Care Home: Hendon Road (3)

What the care home does well The team of support workers are experienced and competent to ensure Hendon Road is run in the best interest of the people living there until a suitable person is appointed as the scheme manager. The support given to the resident confirmed that support workers were fully competent and knowledgeable in their role. It is commendable that the team of support workers are working effectively in the absence of a registered manager to meet the residents` needs When asked what the service does well, a person using the service told us, "I always receive support from the same staff in the scheme". What has improved since the last inspection? Improvements were not identified at this visit What the care home could do better: The service must appoint a registered manager because the lack of a registered manager prevents the service from meeting the corporate aims and objectives. Residents` changing needs and personal goals must be up to date and clearly reflected in their care plan so that support workers can fully meet their needs. The lack of a quality assurance system at Hendon Road hinders effective service development and improvements. This prevents residents and staff from letting their views be known about way the service is operated. To ensure residents live in a well-maintained home the registered person must ensure there is a planned record of maintenance and decoration with timescales. So that the residents have the specialist equipment to maintain their independence the registered person must make sure the washing machine is in good working order. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Hendon Road (3) 3 Hendon Road Nelson Lancashire BB9 9JL     The quality rating for this care home is:   one star adequate 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: Christine Mulcahy     Date: 3 0 0 1 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 29 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 29 Information about the care home Name of care home: Address: Hendon Road (3) 3 Hendon Road Nelson Lancashire BB9 9JL 01282690703 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Pendle Residential Care Limited Name of registered manager (if applicable) Mrs Ann Suleman Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: The service may accommodate up to a maximum of 2 service users in the category mental disorder, excluding learning disability or dementia (MD) The service should employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. Date of last inspection Brief description of the care home 3, Hendon Road (accommodating 2 younger adults) is part of Pendle Residential Care Ltd. (Dispersed Homes Scheme) in Nelson. This is a semi-independent living scheme for younger adults who have mental health problems. This dispersed house has staff support according to the assessed need of the residents. A designated house keyworker visits at least once a day and care support is available in the evening and at week-end as needed. Senior staff are on call at night and 24 hour emergency support is provided by the core house at Pendle View. Further Care Homes for Adults (18-65 years) Page 4 of 29 care home 2 Over 65 0 2 Brief description of the care home support is provided by visits from the registered manager and provider. Hendon Road is a small semi-detached house, located in a quiet residential area, near to local shops. Nelson town centre shops and other amenities are a short distance away. The house has on-street parking and pleasant gardens to the front and back. Transport in staff cars is provided for people using the service users. There are two single bedrooms and a house bathroom (shower and WC) on the first floor, and kitchen, dining/lounge and living room on the ground floor. Fees at Hendon Road are paid weekly and are determined by a comprehensive needs assessment and can be discussed with the manager Information about the home is given to people on referral. Care Homes for Adults (18-65 years) Page 5 of 29 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: one star adequate 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: We made an unannounced visit to the home on the 30th January 2009. It took 4 hours altogether and was done by one inspector. During the visit we looked at the care plans of one person using the service, written records, management systems, and talked to one person who uses the service to get their view of what its like to use the service. We also spoke to the two care workers to find out how the service operates and how it is organised. The visit was just one part of the inspection and we got more information from the Annual Quality Assurance Assessment (AQAA). This is a self assessment that is filled in by all care providers once a year whatever their quality rating. It is one of the main ways that we will get information from providers about how they are meeting Care Homes for Adults (18-65 years) Page 6 of 29 outcomes for people using their service. It also provides us with statistical information about the individual service and trends and patterns in social care. The quality rating for this service is 1 Star. This means that people who use this service experience adequate quality outcomes. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 29 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 29 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. Admission and assessment procedures in place ensure the care needs of people are met. Evidence: A care plan of one of the residents was examined and found to contain a local authority needs assessment that detailed the residents needs at the time of moving into the home. There were no records of recent and up to date reviews and assessments of the residents needs so it could not be shown if the current needs of the resident were being fully met. When asked if they thought their needs were being met one resident commented, Im very well thank you, the staff are good to me, Im ok here. Care Homes for Adults (18-65 years) Page 10 of 29 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The way in which peoples needs were being met meant they could make choices and maintain their independence however individual care plans did not reflect the residents current personal goals and aspirations. Evidence: We examined one of the care plans that was in the home. The care plan seen included a needs checklist that listed information about the residents physical health, personal hygiene, mental health needs, likes, dislikes, finances and where the resident needed support in their daily living. Although the care plan was person centred a lot of the written information was out of date. This means that because the residents changing needs had not undergone a recent assessment it could not be shown that residents care needs and aspirations were being fully met. Risk assessments that focused on the residents daily routines were in place but were also out of date and some parts of the care plan had not been reviewed since 2007. Care Homes for Adults (18-65 years) Page 11 of 29 Evidence: This means that new risks had not been identified and residents actions were not fully safeguarded. A lot of written information in the care plan was not in an easy to follow order and because of this it was not clear how the resident was supported, how risks were managed and if the residents needs were being consistently met. There was visible evidence that the resident received regular support from a support worker who made daily visits to ensure their daily living needs and routines were supported so that they could make decisions about their lives. Written evidence to confirm that tasks had been done were clearly documented in the residents file by the duty support worker. Care Homes for Adults (18-65 years) Page 12 of 29 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People had choice and support to meet their daily lifestyle expectations and preferences Evidence: A support worker confirmed that people using the service were able to make choices about daily routines in their lives and were supported to do this as detailed in the care plan. Examination of one of the care plans and discussion with the resident confirmed his independence was maintained and he said that he was looking forward to doing his shopping with the worker that day. He explained that he was always supported by one of the workers to do this but really preferred the comfort of his home and enjoyed watching the TV. Care Homes for Adults (18-65 years) Page 13 of 29 Evidence: He told us that he liked his own company but could always get involved in activities being held at another house in the scheme if he wanted to. Support workers visited daily and were always available if he needed them and could be contacted by phone in an emergency. Meals were chosen, prepared and cooked by residents with support from the workers if necessary and risk assessments showed that residents food preparation and daily living skills were monitored and recorded. Care Homes for Adults (18-65 years) Page 14 of 29 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. Peoples health and personal care needs were met in a way they preferred. Medication policies and procedures ensured residents health and wellbeing was protected. Evidence: Both residents who live at Hendon Road have got a care plan that explains how to meet their needs, however these needed to be reviewed more frequently. The peoples health needs are identified on the care plan and there was evidence they had access to GPs and specialists. Notes of these visits were recorded daily and kept in the residents care file. There is a medication policy supported by procedures and practices that support workers understand and follow and medicines received, administered and disposed of were recorded. Medication was stored and managed appropriately and medication administration (MAR) sheets were signed and properly completed. When asked if he felt his health needs were treated with respect and dignity the Care Homes for Adults (18-65 years) Page 15 of 29 Evidence: resident told us, The staff are very good and always tell me when theyre coming to the house. Yes I feel they treat me with respect and dignity. The support worker was observed throughout the visit talking to the resident in a tone and manner that was courteous, helpful and respectful. Care Homes for Adults (18-65 years) Page 16 of 29 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. People using the service were protected by the complaints and safeguarding procedure which were understood by staff. Evidence: People using the service are encouraged to discuss their views at any time if they have a concern, complaint or worry. We observed the duty staff showing a professional but approachable manner that helped the resident to be open and honest. The complaints procedure is clearly written and easy to understand. When we spoke to the residents about the complaints procedure he said, I know that if I was worried about something then the staff would sort it out, theyre very good. A complaints book was held centrally at the main scheme house and if there were any immediate concerns these would be recorded on the residents individual daily record sheet and dealt with immediately to prevent escalation. There is a robust policy and procedure for safeguarding adults and gives clear guidance to the staff. All support workers are trained in safeguarding and there is a programme of refresher training. The support worker when asked about the services safeguarding policy and procedure was fully aware of where to find the policy and how it should be used. Care Homes for Adults (18-65 years) Page 17 of 29 Care Homes for Adults (18-65 years) Page 18 of 29 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. The standard of decoration, furnishings and equipment at Hendon Road need to be improved to suit the needs and lifestyle of people using the service. Evidence: A tour of the house showed many areas looked shabby and in need of redecorating and new furniture. Communal living furniture needed updating and according to the support worker the residents only had 2 sets of bedding each. We were told that the washing machine needed replacing as it was always breaking down. This means that residents didnt have access to the equipment needed to maximise their independence. The bedroom seen was spacious and had been newly decorated, as had the dining room. It wasnt clear if residents had been involved in choosing the colour scheme throughout the home, but when asked about it a resident told us that the rooms looked better. The support worker said there was a plan to improve and replace some of the furniture, fixtures and fittings but this was not available at this visit. Care Homes for Adults (18-65 years) Page 19 of 29 Care Homes for Adults (18-65 years) Page 20 of 29 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. Staff are trained, skilled and in sufficient numbers to support the residents at Hendon Road. Recruitment practices protected the residents from risk of harm. Evidence: The resident told us that support workers usually visited Hendon Road twice a day to give practical support like help with shopping or just to say hello and catch up with the residents plans for the day. There is also assistance available from the main scheme house at Pendle View in Nelson by phone. All staff files were kept at the main scheme house and could not be examined at this visit. There is a robust recruitment procedure that defines the process to be followed when recruiting new staff and this ensures the protection of people using the service. The support workers when asked said there had been no new employees to the scheme since the last visit to the main house in June 2008 and residents at Hendon Road were always supported by existing workers within the scheme. Care Homes for Adults (18-65 years) Page 21 of 29 Evidence: A resident confirmed that he always received support from the same workers within the scheme. This means that residents received familiar and consistent support so they could benefit from clarity of staff roles and responsibilities. Staff confirmed that training was ongoing and all staff hold an NVQ level 2 or above in care and a first aid qualification. It could not be shown if the staff had received any mental health training to meet the needs of people using the service. Care Homes for Adults (18-65 years) Page 22 of 29 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The lack of a registered manager prevents the service from meeting the corporate aims and objectives but support workers ensure the interests and welfare of the people at Hendon Road are promoted and protected. Evidence: The team of support workers are experienced and competent to ensure Hendon Road is run in the best interest of the people living there until a suitable person is appointed as the scheme manager. Records were kept securely but not kept in good order and residents care needs required reviews. Support workers were familiar and aware of the residents changing needs even though they werent properly recorded. This means that the lack of direction and leadership prevent the staff and residents from relating fully to the protocols, aims and purpose of the home. Observations of the support given to the resident at the time of the visit confirmed that the support worker was fully competent and knowledgeable in his role. It is commendable that the team of support workers are working effectively in the absence Care Homes for Adults (18-65 years) Page 23 of 29 Evidence: of a registered manager. The lack of a quality assurance system at Hendon Road hinders effective service development and improvements and this prevents residents and staff from letting their views be known about way the service is operated. Care Homes for Adults (18-65 years) Page 24 of 29 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 6 Reg 14 The registered manager 30/04/2007 develops and agrees with each service user an individual Plan which may include treatment and rehabilitation, describing the services and facilities to be provided by the home, and how these services will meet current and changing needs and aspirations and achieve goals. 2 39 Reg 24(1) (a) Effective quality assurance (b)(2) (3) and quality monitoring systems, based on seeking the views of service users, are in place to measure success in achieving the aims, objectives and statement of purpose of the home. 30/04/2007 Care Homes for Adults (18-65 years) Page 25 of 29 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 6 15 The registered person must 10/04/2009 after consultation with the resident prepare a written plan that shows how the residents health and welfare needs are to be met, keep the plan under review and notify the resident of any changes made to the care plan. The manager must ensure that residents know their assessed and changing needs and personal goals are up to date and clearly reflected in their care plan. Previous timescale of 30/04/07 not met. 2 9 13 The registered person must ensure that unnecessary risks to the health and safety of residents are identified and as far as possible eliminated. Individual risk assessments must be reviewed regularly 10/04/2009 Care Homes for Adults (18-65 years) Page 26 of 29 to fully safeguard the residents actions in their home. 3 24 23 All parts of the care home are kept clean and reasonably decorated. To ensure residents live in a well-maintained home the registered person must ensure there is a planned record of maintenance and decoration with timescales. 4 29 23 Equipment provided in the 13/05/2009 home for use by residents or people who work in the home is maintained in good working order. So that the residents have the specialist equipment to maintain their independence the registered person must make sure the washing machine is in good working order. 5 37 8 The registered provider must appoint an individual to manage the care home. The registered person must inform the Commission of their intention to appoint a person to manage the home and the date when the appointment is to take place. By the date shown 6 39 24 The registered person shall 27/04/2009 establish and maintain a system for reviewing at appropriate intervals and improving the quality of care provided at the home. 30/03/2009 13/04/2009 Care Homes for Adults (18-65 years) Page 27 of 29 Effective quality assurance and monitoring systems based on seeking the views of the residents must be in place to measure success in achieving the aims, objectives and statement of purpose of the home. Previous timescale of 30/04/07 not met 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 Care Homes for Adults (18-65 years) Page 28 of 29 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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