Care Home: High Street (196)

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What the care home does well The service has improved since the last inspection. A new manager has been appointed. This manager appears to put the care of the residents at the heart of the home. Staff no longer work very long hours and are therefore better able to respond to the needs of the residents. The staff appeared to be caring and kind any interaction we saw was carried out with kindness and affection. Meal times were better organised staff sit with the residents and create a calm atmosphere where the residents can enjoy their meals. Complaints were responded to in a timely manner and relatives we spoke with told us that they were getting responses to their queries and worries. We saw the residents being taken outside to enjoy the fresh air. There are better activities and care was taken to ensure all residents where possible had a holiday. The care plans are more focused on caring for the individual and their needs that on tasks that need to be carried out. The home was bright and clean. Many rooms have been decorated giving the home a more domestic atmosphere. What has improved since the last inspection? In addition to the above the new manager is in place and she has made improvements to the home. There is a more homely atmosphere and the residents appeared calmer. A new driver has been appointed making it possible High Street (196) DS0000067371.V378218.R01.S.doc Version 5.3 for the residents to go out more. Care plans are more detailed giving staff better direction on how to care for the residents. We observed staff sit with residents over lunch and assist them in a manner that promoted dignity and respect. One resident we spoke with showed us photographs of a recent family event they attended. They told us that staff assisted them in all possible manners. Parents are now offered regular meetings with staff to ensure involvement in the running of the home. More care is taken to ensure that the needs of the individual are met. By this we mean that staff have more time to carry out handovers at the finish of each shift. Care plans detail the needs of the residents well and give staff good instruction on how to meet the resident’s needs. What the care home could do better: The home recently had its budget cut by the providers. We were told that the cut in the budget impacts on the home in so far as there is not sufficient funds to provide a choice at mealtimes for the residents. Staff who sit down to eat with the residents to create a homely atmosphere are now forced to eat different food to them. Not all the residents understand the reason for this. Good progress has been made on the care plans, however this needs to be finished as a matter of urgency. The mix of residents continues to make it difficult for staff to meet all the resident’s needs. There are residents who live on the top floor who would better have their needs met if they were on the ground floor with free access to fresh air. Staff continue to have a heavy workload in so far as caring for residents with very complex needs they still have to clean the home, cook for the residents and carry out the resident’s laundry needs. Many of the residents are unable to assist with the domestic tasks. Key inspection report CARE HOME ADULTS 18-65 High Street (196) 196 High Street Rickmansworth Hertfordshire WD3 1BD Lead Inspector Marian Byrne Key Unannounced Inspection 2 November 2009 09:00 High Street (196) DS0000067371.V378218.R01.S.doc Version 5.3 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care home adults 18-65 can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. High Street (196) DS0000067371.V378218.R01.S.doc Version 5.3 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address High Street (196) DS0000067371.V378218.R01.S.doc Version 5.3 Page 3 SERVICE INFORMATION Name of service High Street (196) Address 196 High Street Rickmansworth Hertfordshire WD3 1BD 01923 774869 01923 771670 keithparkes@tiscali.co.uk www.caretech-uk.com CareTech Community Services Ltd Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) The Manager has yet to register with the CQC. Care Home 12 Category(ies) of Learning disability (12), Mental disorder, registration, with number excluding learning disability or dementia (5), of places Physical disability (7) High Street (196) DS0000067371.V378218.R01.S.doc Version 5.3 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 15th July 2008 Brief Description of the Service: 196 High Street is a 12-bedded home. It has been renovated from an original 22-bedded older person home. The home is in a residential area of a small bustling town and is located ideally to meet the needs of the service users, with amenities located within a short walking distance. The property benefits from being located within spacious grounds with landscape gardens designed to provide privacy for the service users and accessible flowerbeds, which will empower and enable service users to participate if desired. The 12-bedded home operates as two separate units with the ground floor supporting 7 persons with associated physical disabilities and the first floor supporting 5 more able people with associated behavioural issues that may challenge. All bedrooms have en-suite facilities with walk in shower areas. Suitable private lockable storage is provided in each room. Each bedroom exceeds the minimum measurements and presents extremely well with a number of bedrooms having exits straight into the private garden area. Each floor also has a lounge, dinning room, kitchen, and activity room, separate laundry with equipment as required to meet individual needs. All bathrooms and toilets are equipped to meet individual needs with aids and equipment. In addition to individual space and bathrooms there are additional bathing facilities that provide 2 bathrooms with ample space. Specialist Parker and Bagheera systems are provided including shower attachments and overhead tracking in the ground floor bathroom. There is a lift and staircase to the first floor with suitable fire exits throughout the building. Information regarding the service is available in the Statement of Purpose and Service User Guide. These and a copy of the most recent CSCI inspection report are available on request from the manager. For details of the most up to date fees please contact the service directly. High Street (196) DS0000067371.V378218.R01.S.doc Version 5.3 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is one star. This means people who use the service experience adequate quality outcomes. This inspection was carried out by one inspector over one day. We spoke to people who use the service, staff, The Manager of the service and visitors to the home. We looked at records pertaining to the care of the people who live in the home, the recruitment, selection and training of staff. Prior to the inspection the Manager sent us a copy of the Annual Quality Assurance Assessment (AQAA) this is a legal requirement and the Manager returned it to us in a timely manner. What the service does well: What has improved since the last inspection? In addition to the above the new manager is in place and she has made improvements to the home. There is a more homely atmosphere and the residents appeared calmer. A new driver has been appointed making it possible High Street (196) DS0000067371.V378218.R01.S.doc Version 5.3 Page 6 for the residents to go out more. Care plans are more detailed giving staff better direction on how to care for the residents. We observed staff sit with residents over lunch and assist them in a manner that promoted dignity and respect. One resident we spoke with showed us photographs of a recent family event they attended. They told us that staff assisted them in all possible manners. Parents are now offered regular meetings with staff to ensure involvement in the running of the home. More care is taken to ensure that the needs of the individual are met. By this we mean that staff have more time to carry out handovers at the finish of each shift. Care plans detail the needs of the residents well and give staff good instruction on how to meet the resident’s needs. 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. High Street (196) DS0000067371.V378218.R01.S.doc Version 5.3 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection High Street (196) DS0000067371.V378218.R01.S.doc Version 5.3 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who use the service can be sure their needs and aspirations are assessed to ensure plans of care are drawn up that meet their identified needs. EVIDENCE: There have been no new referrals since the last inspection. The people who are admitted to the home have had a full assessment. However, none of the younger resident were admitted with their life history, this should have been written up by the professionals who were responsible for their care and their referral to the home. Staff continue to amass information pertaining to the service users from their families. This information assists staff in meeting the needs, wants and wishes of the residents who are unable to tell staff what their wishes are. High Street (196) DS0000067371.V378218.R01.S.doc Version 5.3 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Not all the people who use this service can be sure that their identified needs and wishes will be met. EVIDENCE: We looked at three care plans. The care plans contained good information on the three residents. Some of the care plans had been re-written since the last inspection we asked to see one of them. We noted that information is written in the first person i.e. I slept well last night. The person in question could not have written or verbalised this themselves. Other places in the care plan staff had written observations e.g. X was sleeping when checked throughout the night. This is confusing and as residents can’t always express themselves therefore there is no way of knowing if that is what they wish to say. High Street (196) DS0000067371.V378218.R01.S.doc Version 5.3 Page 10 The home endeavours to involve families in the drawing up of care plans and the information contained in the care plans reflected our finding at the site visit. Staff are aware of the need to promote the independence of the residents, this is done through thorough risk assessments that highlight risks and identify what can be done to reduce them to ensure all foreseeable risks are identified and plans put in place around them. Staff are dedicated to promoting the independence of the residents and work closely with families to ensure that the residents have as much independence as possible. The only barrier to this is the staffing numbers - this is explored later in the report. The home keeps information pertaining to the residents in a locked cupboard and only staff and families have access to this information. High Street (196) DS0000067371.V378218.R01.S.doc Version 5.3 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): This is what people staying in this care home experience: People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Not all people who use this service can be sure that their needs will be identified and met. EVIDENCE: On the day of the site visit we found that some of the residents were at a Day Centre. Others were in their rooms listening to music or were engaged with staff or involved in their own activities. For example one resident was ‘on line’ chatting with friends. Staff have arranged for residents to have outside activities and the opportunity for the residents to meet with friends outside the home. We were told that the home’s food budget had been cut. This was done without consulting the Manager or staff and no communication was made to ensure the residents had a varied diet and alternatives to the main dish should they prefer something else. We noted that there was no choice at the evening High Street (196) DS0000067371.V378218.R01.S.doc Version 5.3 Page 12 meal. When we asked why we were told that there was not enough resources to do this. We were told that staff’s food budget had to be cut due to lack of funds, when they joined the residents for a meal staff had sandwiches rather than the same as the residents. Not all the residents would understand why staff were eating different food. We were told that all the residents were offered a holiday this year. Those who choose to go on holiday told us that they enjoyed themselves. Every effort is made to ensure that all the residents have the opportunity to go to day centres. Not all the residents are able to take this opportunity due to their complex needs. Those who can’t attend day centres do not appear to have the same quality of life as those who can. There is not enough staff to take some of the residents out on a very regular basis. We noted that one resident who ate their meals outside the dining room at the last inspection was now joining in with the other residents. One resident has been identified as needing equipment in the garden that will offer him comfort we were told that this is being dealt with and should be available to him soon. High Street (196) DS0000067371.V378218.R01.S.doc Version 5.3 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in this home can be sure that their personal and healthcare support is carried out in a manner that promotes their physical health. EVIDENCE: We looked at care plans that gave staff instructions on how to administer care to the residents. Each resident has a Health Action Plan that gives staff information relevant to the person. None of the residents are self medicating. We checked the medication procedures and found them to be in order. Medication was stored, administered and recorded appropriately. Residents are accompanied to all health appointments and all routine health checks are carried out regularly. High Street (196) DS0000067371.V378218.R01.S.doc Version 5.3 Page 14 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who use this service can be sure that their complaints are investigated and that they are safeguarded from all forms of abuse. EVIDENCE: Staff we spoke with were aware of whistle blowing and of safeguarding adult’s procedures. Staffing levels have improved since the last inspection and staff’s hours are managed better and staff are no longer work very long hours. The Manager investigates all complaints under the home’s complaints procedures. We were told by resident’s families that they are now getting a response to their complaints. High Street (196) DS0000067371.V378218.R01.S.doc Version 5.3 Page 15 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. All the residents can be sure that the home is comfortable and safe, and clean and hygienic to meet their needs. EVIDENCE: The home is bright and clean it is decorated in a domestic style. Many of the communal rooms have been decorated since the last inspection. The home was clean and fresh. All the resident’s rooms were decorated to reflect their taste and were personalised in the furnishings. The garden was well tended to and well suited to the high needs of the residents. We saw that it was not being used on the day of the inspection High Street (196) DS0000067371.V378218.R01.S.doc Version 5.3 Page 16 despite the day being dry and sunny. The Manager told us that she was planning to erect a swing for one of the residents as this is knows to offer them solace. The Manager also plans to use the garden for the residents to grown their own vegetables. We were told that some of the residents want to do this. High Street (196) DS0000067371.V378218.R01.S.doc Version 5.3 Page 17 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Some of the people using this service do not have their all their identified needs met. EVIDENCE: We were unable to check all the recruitment records as they were stored at head office. We found the staff on duty to be both dedicated and have a good knowledge of the needs of the residents. The training of staff is good and while we were unable to see the records on recruitment the manager told us that she is happy with the calibre of staff recruited. Staff have very heavy work loads. They are responsible for the care of very vulnerable young people with complex needs in addition to this they cook all the meals, they clean the home and they do all the laundry for the home. High Street (196) DS0000067371.V378218.R01.S.doc Version 5.3 Page 18 There are residents both upstairs and downstairs in the home who need constant attention and two residents who life in rooms next to each other have very different needs i.e. one needs a quite atmosphere and one needs to play their music very loud. Staff have to be very vigilant to ensure both person’s needs are recognised and met. Their rooms can’t be changes as it would create more problems. We were told that the home is being provided with cleaning staff in the near future. High Street (196) DS0000067371.V378218.R01.S.doc Version 5.3 Page 19 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who use this service cannot always be sure that it will be run in their best interests. EVIDENCE: The new manager took over on May 2009 and had been managing in an acting up capacity since Nov 2008. The registration process has yet to be fully completed. The home has not had a registered manager for a year. The AQAA was returned when we requested it. The new manager has made positive improvements to the home. We have noted some improvement in all aspects of care and life in the home generally. However we note that the very complex needs of the young people cannot High Street (196) DS0000067371.V378218.R01.S.doc Version 5.3 Page 20 always be met due to the number of residents with very high different needs living so closely together. An example of this is the two residents who have very different needs one who needs a quiet atmosphere and one who needs to play their music very loud. We saw that staff do their best to ensure that neither of the residents are upset. The manager told us that she is well supported by her line manager. We were told that the provider of the service has cut the household budget, this means that there is not sufficient funds to ensure the residents have a choice at mealtimes. Staff do not eat the same food as the residents at meal times as they home’s budget only allows them to have sandwiches. The home staff and residents should eat together to promote a homely atmosphere different food takes from this experience. The manager of the home was not consulted on the budget cuts nor has the provider checked to see the effects of the budget cuts on the resident’s lifestyle. Staff are responsible for cleaning the home. This takes them away from caring for the residents, who, as already stated have very complex needs. The staff now have a handover that allows them to discuss the needs of the service users and to be sure of continuity of care. Staff no longer work very long hours and are therefore better able to respond to the needs of the residents. All the required health and safety checks pertaining to the running of the home were met. These include fire training and checks on equipment. High Street (196) DS0000067371.V378218.R01.S.doc Version 5.3 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 2 3 X 4 X 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 X 23 X ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 X 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 2 X LIFESTYLES Standard No Score 11 X 12 2 13 2 14 X 15 2 16 2 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 2 X 2 2 X 2 x Version 5.3 Page 22 High Street (196) DS0000067371.V378218.R01.S.doc YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA33 Regulation 18(1)(a) Requirement The responsible individual must ensure that there are sufficient numbers of staff on duty who are trained to meet the needs of the residents as set out in this report. This includes ensuring that meals are eaten in a peaceful and homely environment. This has been met in part. We have extended the dead line as we have been told that a cleaner is being recruited. 2. YA18 12 (1)(b) The resident identified as X in this report who has very sensitive hearing must be reviewed to ensure that their needs are met. This has been met in part. 3 YA17 16(2)(i) The Provider must provide sufficient funds to ensure the home has sufficient funds to run effectively and in the best DS0000067371.V378218.R01.S.doc Timescale for action 31/01/10 31/12/09 30/11/09 High Street (196) Version 5.3 Page 23 interests of the people who live there. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations High Street (196) DS0000067371.V378218.R01.S.doc Version 5.3 Page 24 Care Quality Commission Care Quality Commission Eastern Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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