Care Home: High Street (31)

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What the care home does well The service is small and provides an individualised service. People are supported and encouraged to be as independent as possible and to get involved in everyday tasks around the home. The people living in the home say they are happy with the service they are receiving. What has improved since the last inspection? Some areas of the home have been redecorated and the kitchen floor has been replaced. The garden wall has been repaired making the garden safer for people to use. What the care home could do better: The manager must ensure that any restriction on the rights or freedom of the service users is regularly reviewed to ensure it is still required and is in their best interests. How the decision is made to place any restrictions on people`s lives must be clearly documented with the reasons why it is necessary stated. The decor in some areas of the home could be further improved to ensure the home is comfortable for service users. The manager should make the complaints procedure available to service users in format that is suitable for their needs. The use of visual aids in the individual plans may help service users to be more involved in writing and reviewing them. How people are to be supported to see their friends and make new friendships should be included in the individual plan. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: High Street (31) 31 High Street Horsell Woking Surrey GU21 4UR     The quality rating for this care home is:   two star good 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: Jo Griffiths     Date: 1 1 0 3 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 28 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.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 28 Information about the care home Name of care home: Address: High Street (31) 31 High Street Horsell Woking Surrey GU21 4UR 01483757995 01483757995 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Quest Haven Ltd Name of registered manager (if applicable) Mr Isaac Tagoe Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of service users to be accommodated is 3 The registered person may provide the following category of service only: Care home only (PC) to service users of the following gender; Either whose primary care needs on admission to the home are within the following category; Learning disability (LD) Mental disorder, excluding learning disability or dementia (MD) Date of last inspection Brief description of the care home 31 High Street is a detached bungalow situated in a residential area of Horsell close to shops and facilities. The service provides care for up to three service users with learning disabilities or a mental disorder excluding learning disability or dementia. Each service user has their own furnished bedroom and there is a communal lounge and small dining room. A medium sized garden area surrounds the bungalow with car Care Homes for Adults (18-65 years) Page 4 of 28 care home 3 Over 65 0 0 3 3 Brief description of the care home parking facilities to the front of the property. The service is close to Woking town centre where good transport links are available to the surrounding areas. Care Homes for Adults (18-65 years) Page 5 of 28 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: This was a key inspection of 31 High Street that took place on 11th March 2009 between 3.00pm and 6.30pm. The manager of the service, Mr Issac Tagoe, was present during the inspection. Both service users were at home for part of the inspection visit. Prior to the inspection visit the manager completed and returned the Annual Quality Assurance Assessment (AQAA) which provided information about the service and its improvements since the last inspection. The information was used along with evidence collected during the visit to form a judgement about the quality of service provided. The fees for this service range from 1200GBP to 1500GBP per week. Further Care Homes for Adults (18-65 years) Page 6 of 28 information can be obtained from the manager of the home. 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.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 28 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 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have an assessment of their needs to ensure they can be met and have their needs kept under review. Evidence: There have been no new people admitted to the home since the last inspection. The people currently living in the home have had an assessment of their needs. This is reviewed at their care review meeting and a copy is sent to their care manager. The assessments link to the care plan guidance protocols that are in place for supporting service users in their daily lives. Care Homes for Adults (18-65 years) Page 10 of 28 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. People have an individual plan that meets their assessed needs, supports them to make decisions in their lives and be as independent as possible. Risk assessment have been completed to ensure people are safe, however some restrictions placed on peoples lives must be carefully reviewed to ensure they are relevant and not unnecessarily removing peoples rights. Evidence: The individual plans for both people using the service show that these address the needs identified in the assessment. Both people living in the home said that they are happy there and feel they get the support they need. Guidance protocols are in place for staff to follow to support people with their daily needs. Some of these protocols place restrictions on peoples lives, for example, by not having certain items in their bedrooms or by limiting the number of cups of tea they can have. The manager explained that these restrictions are in place following a risk assessment ,to ensure the safety of the individuals, and agreement of the protocols within a multi disciplinary Care Homes for Adults (18-65 years) Page 11 of 28 Evidence: meeting. Whilst the manager has followed appropriate procedures for introducing these restrictions the protocols have been in place for some time and there is no recorded evidence of how these decisions have been reviewed. Minutes of a care review report show that the manager has suggested the removal of the restrictions, but there is no recorded evidence showing what has happened with this recommendation. The manager must ensure that any restrictions are reviewed with the involvement of all relevant professionals and that restrictions are lifted as soon as possible so as to promote the rights of the individuals. The manager must also consider the impact of the Deprivation of Liberty section of the Mental Capacity Act 2005 and ensure that all practices reflect this legislation. Some of the protocols that place restrictions on peoples lives have been put in place to help them manage their own behaviours and the manager described how these have been successful. The review of the protocols should also reflect where people no longer require restrictions in their lives and are able to manage their own behaviours with just guidance and advice. Other guidance protocols in individuals plans that relate to their daily support have been reviewed monthly. There is an emphasis on supporting people to be as independent as possible in their daily lives and examples of this was seen in practice, such as preparing their own meals. Some person centred planning tools have been used to help people make decisions about the support they need. This could be further developed by use of pictures and other visual aids to help people take ownership of their own plans and complete areas of their plans where possible. Risk assessments have been completed as needed, but as described above, those relating to restrictions in peoples lives need to be reviewed with clear recorded action stating how and why the restrictions are to continue. The individuals care managers must be involved in this process. Care Homes for Adults (18-65 years) Page 12 of 28 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 using the service are supported to participate in the activities they enjoy. They have regular access to the local community for activities and to use local services. People are supported to see their visitors and friends when they wish, but would benefit from this being included as part of their plan. People living in the home are supported to be as independent as possible and to be involved in everyday tasks in the home. People using the service have a varied and healthy diet and are supported to make their own choices and prepare their own meals. Care Homes for Adults (18-65 years) Page 13 of 28 Evidence: People using the service are currently supported to use local authority day services 5 days per week, this includes both activities at the centre and some college courses. The manager said that people are encouraged to make their own decisions about the activities they do and gave an example of how a persons choice about not doing an activity was respected. The manager should keep peoples social needs under review to ensure the use of the day centre continues to be the most appropriate option for them. In addition to the use of the day centres staff in the home support people to go out to the pub, for meals out, to social clubs and to do their shopping. On the day of the inspection both service users were going out in the evening to a social club. Records are maintained of the activities people participate in including the opportunities they have to participate in daily living tasks such as preparing their meals and food shopping. The inspector spoke with both people using the service and observed them in their routines in the communal areas on their return from the day centres. Both service users appear relaxed and comfortable in their home and are supported to do as much for themselves as they can. The service users do not currently have keys to their own front door and the manager said that this could be explored to promote their independence and to acknowledge it as their own home. The manager advised that people had been offered keys to their bedroom doors but choose not to use them. The manager stated that people can have visitors when they wish to and that they are supported to see their friends when they want to. The individual plans could be further expanded to include how people are supported to do this and how they are supported with regard to any personal and intimate relationships with others. There is a four week menu in the home, which is used as a guide. The service users choose what they would like for their meal, when they return home, and are supported to cook and serve it themselves. The staff on duty said that people are supported to go and do their food shopping each Sunday. Records are kept of the meals provided and these show that people have a choice of meals and can choose something different to each other if they wish to. The range of meals provided appears to reflect a balanced diet. Care Homes for Adults (18-65 years) Page 14 of 28 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. People have their personal and health care needs met through their individual plan. They are supported to manage their medication safely. Evidence: Each person has their personal care needs identified in their individual plan. Staff provide support and guidance in this area as needed. All personal care takes place in the bathroom. Each person has a health action plan that outlines what their health needs are and how these will be met. These show that people are supported to see their GP and other health professionals when they need to, such as psychiatrists, dentists, opticians and speech therapists. Records are maintained for any health professionals input. One person uses some prescribed medication and is supported to store this securely in a medication cabinet and to take this as prescribed. Staff that support the service user with medication are trained to do so and have been assessed as competent by the manager. Care Homes for Adults (18-65 years) Page 15 of 28 Care Homes for Adults (18-65 years) Page 16 of 28 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. Service users are offered regular opportunities to raise any concerns with the manager. They would benefit from the complaints procedure being made available to them in a format appropriate to their needs. People using the service are safeguarded from harm and abuse by trained staff and robust procedures. Evidence: The home has a complaints procedure, a copy of which has been provided to all service users families. The complaints procedure is currently in written form and needs to be adapted to a suitable format for the service users. The manager stated that he regularly talks with service users to check if they are happy or have any concerns about their care. There have been no complaints received by the home or by the Commission since the last inspection. All staff are trained in safeguarding vulnerable adults and know how to report any allegations of abuse. The manager is arranging training updates for staff and has a copy of the Surrey Multi Agency Safeguarding policy in the home. The staff recruitment procedures for the home ensure that the necessary checks are made of any new employees before they start work to safeguard the service users. There have been no safeguarding issues raised. Care Homes for Adults (18-65 years) Page 17 of 28 Care Homes for Adults (18-65 years) Page 18 of 28 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 layout of the home is suitable for the service users, but they would benefit from more attention to the decor of the home to make it feel more homely and comfortable. The home is clean, well maintained and safe for the people living there. Evidence: The home is a small domestic style bungalow and is appropriate for the needs of the people that live there. Since our last inspection there has been some redecoration to the shared areas of the home, including the lounge, and new sofas have been purchased. The home is clean and well maintained. Some areas of the home are sparsely decorated, including the bathroom and the dining room, and would benefit from attention to the decor to make it feel more comfortable and pleasant for people to use. The garden wall has been repaired since our last visit and the kitchen floor has been replaced. The kitchen is accessible to the people living in the home and people were being supported to prepare their meals during the inspection. Care Homes for Adults (18-65 years) Page 19 of 28 Evidence: Individuals bedrooms are a good size and they have the furniture they need. One person has chosen not to have curtains in their room and this is being kept under review by the manager. The bedrooms do not contain many personal belongings and this is linked to the restrictions in risk assessments and protocols referred to earlier in this report. The manager must continually revisit this issue to support people to be comfortable in their own personal space. Care Homes for Adults (18-65 years) Page 20 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service are safeguarded by the procedures in the home for recruiting new staff. They are supported by sufficient numbers of trained and qualified staff to meet their needs. Evidence: The recruitment files seen for two staff show that robust procedures are followed for recruiting any new employees to ensure that the service users are safeguarded. This includes taking references, a Criminal Records disclosure and an interview for all prospective employees. There is a low turnover of staff in the home with no use of agency staff. The staff in the home have completed a range of training courses and most have their NVQ award. The manager has completed a Skills for Care assessment to identify where further training is required and is booking these courses currently. The staff on duty at the time of the inspection demonstrated a good understanding of peoples needs and a respect for their individual choices. The staff were patient and spoke respectfully toward the service users. Staff were seen to encourage people to be as independent as possible. Care Homes for Adults (18-65 years) Page 21 of 28 Care Homes for Adults (18-65 years) Page 22 of 28 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is managed by a qualified, experienced and competent manager. The views of the service users are sought regularly in order to ensure they remain happy with the service. The health and welfare of the service users and staff in the home is promoted through regular health and safety checks and risk assessments. Evidence: The manager is a registered learning disability nurse has completed the Registered Manager Award since the last inspection. The manager is a member of the Chartered Institute of Management and the Surrey Care Homes Association. He has completed training in safeguarding adults with Surrey Council and is a trainer in NAPPI (non aversive techniques for managing aggression). The Registered Provider and manager review the service at least annually to ensure it continues to provide a good service for the people living there. As required earlier in Care Homes for Adults (18-65 years) Page 23 of 28 Evidence: this report any restrictions on individuals rights and freedom must be regularly reviewed and how decisions are made must be recorded. The manager meets with the service users for residents meetings regularly, where they have the opportunity to comment on the service provided and make suggestions for improvement. The manager ensures that the home complies with the Fire Safety Regulations and other areas of Health and Safety. Checks are made of all equipment in the home and servicing arranged as needed. Care Homes for Adults (18-65 years) Page 24 of 28 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 25 of 28 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 9 14 The registered person must ensure that any restriction on a persons rights, choice or freedom is reviewed and decisions made are documented. This is to ensure that peoples rights are promoted. 24/04/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 7 It is recommended that visual aids be used to help people take ownership of their individual plans and to be involved in completing them. It is recommended that the support individuals need to make and maintain friendships and relationships outside the home be included in the individual plan. It is recommended that service users be supported to have and use their own front door keys. It is recommended that the complaints procedure be produced in a format suitable for the needs of the service users. Page 26 of 28 2 15 3 4 16 22 Care Homes for Adults (18-65 years) 5 24 It is recommended that consideration be given to the decor of the home to ensure it is homely and comfortable as some areas are currently rather bare. This includes individuals bedrooms and relates to the requirement made under standard 9. Care Homes for Adults (18-65 years) Page 27 of 28 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 28 of 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!