed interests. The homes contracts with residents include details of the fees to pay and details of termination notice and are signed by the residents to show that they have agreed and understood. Formal supervision for care staff and nursing staff has been improved so that all staff now have supervision should least six times a year. The home now employs an activities coordinator to improve the level of social and leisure care activities for residents. Key workers and other staff are now involved in care reviews and other meetings and are able to participate fully to represent the residents needs in these meetings. Some work has been done to redecorate various parts of the home with plans in place for further redecoration. The communications between staff and health professionals are now very good. Care Homes for Adults (18-65 years) Page 8 of 35 What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 35 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 35 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. Quality in this outcome area is Good. This judgement has been made using available evidence including a visit to this service. Prospective residents now have all of the information they need to make an informed choice about whether to move to the home. Residents individual aspirations and needs are now fully assessed in the areas of social and leisure care and religious and cultural needs. Each resident has a written contract showing terms and conditions which adequately provide all of the information needed by residents. Evidence: There was a requirement made at the last inspection for the home to include better information in the Statement of Purpose and service users guide about the services provided by the home. This requirement has now been met. The homes Statement of Purpose and Service Users Guide were reviewed in October 2009 and now contain excellent information about how the home provides for social leisure religious and educational activities. The information about the range of fees charged to residents is referred to but needs to be made clearer. This information must be included in these Care Homes for Adults (18-65 years) Page 11 of 35 Evidence: documents. (Refer to Recommendation YA1) There was a requirement made at the last inspection for the home to ensure that care assessments for residents included more information about their individual support needs in social educational religious and cultural areas of support. This has now been done and this requirement has been met. I looked at five residents files and found these to have much improved since the last inspection. The contained assessments of healthcare needs which were very detailed and clear and details of social and leisure histories and interests such as one residents interests in sailing and music group activity and movie interests. Another included dancing and running and spiritual beliefs and favourite foods all of which gave a better picture of the resident as an individual rather than just as a patient who needed help. Staff commented that they felt this helped them to understand better what to speak to residents about and what activities and TV programmes to help them access. Care assessments regarding health support were excellent showing goals for walking and mobility improvement and all were supported by relevant professional clinicians assessments. Consideration was fully given to areas of risk including use of equipment and falls and tissue viability and risk of depression due to inability to cope. Health and social care assessments are well managed by the home. The homes primary reason for being is to provide support and rehabilitation for victims of trauma. The assessments showed excellent detail in a broad range of health-related information and a number of assessments showed the main reason for admission to be brain injury with a range of secondary medical support needs such as pneumonia poor mobility behavioural support needs and diet and mobility. There is involvement from specialist peg feeding practitioners in the assessment process and in ongoing provision of care and relevant assessments are on file. As at the last inspection the home does not initially plan to provide long term care for residents and so social care provision has not been a feature of the homes expertise. Since the last inspection move on options have been found for some residents and the number of long term residents has more than halved. There is information on file showing that those remaining have chosen to stay and in some cases insisted on staying on at the home. In these cases more provision has been made for longer term care. There was a requirement made at the last inspection for the home to ensure that residents were in possession of contracts showing the care to be provided and the fees payable. This has now been done and the manager said he has almost completed the process of distributing the final documents to residents for signing their agreement. I Care Homes for Adults (18-65 years) Page 12 of 35 Evidence: saw a number of these and found they contained the appropriate information. The fees the home charges are between 1290 pounds per week and 2230 pounds per week depending on the level of clinical support required. There is a contract in place between the home and care commissioners which shows fees to be paid and what is involved and included. Separately the residents are given a contract between the home and themselves. Care Homes for Adults (18-65 years) Page 13 of 35 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Quality in this outcome area is Good This judgement has been made using available evidence including a visit to this service. Residents assessed and changing social care needs are now reflected in their individual care plans. Residents are given adequate independent support to be able to make decisions about their lives and in relation to financial matters. The home does an excellent job in assessing risk with residents to enable them to remain as independent as possible and to regain mobility in a safe environment. Evidence: There was a requrement made at the last inspection for the home to improve residents acre plans to include information about socila leisure and educational support needs and to show plans for how these will be met by the home. I examined five residents care plans and found that these areas are now fully included and this requirement is met. in the main this assertion was also supported by the majority of residents who took part in the inspection process speaking with the expert by Care Homes for Adults (18-65 years) Page 14 of 35 Evidence: experience and in response to inspection surveys. Ther are areas ahich need some improvement regarding the implementation of plans regarding activities aoutside of the home which the home manager is now aware of. (See Standard 12 and 14 of this report) Care plans were very detailed regarding health and rehabilitation support needs and were supported by very detailed pre admission screening assessments involving appropropriate health care professionals. Some residents required occupational therapy and physiotherapy support planning and tehse were in pace and were managed and reviewed by the relevant clinicians almost weekly. The care staff now are consulted about the paractical areas such as exercise programmes and eating support plans and give infromation back regarding progress for consideration in reviews. Two health care professionals who took part in this inspection spoke highly of care staffs involvement and said they follow care plans and comminuicate well about progress or changes needed and that they involve residents more now and are very interactive with them. One said that this has resulted in a better more welcoming environment within the home. Examination of five residents records regarding their financial arrangements and discussion with the manager and a number of relatives clarified that residents are responsible with their families for their own finances with the home looking after small amounts of money for some residents for day to day spending. Comments received by the Expert by Experience from 6 residents and other comments received by me to residents surveys were that residents highly valued the independence that they were achieving at the home and the vast majority felt that they now had a high level of choice over their lives on a day to day basis. One example given by a resident was that he was now enabled to manage his own medication which gave him a greater sense of independence and self worth. The Expert by Experience received a number of comments from residents about delays in getting equipment such as appropriate wheelchairs and commodes in raesonable time when needed. Although the home provides such equipment in the interim residents commented that this equipment is sometimes uncomfortable and unsuitable or is also used by others causing delays. The home itself is not responsible for carrying out these assessments or provisiong this equipment and delays were caused externally. It is recommended that the home examine the problems experienced and notify the relevant providers in writing of their concerns and also provide more advocacy for residents to focus on the follow up for each referral made. Residents said they would find this helpful. (Refer to Recommendation YA7) Care Homes for Adults (18-65 years) Page 15 of 35 Evidence: Residents concerned als0 asked that the home provide more frequent information to individual residents when delays occur as to the reasons and as to timescales for provision of the equipment. Care plans I examined contained a range of risk assessments regarding individual residents which were very well written and which were reviewed very regularly. These also were supported by guidance for staff in how to manage the risk. Risk is well managed by the home Care Homes for Adults (18-65 years) Page 16 of 35 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Residents are not supported to fully take part in age peer and culturally appropriate activities and are not participating fully in their local community. Residents have appropriate personal family and sexual relationships and their rights are respected. A healthy diet is provided but residents have asked for more choice in the food provided. Evidence: I examined five residents care plans regarding activities and family involvement and the food provided. The Expert by Experience spoke with six residents and I received information in surveys from six residents and eight relatives. The nature of this service and the needs of the residents on admission normally Care Homes for Adults (18-65 years) Page 17 of 35 Evidence: means that they would be unable to engage in many of the activities available to them before admission. For example many residents are admitted as a result of physical trauma and have to undergo a period of treatment and rehabilitation before being able to take part in activities again. There are a number of long term residents who need more social and personal development activities in order to have a fulfilling life. The number of these has reduced from nine to three since the last inspection due to the conscious decision made by the provider to find more homely and suitable accommodation for them. However the remaining longer term residents would benefit from having a structured plan for individual social and leisure activities and activities in the local community. Some of the other residents whose physical abilities have improved would also benefit from in house activities and outings. To this end the home has employed an activities coordinator who works 20 hours a week dedicated to providing activities for the 18 residents. I interviewed the coordinator and found he had completed Life Stories for residents so that the staff would understand residents as individuals and be more aware of the areas of activities and conversation they might like to engage in. It was clear from residents activities plans that the coordinator has done a lot to plan activities such as exercise sailing music groups and movie groups for residents and he was mainly available on Wednesdays and Fridays to focus on these activities. He used a weekly social activities plan and a 6 monthly review plan to plan and monitor activities for each resident. The residents and families said that the work he has done is very good and is successful in providing focused personal activities for some residents and some good group activities which are well received. The transport arrangements for going out is now primarily Dial a ride or Taxicard as the home does not now have its own transport. While this provides well for longer term planned outings it does not provide well for the more day to day needs of some residents to go out locally as individuals or together with other residents. Staff have expressed that they were having problems in taking some residents out as most residents have mobility support needs and the local area is hilly and has a lot of road traffic. The home had previously bought a small bus in addition to a car to enable more people to regularly get out. However these vehicles are no longer available to residents. The majority of the residents who spoke with the Expert by Experience and those residents and families who responded to surveys said that the coordinator is doing a good job with the time he has but that he could not possibly cater for the activities for all residents in the time he has. It was felt that involving the other care staff more in the role of delivering activities and the coordinator playing a lead for them would be more helpful. The home must review the processes for delivering community based activities and outings for residents so that residents can plan and Care Homes for Adults (18-65 years) Page 18 of 35 Evidence: access more of these activities consistently. (Refer to Requirement YA14) It is also recommended that the home seek to provide adequate transport for residents use to help staff respond more successfully in taking residents out in the community when planned or requested. (Refer to Recommendation YA14) All residents and families of residents commented very positively about staff saying that the staff are always very respectful and are always available to help them when they need it. I observed that staff always address residents by their names and are careful to ask permission before entering their rooms. There are no restrictions placed on residents rights and there is a good atmosphere within the home. Visiting healthcare professionals also agreed with this saying the atmosphere in the home was very welcoming and that staff are very interactive with residents. Families and friends are welcomed in the home without restriction. The residents spoken to by the Expert by Experience said that the food provided is often good but that they are not offered choices which they feel they like and that not enough fruit or fresh vegetables are available. Although they offered choices in advance of meals each day the food does not reflect their tastes and when it comes a number of residents said it can sometimes be cold. One recommended the home get an extra hotplate to keep food hot while it is being distributed between the two dining areas or to residents bedrooms. These comments were also supported by the majority of those who responded to the inspection surveys. The home must survey all residents about their views on the food provided in relation to choice and whether the food is hot and take appropriate action in response to their findings. (Refer to Requirement YA17) Specialist food and eating support is provided for residents who need this support such as peg feeding and there are specialist peg feeding healthcare professionals involved in care planning and monitoring on a weekly basis. I spoke to one of these professionals who said she was very pleased at the quality of the care provided by staff in this area. Care Homes for Adults (18-65 years) Page 19 of 35 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Residents receive personal support in the way they prefer and require it and their physical and emotional needs are being met. Residents do retain and control their own medication where appropriate Evidence: The homes assessment system does identify the likes dislikes and preferences of residents in relation to personal care needs food preferences and some activities. Many residents are highly physically dependant and care is taken by the home to provide all care and support in a sensitive manner through discussion with residents and their families. There are a range of highly skilled health care professionals employed by the home such as physiotherapists Occupational Therapists and qualified nurses who provide support and advice on a daily basis. Neuro psychology support is also available when needed within the homes own staff team. Other health care needs such as nutrition and dental care are well supported with relevant healthcare professionals such as dentists and peg feed specialists visiting the Care Homes for Adults (18-65 years) Page 20 of 35 Evidence: home regularly. One of these commented that the patients are very involved in their care in peg feeding and staff are very consistent in following care plans in this area of support. Each resident has excellent care plans in place to support all health care needs and involving specialist health care professionals. The majority of residents have physical disabilities which require the need of use of hoists and wheelchairs and other specialist equipment. As the service provided is regularly for people whom have previously not needed this equipment the home has to do referrals to access equipment such as wheelchairs so that individual assessments can be done by relevant external agencies who then provide the equipment. A number of residents who spoke to the Expert by Experience said that they felt strongly that they have to wait significant periods of time for their own wheelchairs to arrive and in the meantime the home provides alternative chairs. A number of residents said these chairs are often uncomfortable and not suited to their specific needs. Another said the commode provided is not always available in his room and he has to wait for it to be available. These issues were discussed with the homes manager at the inspection. He felt that they do their best to provide adequate equipment but that there are delays by the equipment assessors and providers which are outside of the homes control. The home must review the system for assessment and referral for specialist equipment in consultation with relevant residents and the equipment providers to identify causes for delays and notify the providers in writing where delays are felt to be unreasonable in order to improve the service to residents. (Refer to Requirement YA18) Some residents commented that where delays are experienced the homes management should regularly inform them of the reason and what they are doing to prompt the equipment providers. (See also Standard 7 of this report) The homes medication policy caters for residents to self medicate and currently two of the residents are self medicating and assessments are in place to assess risk and abilities to do this. The home has an adequate medication policy which was last reviewed in 2009. The medication policy is consistent with current best practice. Medication is stored recorded and administered safely by the trained nursing staff. There are also suitable arrangements in place for the safe disposal of medication by a licensed agent. Residents abilities and wishes regarding self medication are now being fully assessed as part of the homes assessment process. There is now a standard assessment form for doing this which is comprehensive. Medication is well managed by the home. Care Homes for Adults (18-65 years) Page 21 of 35 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. Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Residents feel their views are listened to and acted on appropriately and that they are protected from abuse neglect and self harm. Evidence: The home has a complaints policy in place which was last reviewed in 2009. This contains all the information needed by this standard. There have been five complaints recorded since last inspection. One of these was about the food being too spicy and another was regarding the personal care provided being not as good as usual. The remaining complaints were dealt with under the local authoritys safeguarding adults policy. All complaints were recorded and responded to efficiently. Four of the 14 residents and families who took part in the inspection process said they were not sure how to make a complaint. I saw information about how to complain displayed in the home and in residents rooms. Given the nature of the care needs of some residents this may be expected but the home should remind all residents of the process for complaining. The home keeps a register of complaints including dates received and dates when the complaint investigation is completed. This register shows that the majority of complaints were completed within 28 days and that the home was responding quickly to complaints and concerns. Care Homes for Adults (18-65 years) Page 22 of 35 Evidence: The home has a Safeguarding Adults protection policy in place which was last reviewed in 2009. This policy is detailed and has had some guidance added regarding when to involve the police and a useful spreadsheet directing staff and management in their responsibilities. Staff have confirmed that they had received information about this from the management of the home. There have been three adult protection allegations reported since last inspection. All of these were reported appropriately to the Care Quality Commission and to the local authority and the home cooperated fully in investigation and in providing information for social services and the police. Appropriate action was also taken in suspending and dismissing staff when necessary and in considering referral to the POVA register. Staff interviewed were aware of their responsibilities regarding this policy and the homes training records show that all staff are receiving adult protection training. Care Homes for Adults (18-65 years) Page 23 of 35 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. Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Residents live in a homely comfortable and safe environment and shared spaces are adequate in size. The home is maintained to a good standard of cleanliness and hygiene but comments received suggest that cleaning routines could be improved. Evidence: All residents have a private single room and 15 out of the 18 bedrooms have en suite toilet and shower facilities. The home is large bright and well maintained. (Please refer to the Brief description of the home to the front of this report) The home is fully wheelchair accessible and is suitable for its stated purpose. The home has got two dining areas which are suitable for the dining needs of the residents many of who are wheelchair users or have physical disabilities. Discussion with staff residents and families suggest that the homes arrangements for seating residents for meals are adequate. The Expert by Experience suggested that the smoking room is too cluttered with furniture making the manoeuvring of wheelchairs difficult. It is recommended that this be considered in consultation with residents who use this room and appropriate action taken. (Refer to Recommendation YA24) Care Homes for Adults (18-65 years) Page 24 of 35 Evidence: I observed the home to be maintained to a good level of cleanliness and hygiene on the day of the inspection. Good records are being maintained and there are good systems in place for checking and monitoring practices to prevent infection and to protect staff and service users. Laundry is done in a separate area by a housekeeping team and cooking is done in a modern and clean kitchen by dedicated kitchen staff. I examined the kitchen and food storage areas and found that they were very well maintained and kept in a spotless condition. All flooring and tiling in kitchen and bathroom areas too are very well maintained. Although continence management is an issue for this home the home was free from unwanted odours and smells throughout. However comments received from four of the fourteen residents and families who took part in the inspection process suggest that there is a need for more monitoring of cleaning at the moment as sometimes areas such as tops of tables may be left for periods uncleaned. This has not been the experience of the majority of residents but the manager should check that systems for periodic monitoring of cleaning are in place and are effective. (Refer to Recommendation YA30) The home has a maintenance plan in place for 2009 and this included plans for redecoration of the home. Curtains have been replaced in all areas with matching colour bed spreads which looks very homely. The dining room and smoking room have also been redecorated re-decorated. Laundry services have been improved and there are fewer complaints about missing or damaged laundry. Care Homes for Adults (18-65 years) Page 25 of 35 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. Quality in this outcome area is Good This judgement has been made using available evidence including a visit to this service. Residents are supported by a competent staff team but they are currently not effective in providing enough support for all residents activities. Recruitment and induction of staff are well managed and individual staff training and supervision is now well managed. Evidence: There were three requirements made at the last inspection regarding the management and training and supervision of care staff. These requirements have now been met. Staff are now happy with the pattern of their shifts having been consulted by the homes management. All five staff files examined and surveys received from five other staff confirmed that they are now receiving adequate supervision and training. All staff have their roles clearly defined in their job descriptions and there is a good relationship between staff and management and between the different professionals employed. Visiting professionals commented that there is a good welcoming atmosphere at the home and that staff are good at their jobs and take care to involve residents and to follow care plans. Discussion with staff show that they have a clear understanding of residents needs and how to consult with other professionals such as Care Homes for Adults (18-65 years) Page 26 of 35 Evidence: Occupational Therapists or Physiotherapists. Discussion with some of the homes professionals and comments received from care staff showed that communications is good and staff are working well as a team. Staff consistently follow guidance on how to provide residents with the right food or how to support residents with mobility equipment and any problems are discussed openly. Two professional commented that they felt management act effectively in supporting both themselves and the care staff to deal with any areas of concern. 17 of the 25 health care assistants are qualified to NVQ level 2 or 3 representing more than 70 percent of the care staff. This meets the NVQ training requirements for the home. There is an induction programme in operation which meets the sector skills training councils requirements and there is a very good general training plan in the home showing and a range of appropriate training is provided for staff. There are individual training plans also in place for each members of staff personal development. The home is staffed by a registered manager who is a trained nurse and there are always at least two trained nurses working in the home day and night supported by between two and three care staff. (Rehab. assistants) Some residents require one to one care and when this is contracted for there is an additional staff member allocated to work with that resident. Staffing levels have been agreed with the commissioning authorities and seem adequate for the support required. Staff said they feel there is enough staff to do their jobs, but there needs to be some more emphasis placed on staff working in a more coordinated way to provide community activities for residents who require these activities. (See Standard 14 of this report) Staff meetings take place every month with weekly care review meetings involving a range of staff also taking place. I observed staff to communicate very well with residents and residents and relatives commented that staff are very sensitive and supportive in how they speak with residents. Recruitment practices are good and staff CRB records are now being held until inspected by the Care Quality Commission. There is good adherence to equal opportunities practices in the recruitment process with pre arranged questions relevant to the post advertised being asked of all candidates. At least two managers form the interview panel and all staff who took part in the inspection process said that they felt that interviews are fairly conducted. The home provides good structured induction training for care staff and nursing staff. All staff files I inspected showed that they had a range of training in the last 12 months including moving in handling infection control swallowing health and safety adult protection fire safety complaints equal opportunities training and training on Care Homes for Adults (18-65 years) Page 27 of 35 Evidence: respecting diversity. The home employs up to nine nursing staff and some additional nurse bank hours. Checks are done to ensure that these are registered with the Nursing and Midwifery Council. Care staff files I examined now had an individual training and development assessment profile and an individual training plan showing intended training for the future. The five staff files I examined had evidence of consistent supervision being carried out. Discussion with a number of staff confirmed that staff are now receiving regular two monthly supervision. Annual appraisals are also now happening for staff. Care Homes for Adults (18-65 years) Page 28 of 35 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. Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Residents benefit from a well run home and there is good leadership and management practices in operation. Residents are confident that their views underpin the homes development and there is now an annual quality audit system in place. Residents and staff health and safety is actively promoted in the home. Evidence: There has been a new care manager in post at the home since September 2007. This manager is a qualified Register General Nurse and has worked within the organisation for a number of years. He is experienced in the management of physical and health care needs relevant to the residents of this home. The manager is registered with the Care Quality Commission and the CQC certificate of registration is correct and is displayed. The manager is supported on a weekly basis by the clinic services manager who is Care Homes for Adults (18-65 years) Page 29 of 35 Evidence: present at the home on a daily basis. The care manager has completed an NVQ level 4 in care and management. The manager has also done some further training in the investigation and recording of adult protection situations and has become competent in reporting and investigating these issues when requested. All of the staff and residents and relatives commented positively on the abilities of the management within the home and on their commitment to making improvements when necessary. The home has a quality assurance system in place and quality reviews are carried out quarterly. The home does have some good quality assurance systems in place and does have regular consultation with residents and their families. There is a good culture of inviting family to review meetings and due to the nature of the service being provided these reviews are held every 8 to 12 weeks providing a good opportunity for the home to consult directly with residents. Surveys are carried out to find out about residents views on how the home is run. There are also weekly meetings with residents as a group taking place each Friday and chaired by the registered manager. There are also quarterly meetings with relatives. Leaflets surveys and suggestion boxes are readily available to encourage residents and relatives to raise any concerns and air their views. The home takes the management of health and safety very seriously and is able to show that there is a high standard of checks and balances in place for making the home safe. The home has a long standing health and safety and maintenance officer who has worked at the home for the past 12 years. There is a health and safety policy in place including a fire safety risk assessment which was reviewed in 2009. The fire alarm is tested weekly and records are consistently kept. Fire evacuation drills are done quarterly on there is a clear understanding of how to support residents including where to take them to within the building during the course of a fire drill. A hydropool is used for the purposes of physiotherapy and this pool is tested monthly for bacteria content. The homes water system was adequately tested for legionella and is safe. All gas and electrical and hoist maintenance certificates are up to date. Kitchens are well maintained and kept very clean. Manual Handling fire, infection control and food hygiene training is provided for all staff. First aider training is also provided. There is a health and safety committee set up to review all H&S issues. Care Homes for Adults (18-65 years) Page 30 of 35 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 31 of 35 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 14 16 The registered provider and manager must review the processes for delivering community based activities and outings for residents so that residents can plan and access more of these activities consistently. This is to ensure that residents residents have access to a range of appropriate leisure activities 31/03/2010 2 17 16 The registered provider and manager must consult with residents regarding the choice of food available including in relation to religious or cultural needs and act on any findings. This is to ensure that residents are given adequate choice about the food they eat. 31/03/2010 3 18 16 The registered provider and manager must review the 31/03/2010 Care Homes for Adults (18-65 years) Page 32 of 35 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 system for assessment and referral for specialist equipment in consultation with relevant residents and the equipment providers to identify causes for delays and notify the providers in writing where delays are felt to be unreasonable in order to improve the service to residents. This is to ensure that residents are able to access specialist equipment which match their needs without undue delay 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 1 The registered provider should include clearer information about the full range of fees charged in the homes Statement of Purpose or Service Users Guide as discussed in this report The registered manager should examine the problems experienced by residents in delays of provision of specialist equipment and notify the relevant equipment providers in writing of their concerns and also provide more advocacy for residents to focus on the follow up for each referral made as discussed in this report. The registered manager should provide ongoing information regarding delays to relevant residents who are waiting for specialist equipment such as wheelchairs as discussed in this report. The registered provider and manager should explore with Page 33 of 35 2 7 3 7 4 14 Care Homes for Adults (18-65 years) Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations staff and residents the best means of improving transport arrangements for residents so that the home can plan for more residents outings in the local community as discussed in this report. 5 24 The Registered manager should consult with residents who use the smoking room as to whether there should be less furniture and take any appropriate action as discussed in this report The Registered manager should check whether there is a need for more monitoring of cleaning as discussed in this report 6 30 Care Homes for Adults (18-65 years) Page 34 of 35 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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