Care Home: High Trees

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What the care home does well In answer to the question in the survey about what the home does well, the following comments were made by staff:- `training` `supporting the service users and putting their needs first` `we care for the needs of young adults with autism and learning disabilities very well` `works in a person centred way with all service users` `ensures respect, privacy and dignity at all times` `always looking for new opportunities for the people we support`. We saw that the home provides aids to communication, space and privacy, structure and encouragement - all based on the individual needs of the people living at High Trees. What has improved since the last inspection? The AQAA reflects that the home has improved their practices around finance, with more financial checks and updated risk assessments. Each person now has a personal financial profile. The programme of enabling staff to achieve national vocational qualifications is proceeding. More communication aids have been put in place for people living in High Trees to increase their involvement in menu planning and choosing activities and more activities have been put in place for people on a weekly basis. What the care home could do better: There are no requirements from this inspection. Within the AQAA, and in discussions on the day of this inspection visit, the manager has identified the following things for improvement or progress:- to continue to update decor and furnishings, including involving residents; to continue to look for voluntary and paid employment for people wishing to do so and to continue to develop the activities available within the community; to continue to work with family (where residents have indicated this as important) to understand the changes that have occurred with the implementation of the Mental Capacity Act; to provide information in a more accessible format; to continue to develop the person centred plans; to develop staff communication skills; to provide training on behaviour management; to provide a sensory garden; to replace flooring in the entranceway and lounge; to refit the kitchen; to install a sensory bathroom. She has also identified that the staff want to look at ways of involving the people who live at High Trees more in the everyday running of the home. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: High Trees Lympne Place Aldington Road Lympne Hythe Kent CT21 4PA     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: Christine Lawrence     Date: 0 8 0 6 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 23 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 23 Information about the care home Name of care home: Address: High Trees Lympne Place Aldington Road Lympne Hythe Kent CT21 4PA 01303260453 Telephone number: Fax number: Email address: Provider web address: nigel.horne@hft.org.uk www.hft.org.uk Name of registered provider(s): Type of registration: Number of places registered: Home Farm Trust Ltd care home 4 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users to be accommodated is 4. The registered person may provide the following category/ies 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 categories: Learning disability (LD). Date of last inspection Brief description of the care home High Trees is a care home registered to accommodate up to four service users with a learning disability. The fees are approximately £1900 per week but this depends on individual assessments and contracts. Home Farm Trust is the Registered Provider the manager is currently applying for registration. The home is one of several operated on the Lympne Place site by the Trust. High Trees was purpose built with a specific client Care Homes for Adults (18-65 years) Page 4 of 23 Over 65 0 4 Brief description of the care home group in mind and currently provides for an all male client group. The home is situated in a rural setting but within easy travelling distance of the towns of Hythe, Ashford and Canterbury. The home has vehicles to enable residents to go out and about. Care Homes for Adults (18-65 years) Page 5 of 23 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The inspection visit was notified to the home the day before to ensure that there would be someone available and started at 10.30 and finished at 14:00. We (the Care Quality Commission, CQC) looked at various records in the home and also used information sent to us by the manager before the visit. This was the Annual Quality Assurance Assessment (AQAA). Information from the previous inspection carried out on 13 July 2006 and the annual service reviews undertaken in January 2008 and November 2008, was also referred to. We observed the residents who live at the home, noting how they reacted to staff and how relaxed and comfortable they were within the home. A tour of the building was undertaken and this included residents rooms. We made observations of staff interacting with, and supporting residents. We spoke to staff including the manager and staff on duty. We spoke to some residents. Staff and residents (with support or completed on their behalf by staff) completed surveys and information from these is also used within this report. Care Homes for Adults (18-65 years) Page 6 of 23 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 7 of 23 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 8 of 23 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. Prospective residents individual aspirations and needs will be assessed. Evidence: There have been no new admissions to High Trees for some years. The new assessment system in place, as well as relevant policies and procedures, show that any admission would be carefully considered and would include an individuals wishes and goals for the future. The manager told us in the AQAA and during the inspection visit that it would be important to fully consider the needs of people living in High Trees as well as any new person especially as the home was so small. Care Homes for Adults (18-65 years) Page 9 of 23 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can be confident that their changing needs will be noted in their individual plans and that they will be supported to make decisions and take risks to enable as independent lifestyle as possible. Evidence: We looked at individual records for two people living at High Trees. Home Farm Trust (the owning organization) is now using a web based system for assessments and care planning called Support Planning Assessment and Recording System (SPARS) and the manager facilitated our access to these records as they are secured by password. The care plans seen were very individual and were person centred. Various aspects of individuals lives are covered including communication, behaviour, health, leisure and hobbies, friendships and relationships, culture and beliefs, and finances. The format allows for clear guidance for staff, a summary of essential infomation and support needed, including support needed to make decisions and plan (reflecting the ethos of the Mental Capacity Act). Goals and risk assessments are included throughout. The SPARS format also includes a diary section and a formal handover. The home is also in Care Homes for Adults (18-65 years) Page 10 of 23 Evidence: the process of completing individual person centred planning books called My Life Story. We looked at one that had been compiled using photographs and comments reflecting the individuals personal life and wishes. Five staff surveys were completed for this inspection and all five people answered yes to the question Are you given up to date information about the needs of the people you support or care for? Two people made comments relating to the fact that updating information is one of the things High Trees does well. Another member of staff noted that the home ...works in a person centred way with all service users.... Care Homes for Adults (18-65 years) Page 11 of 23 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. Activities and involvement in the local community, as well as support for personal relationships will be provided for residents. They will benefit from having a healthy diet. Evidence: The records seen showed that the people living at High Trees have appropriate activities and social events, both inside the home and within the community. Examples noted included voluntary work at a local charity shop (one person); swimming; trampolining; horse carriage driving; yoga; sensory sessions; using a local learning disability resource centre and art and music therapy sessions. One staff survey contained the following comment when asked What does the home do well? Always looking for new opportunities for the people we support. Not everybody always does the same things and the records showed that activities are very individualised. We noted examples from the records, as well as talking to residents Care Homes for Adults (18-65 years) Page 12 of 23 Evidence: and staff that holidays are an important part of residents lives. One person has expressed the wish to go to Spain this year and confirmed that this is being planned. Nobody currently wants to attend church but the manager confirmed that this would be responded to if wishes changed. We noted examples of residents being supported to maintain relationships with friends and relatives. The atmosphere within the home is based on promoting independence as much as possible while acknowledging that individuals need lots of encouragement. The manager explained both in the AQAA and during the visit that that people living at High Trees have rights to make decisions and choices and to be treated as an individual. We saw this put into practice by the way staff interacted with residents. The records seen showed that the menus are varied and nutritious. The dining room is spacious and has one large table so everyone can sit together. Menus are on display in the dining room, in a pictorial format. Care Homes for Adults (18-65 years) Page 13 of 23 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. Residents are protected by the homes policies and procedures regarding medication and their physical and emotional needs will be responded to. Their preferences and requirements for support are respected. Evidence: The care plans contained lots of information about the support people need, as well as prefer, making it clear to staff how this should be done. The SPARS and the key worker system is used to ensure this is all up to date. Residents health care needs are clearly identified within their individual plans entitled health assessments and health action plans, which also indicated that they were regularly reviewed. Each person has clear records relating to their medication. The records seen showed that healthcare professionals are accessed by residents both routinely and as required. Medication storage is appropriate and the records seen were properly completed. Staff have received training regarding medication and where relevant there is specific guidelines about how individuals prefer or need to take their medication. Care Homes for Adults (18-65 years) Page 14 of 23 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. Residents views are listened to or ascertained, and acted on. Evidence: There is a complaints procedure in place and the manager explained that it is available in different formats and they have tried to ensure that residents are able to understand. The key worker system provides opportunities for residents concerns to be heard. There are policies and procedures in place regarding adult protection such as the disclosure of abuse and bad practice (whistle blowing) and the management of residents finances. There are also regular audits of residents finances. The AQAA contained information that staff receive training in vulnerable adults protection and recognition of abuse, communication awareness, awareness of behaviour that challenges, advocacy and empowerment. One member of staff confirmed this and the records of other staff and the staff training matrix on display also reflected this (see also Standard 35). Staff members who we spoke to were very clear about their responsibilities to protect people living in the home. Care Homes for Adults (18-65 years) Page 15 of 23 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from living in a home which is homely and comfortable as well as clean and hygienic. Evidence: The home is attractively decorated, creating a bright, spacious and comfortable atmosphere. This included bathrooms and toilets. It is close to local amenities and public transport. Two residents kindly showed us their rooms which were well decorated and furnished and very individual. The kitchen is going to be re-fitted shortly and there are plans to change a shower room into a jacuzzi bathroom with sensory lights and music to increase residents opportunities for stimulation, relaxation and pleasure. Laundry facilities were satisfactory and staff have received training in infection control and food safety. The house was clean and fresh at the time of this visit. Care Homes for Adults (18-65 years) Page 16 of 23 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. Sound recruitment procedures and training already provided and training planned, will have a beneficial impact on residents. Evidence: We observed staff interacting with and supporting the people living at High Trees. They were polite and respectful and gave people time to respond or make a choice. They demonstrated through their actions and language an understanding of and commitment to enabling people to be as independent as possible. They showed that they understand individuals communication needs. Six of the staff have achieved a national vocational qualification at level 2 or above and others are working towards this. We spent time in the Home Farm Trusts Kent office looking at staff records. Procedures for recruitment are thorough and include application forms, interviews, criminal record bureau checks, references and terms and conditions of employment. Each person has a copy of the general social care councils code of practice. We saw training and supervision records and the programme of planned training and this all reflected that Home Farm Trust takes training seriously. Staff spoken to confirmed they had opportunities to do various courses. One comment made within the staff surveys in answer to the question What could the home do better? was ...more in depth autism training and awareness for all staff.... Each person also has a professional passport devised by the organization to monitor roles and responsibilities Care Homes for Adults (18-65 years) Page 17 of 23 Evidence: as well as achievements. Care Homes for Adults (18-65 years) Page 18 of 23 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. Residents benefit from a well run home and their health and safety is promoted and protected. Evidence: The manager has now been in post since September 2008 and previously worked in another Home Farm Trust home. She has experience in providing care services for individuals with challenging behaviour, autism, learning difficulties and is currently completing the Leadership and Management for Care Services Award. She informed us that her application for registration has recently been sent to the Commission. Home Farm Trust has a quality assurance system which includes sampling individuals care planning as well as internal yearly audits which result in action plans which can be made available on request. The move towards person centred planning and reviewing, as well as the key worker system in place underpins the ethos of the provider in looking at how services are performing at all times. There are regular managers meetings also. There is also a residents forum (Speak Out Group) which supports residents to comment on the organization. Surveys are sent out regularly to Care Homes for Adults (18-65 years) Page 19 of 23 Evidence: relatives and other interested people. The manager said that Home Farm Trust reviews its policies and procedures on an annual basis but in the AQAA completed for this inspection some of the dates against policies are more than a year old so they may need to be re-dated. The AssessNet tool, part of the organizations web based procedures, is used to record risk assessments as well as recording accidents and incidents. The fire safety checks were properly recorded and a spot check on some of the maintenance and service checks showed them to be appropriate and up to date. There are relevant policies and procedures in place and the records showed that staff have the appropriate health and safety training. Care Homes for Adults (18-65 years) Page 20 of 23 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 21 of 23 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 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 22 of 23 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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