Care Home: Honeybrook House

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What the care home does well New people can come to visit and try out the home before moving in.People can spend time doing things they like at home and they are helped to stay in touch with their families.People like the food and they are given a choice at each mealtime.People are always helped with health care and their tablets.The house is warm, homely and safe. People have private bedrooms with their own bathrooms. They can have their own key.There are enough staff to give people one to one time. People say they are happy at the home and like the manager and staff.Proper checks are made on new people who come to work at the home.The home is well run and people are asked their views. What has improved since the last inspection? More people are now looking after their own money.The kitchen has been moved from the cellar to the centre of the house so it is easier to use.People have their needs and wishes written in their care plans.Staff are staying in their job longer which means less change for people in the home. What the care home could do better: People can be given more information in a way that would help them understand it.More staff are needed at times to help people go on outings.Staff could be given training more quickly to help them do a good job.The living space could be changed to give smaller groups. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Honeybrook House Honeybrook Lane Kidderminster Worcestershire DY11 5QS 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: Jean Littler Date: 2 1 0 5 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. They reflect the things that people have said are important to them: 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. Reader Information Document Purpose Author Inspection report CSCI Page 2 of 39 Care Homes for Adults (18-65 years) Audience Further copies from Copyright 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 39 Information about the care home Name of care home: Address: Honeybrook House Honeybrook Lane Kidderminster Worcestershire DY11 5QS 01562748109 01562750622 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : TRACS LTD care home 10 Number of places (if applicable): Under 65 Over 65 10 0 learning disability Additional conditions: The registered person may provide the following category of service only: Care Home Only (Code PC) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning Disabilities (LD) 10 The maximum number of service users to be accommodated is 10. Date of last inspection Care Homes for Adults (18-65 years) Page 4 of 39 A bit about the care home Honeybrook House is in Kidderminster near the town centre where there are shops and cafes. The house and garden are big. There are room for ten people who each have their own bedroom and bathroom. There are two cars to help people go on outings. Care Homes for Adults (18-65 years) Page 5 of 39 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 Care Homes for Adults (18-65 years) Page 6 of 39 How we did our inspection: This is what the inspector did when they were at the care home We spent one day in the home. The manager, Mr Cookson, was on duty and helped. We spoke with two staff and looked around the house. Some people who live at the home spoke to us and showed us their bedrooms. The residents, their families, staff, and some social workers returned surveys to give us their views. Care Homes for Adults (18-65 years) Page 7 of 39 We looked at records such as care plans, medication and staff rotas. What the care home does well New people can come to visit and try out the home before moving in. People can spend time doing things they like at home and they are helped to stay in touch with their families. Care Homes for Adults (18-65 years) Page 8 of 39 People like the food and they are given a choice at each mealtime. People are always helped with health care and their tablets. The house is warm, homely and safe. People have private bedrooms with their own bathrooms. They can have their own key. There are enough staff to give people one to one time. People say they are happy at the home and like the manager and staff. Care Homes for Adults (18-65 years) Page 9 of 39 Proper checks are made on new people who come to work at the home. The home is well run and people are asked their views. What has got better from the last inspection More people are now looking after their own money. Care Homes for Adults (18-65 years) Page 10 of 39 The kitchen has been moved from the cellar to the centre of the house so it is easier to use. People have their needs and wishes written in their care plans. Staff are staying in their job longer which means less change for people in the home. What the care home could do better Care Homes for Adults (18-65 years) Page 11 of 39 People can be given more information in a way that would help them understand it. More staff are needed at times to help people go on outings. Staff could be given training more quickly to help them do a good job. The living space could be changed to give smaller groups. Care Homes for Adults (18-65 years) Page 12 of 39 If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Jean Littler 33 Greycoat Street London SW1P 2QF 02079792000 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 13 of 39 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 14 of 39 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Information about the service is made available but this is not in an Easy Read format for people with a learning disability. The needs of prospective new people are assessed. This process has not always ensured that all aspects of providing a service, or the impact the new person will have on others have been considered. People are offered the opportunity to visit the Home and trial the service. The team work hard to help them settle in. Evidence: The Statement of Purpose was reviewed and updated in April 09. There is a Service Users Guide that was reviewed in November 08. This is not in an accessible format. Mr Cookson said he has requested an accessible version from the owners. There is currently one vacancy in the Home. One new person has moved in since the last inspection. This persons records showed an assessment had been completed by the manager and a senior colleague. The person was being accommodated in another service run by the owners, so their needs were already known. The person was given the opportunity to visit the Home for meals and an overnight stay before moving in on a three month trial basis. Records and discussions showed that the team had worked Care Homes for Adults (18-65 years) Page 15 of 39 Evidence: hard to help the person settle and had liaised with the relatives and care professionals. Due to the fact that there is only one lounge and dining room the compatibility of residents is essential. Mr Cookson said he did consult with current residents, who were able to give their views, about the new person following initial visits. No record was made of this process. Some staff felt that because the needs of this person mean the kitchen has to be kept locked this has reduced the potential independence of some existing residents. They told us that one man used to be able to go in alone to make his toast. They also told us that the noise this person makes when unsettled disturbs others and this can be at night as well as during the day. Mr Cookson disagreed and reported that the person has become more settled and incidents are reducing. There were numerous incident reports on this persons file but as they had not been analysed it was not possible to confirm Mr Cooksons view. The person was quiet on the day, but they had been disturbed during the night and had been given additional medication that causes tiredness. Staff also reported that because the new person needs the support of two carers this has made it difficult to offer some outings to the person and has also affected activity planning for the others. Mr Cookson said that the fees for this person are being reviewed with the funding authority. One resident said in his survey, I do not like others doing nasty things like scratching or smashing things. The fees for the Home can vary depending upon the level of support needed. The current fees range is between one thousand three hundred and three thousand pounds a week. Additional charges are made for chiropody, some activities and any personal shopping or services. Care Homes for Adults (18-65 years) Page 16 of 39 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 . People have their needs detailed in their care plans and these are kept under review. Professionals are being consulted appropriately for advice. People are being assisted to make some decisions for themselves when possible and they are enabled to take risks that will be of benefit to them. Monitoring systems can be further improved to help people benefit from the recording processes. Evidence: Each service user has a care plan folder. Two were sampled and found to contain relevant and helpful information for staff. The information was written in a respectful way and highlighted the personal preferences of each person in many areas such as personal care, activities and mealtimes. Several forms are being used to help monitor areas such as epilepsy and activities. The initial plan for the new person had been completed at an early stage and developed as staff gained more understanding of the person’s needs. Some gaps were identified, for example there was no guidance about the person coming out of their bedroom before putting clothes on and a health action plan had not been completed. Care Homes for Adults (18-65 years) Page 17 of 39 Evidence: However, the information there was detailed and very person centred. It included risk assessments about the environment and the community and there was guidance about the management of a chronic health condition. One had not been completed for swimming, which the person enjoys, but staff said they had only been able to go once as a trial and currently did not have enough staff to provide this regularly. An assessment should be completed before the activity is offered again. The service does promote reasonable risk taking to help people try new opportunities and develop new skills. Mr Cookson reported that assessments are in place for all people with epilepsy. For some of these people listening monitors are used. Night staff carry these with them and they also check people each hour. Each person has a Reactive Behaviour Management Plan. A learning disability nurse, employed by the company to support on behavioural issues, helps to develop this guidance. The one seen had been developed for the new person whilst living at the previous service. It had been reviewed and discussions with staff indicated that they were confident in following it consistently. As mentioned, under Choice of Home, analysis systems for incidents should be improved so peoples behaviour changes and triggers can be carefully monitored. The care plans are being kept under review by Key workers who have to record that the information is still accurate each month and complete monthly summaries. The summaries for the new person were very brief and did not give an overview of incidents, issues with staffing community activities like swimming or an update on how the person was settling in. Mr Cookson agreed to follow this up with the Keyworker. Formal review meetings are being held every six months for all residents, which is positive. The design of the care plan is not an accessible one for people with a learning disability. Detail in the plans is important as this client group need their support provided in a very specific way. There are however, some residents who would be able to understand and even become involved in completing their own Easy Read care plan. Mr Cookson said the owners are developing a format and work has commenced on Life Books where people keep photographs and a record of significant events and achievements in their lives. Assessments have been completed in relation to peoples ability to make decisions in line with the Mental Capacity Act. Mr Cookson said he plans to improve the way they demonstrate how decisions are made on peoples behalves. Staff were observed to offer people a choice throughout the day e.g. if they wanted to go on an outing, do an activity, where to spend time in the house, and what food and drink they preferred. Care plan guidance covered offering choices, for example, showing two outfits of clothes, always accepting if the person declines an activity. Some information is being presented in a visual format to support people to understand it and Mr Cookson said some objects of reference are also used. He plans to increase this by having visual activity plans. Speech and Language therapists have been involved and have given Care Homes for Adults (18-65 years) Page 18 of 39 Evidence: advice. The new persons care plan contained a communication profile. Care Homes for Adults (18-65 years) Page 19 of 39 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 are being given the opportunity for personal development. They are being supported to partake in leisure activities that they enjoy and accessing the local community. For some people these need to be further developed and staffing should be flexible enough to carry out peoples plans. Staff respect peoples rights and do support them to take responsibility for themselves. They are encouraged to maintain links with their families and friends. People are being provided with a balanced diet and they enjoy their meals. Evidence: People are given opportunities to experience normal activities as part of an independent lifestyle. They are encouraged to help with tasks they can do or enjoy, such as vacuuming or watering plants. People are supported to buy their own clothes and toiletries in shops and some help with food shopping. Care plans showed independence is promoted during daily tasks such as personal care routines. Independent living skills assessments have been completed. Mr Cookson said in the Care Homes for Adults (18-65 years) Page 20 of 39 Evidence: AQAA that these feed into the care planning process. Those seen were not summarised to show the areas where potential for development has been identified, so there usefulness was not clear. Goals have been identified for some people but the monthly summaries seen did not report on the progress being made. The atmosphere in the home was calm and relaxed and people were clearly choosing where they spent time. People walked around with their cold drinks and were able to go onto the patio if they wanted fresh air. Many chose to socialise in the lounge where there was usually a member of staff based. People have hobby items in their rooms and they are supported to follow their interests. Where there is an obsessional interest a structure has been put in place to help them manage this. Staff said the new basement activities room is being used. This was full of equipment. One man enjoyed colouring in a T shirt making kit. Three people continue to attend college courses on subjects such as music, art and cookery. Two people enjoy gardening and they have sections of their own to tend. Mr Cookson reported that the internal activity planning has been affected recently due to one resident being very unwell and a new person being admitted. He confirmed that staff still aim to take everyone out each day but said that outings are currently being decided upon on the day rather than being planned ahead. People were offered outings during the day, for example one group went to the aquarium. Some changes had been made to plans as one vehicle was being serviced. Staff said staffing levels at the moment have meant the snoozlam sessions have not been taking place. As mentioned, staffing levels have also meant that the new person has not been offered regular swimming sessions, despite this being listed as a favourite activity. Mr Cookson seemed unaware of this difficulty and said he would address it as swimming should be offered. He said that the person can do some cooking and enjoys this but this did not seem to be set up as a regular activity. Some residents are quiet and do not seek out staff attention and stimulation. One man was engaged with ball throwing for a while in the morning but sat in the lounge in the afternoon without being offered what was on his activity plan. When we pointed this out a worker put out bottles for him to recycle, which he then busied himself with for ten minutes and then sat quietly again. Daily planning should ensure staff are delegated to all residents so their personal plans are not overlooked. Peoples rights seem to be generally well respected, for example, five people manage their own bedroom keys and all are given privacy in their bedrooms. Mr Cookson confirmed in the AQAA that links with families are being maintained. Some people visit family regularly. Communication is encouraged, for example some email their families using the wireless internet connection installed for this purpose. Three relative returned surveys. These were generally very positive about the management of the service and the staff attitude. One family reported, The service probably assumes that our son tells us what he gets up to at the home. He does not do this as it is a separate world to him. As a consequence we find it difficult to raise topics for discussion with him. We do feel that they have been very imaginative in Care Homes for Adults (18-65 years) Page 21 of 39 Evidence: striving to find things of interest for our son and encourage greater independence. Another family have concerns that the number and mix of residents in the home causes anxiety for their son. He now goes to his bedroom at 8pm and they worry he is withdrawing because of this. The five residents surveys returned were positive. Comments included, I am happy here. I like it here, they look after me and the others very well. I like my comfy bed and trips out. I would like to go out more to forests, parks or try quad biking or go carting. I like my flat and the staff. Dave Cookson knows his job. The staff cook the meals and shop locally with the residents. The four weekly menus have been designed with peoples preferences in mind. Mr Cookson said they have been reviewed recently to make them more healthy. Those seen contained a good variety of balanced meals with fresh fruit and vegetables. Staff said choices are offered and another option is provided if someone does not like the meal. Staff said all residents come into the kitchen, which more accessible now it is on the ground floor. Only one man was seen in there during the day when he came to collect the lunch that had been laid out for him. A lunchtime and evening meal were observed to be calm. Staff ate with people and assisted them as required. The man who has a bed sit chooses if he wants to eat in his room or with the group. There is now only one dining room so one person has chosen to sit with a worker in the lounge. Care Homes for Adults (18-65 years) Page 22 of 39 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 are being well supported with their care in a flexible manner that takes account of their preferences and wishes. Their physical and emotional health needs are being met. Medication is generally being managed safely. Some recording practices can be improved to help protect people. Evidence: The care records indicated that daily routines are flexible. Observations confirmed this, for example one person had a long lay in after a disturbed night. Another had a sleep before lunch so staff kept the person’s lunch aside. The staffing levels allow each person to be supported with their physical care needs in a personalised manner. Care plans seen contained clear details of how the person prefers to be supported and how staff can promote their independence. Each person has their own toiletries, bedding and towels. Records showed that people were bathing daily and everyone looked well presented. The staff induction booklet includes information on privacy and dignity and staff were observed to interact with people in a sensitive and respectful manner. Health information is included in the care plans and health action plans have been introduced. The records sampled showed that people are being taken for routine health checks and health concerns are followed up promptly. General health checks are being Care Homes for Adults (18-65 years) Page 23 of 39 Evidence: carried out by a GP and peoples’ weight is being monitored. Several people have epilepsy and the staff spoken with said they have attended training on this. As mentioned the owners employ a learning disability nurse who can provide support if there are behavioural changes or difficulties with an individual. People have access to external health consultants. On the day of the inspection Mr Cookson was meeting with one person’s psychiatrist to review his behaviours and medication. One person has been very ill recently. His records showed he was being well supported with his new needs. Staff had been trained by hospital staff to carry out a regular procedure to enable him to return home. The person said staff had visited him regularly in hospital and he was very pleased to be home. His representative reported, ‘I have been in contact with staff over the last few months as I advocate for a friend who has been very ill. The care and attention he has received has been excellent. Mr Cookson in particular has shown great care and compassion. From my observations the staff try to cater for every aspect of the residents needs. There is a good atmosphere and the team seem to work well together. My praise is not achieved easily. To find such high standards is a major achievement’. There is sufficient suitable storage for general medication and the keys are being held safely. Medication profiles are in place. Administration charts were well organised and generally accurate. Some areas for improvements were identified. The controlled drug, CD, storage cupboard had still not been secured to the wall, but Mr Cookson has reported this was done shortly after the inspection. The key for this cabinet should not be stored inside the general medication cabinet as this reduces the level of security. A CD register was set up after the last inspection but this has not been used routinely. A record is not always made of why medication for behaviours has been given on a certain day. For one person the form to record the use of, as needed, medication had not been used for over a month even though four doses had been administered. Records meant that a reconciliation was not possible for one of these medicines. Two of the residents continue to be supported to self medicate, which is very positive. A system is in place to allow staff to monitor unobtrusively to ensure compliance. Care Homes for Adults (18-65 years) Page 24 of 39 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 . Peoples views and concerns are being listened to. Systems are in place to help to protect people in the home from abuse and these have proved effective. Evidence: The Home has a complaints procedure that includes the required information. Mr Cookson said in the AQAA that there is a poster on display and leaflets around the home. The poster was seen but Mr Cookson could not find any leaflets. Information about complaints is in the Service Users Guide but this is not in an Easy read format. The residents who returned surveys and those spoken with said they can speak to Mr Cookson, their representatives or keyworkers if they have a concern. They seemed very relaxed with Mr Cookson. Some would need others to raise issues on their behalf due to their disabilities. Care reviews are held six monthly, which gives a forum for different views to be shared and issues to be addressed proactively. Mr Cookson reported that he communicates well with the residents and their representatives and that many compliments have been received about the service. These have not been recorded. He reported in the AQAA that no complaints have been received since he took over and none have been logged in the home. One family has raised concerns periodically. Meetings and phone calls have been held to resolve various matters. These concerns should be recorded to demonstrate that the service is open and responsive to feedback. Care Homes for Adults (18-65 years) Page 25 of 39 Evidence: Feedback from surveys indicated that external people and staff feel able to raise issues and that they are responded to appropriately. A complaint was made to us and the owners by a member of staff just prior to the inspection. The owners investigated this and did not find any evidence to support the workers view. We looked at elements of the complaint that related to care practice in the home. There was a lack of written guidance about how one person has their dignity safeguarded, but arrangements were able to be explained verbally by Mr Cookson. A carer confirmed these were reasonably effective. The owners reported after the inspection that an electronic device is going to be purchased to alert staff quickly when the person needs their assistance to put some clothes on. Mr Cookson reported in the AQAA, There are robust procedures in place to protect residents from abuse and staff who report concerns. All staff are trained at induction about dealing with challenging behaviours appropriately, prevention of abuse and disclosure of malpractice. Records are kept and audited in relation to clients money and every effort is taken to prevent theft or fraud. In the last year the company has appointed their own Adult Protection trainer who has developed a training pack for all staff. Staff spoken with confirmed that they had received training and they would report any concerns promptly. They felt there was a caring culture where abuse would be identified and reported. A worker did report an incident that was appropriately identified as being a safeguarding matter. Mr Cookson promptly reported this to Worcestershire Safeguarding team and also took steps to protect the residents from further incidents. The owners were asked to investigate and this resulted in the worker concerned being dismissed and referred to the Protection of Vulnerable Adults list. It is positive that residents are not being physically restrained. Staff are being provided with a three day course about how to respond to behaviours that they may find challenging. Staff feedback indicated that there are clear protocols in place that are followed consistently. Care Homes for Adults (18-65 years) Page 26 of 39 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 . People have a clean, safe and comfortable home that is being well maintained. They have personalised bedrooms that assist them to be independent. The house and garden is large and close to amenities. The layout has been improved but is still not ideal for ten people with Autism and special needs. Evidence: The house is an attractive large detached property, which is in good condition externally. It is set in its own secluded grounds that are being maintained by a part time worker. The interior of the house is in good condition and the communal areas and sample of bedrooms seen are all comfortably furnished and personalised. The communal rooms consist of a large lounge, a conservatory with seating, a dining room and a small television lounge on the first floor. The gardens are large but only parts are used as some areas are less accessible. Since the last inspection a kitchen has been built on the ground floor where the sensory room and office were located. This is a great improvement as the kitchen was in the basement and was not easily accessed by residents. The old kitchen is going to be used as a training kitchen and the area in the basement that was a second dining area is now an activities area. There are plans to use the large larder area nearby as a sensory room. The overall impression of the house is modern and attractive. The bedrooms are large and some residents seem very proud of their rooms and spend a lot of time in them. The newest resident’s bedroom was personalised and looked homely. All the bedrooms have en-suite Care Homes for Adults (18-65 years) Page 27 of 39 Evidence: facilities. There is a communal shower room. This is not used often and is quite plain rather than homely. One man uses his bedroom as a bed sit. He has a breakfast bar and some kitchen equipment fitted. The plan to make the adjoining two bedrooms into bed sits has been abandoned as there were no referrals for this type of semi independent service. This means that nine people will be sharing the same communal areas. This is not ideal, as people with autism often prefer a quiet and predictable environment. Staff feedback indicated that there are compatibility issues and people’s behaviours can upset others. Consideration should be given to how the communal living space could be changed to create smaller groups sharing, for example having two lounge diners instead of a large lounge and a large dining room. The bedroom doors lock as they shut. It was reported at the last inspection that most people have their own keys and for the others the door is latched during the day to give people free access. The kitchen and laundry are kept locked but people have access with staff support. As some people are able to use the kitchen independently consideration should be given to fitting a system that enables them to gain access without the safety of other people in the home being compromised. Consideration could be given to providing domestic laundry equipment in the training kitchen to enable the more able residents to learn to do this task independently. An entry system to the basement and training kitchen would also help promote independence. Staff have ideas of how to better use the grounds to enhance the quality of life for some people in the home, such as developing vegetable and fruit growing, animal care, a games area for basketball and a trampoline. Currently there is only minimum grounds maintenance support. If these ideas are to be implemented the owners would need to support the service by providing capital for the initial landscaping and preparation. The care staff are responsible for cleaning the Home. Arrangements appeared to be effective and the chemicals are being stored safely. The laundry equipment is industrial and a worker confirmed it is sufficient for the current residents. She also confirmed that suitable infection control arrangements are in place such as protective clothing and laundry sluice cycles. Mr Cookson said that staff are all provided with basic food hygiene and infection control training. The last Environmental Health inspection resulted in a 2 Star rating. Now the new kitchen is fitted Mr Cookson expects the rating to improve. Care Homes for Adults (18-65 years) Page 28 of 39 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 are being supported by a staff team they like. There are enough staff to meet their day to day needs but levels limit outings on occasion. Staff are generally well trained and competent in their role. They feel supported and well managed. People are being protected by the recruitment procedures. Evidence: Staffing levels have been increased now there are nine residents. There are now two waking night staff rather than one waking and one sleeping in. The rota seen showed that levels have gone from six to seven on most weekday shifts. At weekends there are only six. Mr Cookson said Mondays and Thursdays are the busiest and there are always seven staff on these days. At weekends some go to visit their families so less staff are needed. . As previously mentioned some staff feel staffing levels need to be increased to better meet the new persons needs and to enable more activities to take place. Staff said that often the people that visit relatives need less support and it is still difficult to work with six staff on. No domestic or catering staff are provided. Now the home is nearly fully occupied the desired outcome may be achieved by providing a cook to prepare the sixteen meals needed at lunch and teatime. A separate rota was seen for staff to support one person while in hospital. It is very Care Homes for Adults (18-65 years) Page 29 of 39 Evidence: positive that these additional resources were provided to help him during this difficult time. The staff spoken with were positive about the service and they felt well supported. They confirmed there is always a senior on duty during the day to lead the shifts and they felt there was effective planning. They were receiving regular supervision and attending staff meetings and training sessions. Feedback in staff surveys was very positive in the main. There was a consensus that there is good team work and morale, that the home is well managed and providing a good service. Responses indicated that further improvements could be made in the induction process, how information is shared, and for more staff to be available to enable activities to take place. Specific comments included, ‘Good team who work well together. Excellent structured protocols and routines that enable staff to provide consistent care; The home is well managed with good training and the manager is approachable; There is a genuine caring atmosphere. The quality of the food could be better; We have a really good team which makes it easier when we are short of staff. We need more male staff; We are sensitive to peoples needs and we have a good staff support system. If we had more staff allocated to one resident the others could go out more often; Staff work very well together as a team, which helps give the highest quality care to our clients. There should be a better balance of peoples’ needs; New staff should be allowed to sit with the manager or shift leader and talk about things that concern them or they do not understand. Not just be left to read policy after policy. There should be more fun days out. Funding seems a problem; Need to ensure we have enough staff on shift to enable residents to be taken out in the community more. We also need more than 1 driver on each shift; A male worker on each shift is also needed to help with any incidents. Staff also need time on shift to carry out keyworker duties’. The relatives surveys were positive about the staff. One commented that less staff changes would be positive. The staff on duty were seen to interact with the residents in an appropriate and friendly manner. They seemed genuinely attentive and organised themselves in a calm and professional manner. One did use the term, ‘Kicks Off’ to describe incidents when people become distressed or angry. This is not a respectful term and should be discouraged. Staff turnover has slowed for the second year. Last year seven staff left and this year it is four. One recruitment file was seen as a sample. This showed that the recruitment policies have been followed and that all checks had been returned prior to the worker starting. Mr Cookson said it has been difficult to find high calibre staff locally so staff are supported to develop and take internal promotional opportunities as they arise. A Buddy Booklet is given to new staff and they shadow colleagues while they learn the role. There is then an induction that includes all the required information including the Common Induction Standards. The owners reported that they have recently gained Care Homes for Adults (18-65 years) Page 30 of 39 Evidence: accreditation with City and Guilds to award the Learning Disability Qualification when staff can show this knowledge base. After this foundation process staff are encouraged to gain the NVQ 2. The number of staff with an NVQ has stayed reasonably consistent. It was thirteen last year and it is now 12 out of 23. Mr Cookson said in the AQAA that all senior staff all hold an NVQ 3 and those with a level 2 are encouraged to go on and obtain level 3. There is now a training director in the company and training methods are being reviewed. Staff spoken with confirmed they had attended relevant courses and feedback in surveys showed staff felt the training arrangements were positive. One person said there were gaps in some areas like Food Hygiene. The AQAA indicated that of 23 staff only 14 had attended this basic course. Mr Cookson said all seniors have this qualification and there is a programme in place. As all staff should be able to support residents in the kitchen this should be prioritised in coming weeks. Mr Cookson said they have worked hard to address the shortfalls identified in training at the last inspection such as Autism Awareness, Responding to Behaviours that are Challenging, epilepsy and care planning. Mr Cookson said signing is being used regularly but this was not observed during the inspection. Total Communication training should be provided along with signing training if this is to be used consistently. For a specialised service, training on these essential areas should be given a higher priority by the organisation in line with the Statement of Purpose for the service. It is positive that equality and diversity is promoted and sexuality training is provided annually. Care Homes for Adults (18-65 years) Page 31 of 39 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 . People using the service are benefiting from a well run service. They and their representatives are consulted but the way this feedback is used could be better developed. Suitable policies and record keeping systems are in place to help safeguard peoples best interests. Their health, safety and welfare are being promoted. Evidence: Mr Cookson has been manager since April 07. He became registered by us on July 15th 2008. He has relevant experience. He has a degree in psychology that the owners have verified. He holds an NVQ 4 in Care and is awaiting verification of his Managers Qualification. Feedback received from residents, visitors and staff was positive with people reporting that Mr Cookson is a good leader, approachable and keen to help. Specific comments from external professionals included, This is an excellent service that provides an all round service. There is good communication and good documentation. The service has a positive relationship with residents and this has prevented placement breakdown. The service treats each person Care Homes for Adults (18-65 years) Page 32 of 39 Evidence: as an individual. There is a very positive attitude and works in an open way. There is a good knowledge about the needs of people with Autism and consistent intervention. Good progress continues to be made towards improving the outcomes for the people using the service, for example, there is now a stable and positive staff team and effective care planning systems in place. The requirement made at the last inspection regarding risk assessments and most of the recommendations have been actioned, for example now several people keep their personal money tins in their bedrooms. The service is more financially viable now because of increased occupancy. The AQAA submitted by Mr Cookson, prior to the inspection, was more detailed than last years but still very brief in parts. It did not reflect all the improvements in the service that have occurred but it did show that he is aware of the services main strengths and areas to further develop. Some of the content is corporate and discussions showed it was not very relevant to this service or just not accurate, for example it states residents group meetings are held each month. The residents are not able to get involved in meetings so these are not held. Mr Cookson reported that the company policies have all been reviewed in the last 18 months. He has continued to promote these and established staff are now familiar with these working methods. He has managed the departure of a longstanding deputy without impact on the service. Staff reported that the new deputy was carrying out her duties effectively. Mr Cookson has taken action quickly when adult protection matters have been disclosed. Some events have been reported to us appropriately but others should have been, for example when during an incident one resident assaults another. He was reminded to do this so the service is operating openly. Effective recording systems are in place. Audits are being carried out regularly by quality assurance staff and a line manager. Mr Cookson reported that he aims through staff training to reduce the number of gaps found in audits of areas such as care planning. The annual questionnaires to residents, their representatives and staff have been sent out recently but have not been returned yet. The owners say the findings are collated into an action plan but Mr Cookson could not find this report from 2008. There is a current business plan for the organisation and Mr Cookson has developed his own improvement plan from this. He said he does consult residents and their representatives at the care review meetings. It would be positive if the quality assurance process could involve a pulling together of the auditing findings for the year and future plans into an accessible report that can be shared with residents and their representatives. It may also be positive if surveys are carried out in time for the findings to be considered when the AQAA is being completed each year. This may help ensure Mr Cookson is already aware of what staff are likely to inform us about, such as staffing levels, and have given the matter some prior consideration. It is positive that the owners have maintained their ISO 9001 and Investors in People Awards. Systems are in place to help promote the Health and Safety of residents, such as daily checks on fridge temperatures. Mr Cookson reported in the AQAA that all equipment had been serviced. Gaps in core training should be addressed to reduce any potential risks. A fire officer has not visited since May 08. Mr Cookson addressed the three Care Homes for Adults (18-65 years) Page 33 of 39 Evidence: recommendations made at the time. Mr Cookson said the fire risk assessment has been recently reviewed and routine checks and drills are being carried out. Care Homes for Adults (18-65 years) Page 34 of 39 Are there any outstanding requirements from the last inspection? Yes  No  Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 35 of 39 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 Description 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 Description 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 1 2 Give careful consideration to who is admitted in the future to ensure current residents do not have their quality of life adversely affected. 2 6 Analyse incidents routinely so the information is used for the benefit of the person concerned. 3 6 Develop monthly summaries so these are a useful monitoring tool to benefit the residents. 4 6 For those who have the capacity develop person centred plans in a format they can understand and be involved in. 5 7 Develop the use of assisted communication methods to Page 36 of 39 Care Homes for Adults (18-65 years) support residents with their day to day lives. 6 11 Use the monthly summaries to review and report on progress towards development goals. 7 15 Ensure keywork arrangements enable families to have the information they want. 8 20 Use the controlled drug register on a daily basis to keep a running balance of the stocks of relevant medication held in the home. 9 20 Keep emergency epilepsy medication in the CD cabinet. The duty senior should hold the key to this cabinet. 10 20 Ensure staff follow the in house procedures so that the use of as needed medication can be tracked and accounted for. Provide information about how to complain in a format suitable for people with a learning disability. 11 22 12 22 Record concerns raised and the action taken to address them. Record compliments as part of the quality assurance system. 13 35 Provide total communication training and signing training if this is to be promoted. Provide all staff with Food Hygiene training in a timely manner. Review other core training needs and plan how to fill any gaps in the near future. 14 35 15 35 Care Homes for Adults (18-65 years) Page 37 of 39 16 37 Mr Cookson should see and sign all incident forms and ensure those that fall under Regulation 37 are forwarded to the Commission. The AQAA should be accurate and fully reflect the situation in the home. Provide stakeholders with a report on the findings and future plans developed as a result of the quality assurance processes. Consider sending out in house surveys in time for the feedback and planning process to be reported in the AQAA. 17 37 18 39 Care Homes for Adults (18-65 years) Page 38 of 39 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. 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