Care Home: Hothfield Manor Centre

What the care home does well The home enables residents to make choices about their lifestyles. For example, residents can change bedrooms if they wish to do so, so long as the room is suitable for their individual equipment and care needs. The staff team work well together to provide a constructive framework for residents to feel secure, and to develop their own living skills. A letter from a relative to the Commission states that "we send our deepest appreciation for the outstanding care that Hothfield and the dedicated staff provides". The home is good at meeting residents` health care needs, and staff make referrals to other health professionals as appropriate. The home employs an occupational therapist; and other health professionals such as physiotherapist and speech and language therapist are contacted for advice and support. There are good quality assurance procedures in place. These include monthly care plan reviews with each resident; six-monthly full reviews with the resident, family members, care manager and health professionals; residents` meetings; and a quality assurance survey process. What has improved since the last inspection? The home has made significant improvements, working hard to meet the requirements given at the last inspection. The improvements include considerable updates to the admission assessments and care planning, which now contain comprehensive data about all aspects of care; and detailed risk assessments. The activities organiser has developed a weekly activities plan, and is working with staff to provide individual activities plans for each resident. She has increased the amount and range of activities, and these take place at evenings and weekends, as well as during the day; in accordance with residents` choices. Residents have been consulted about the choices of menus, and new food choices are being offered. Residents said that "the food is good", and "I like the food". The statement of purpose and service users` guide have been updated and amended to ensure that they reflect the life in the home, and the services available. Improvements have been made to the grounds, with the addition of ramps and handrails to assist wheelchair users, and people with reduced mobility. The company have increased the opportunities for staff training programmes. What the care home could do better: The care planning could include more information to show how residents are being able to develop their independent living skills, using small goals. Some staff and residents were able to express how this takes place in practice, but documentation does not always support this. The home could provide additional kitchen staff in the afternoons and evenings, to provide a better choice of food at tea times. A specified bedroom carpet needs replacing, and there is a requirement for this. There are no hand washing facilities in the laundry, and this does not promote good infection control. There is a requirement for this. The company need to keep staffing numbers under review in respect of the dependency levels of the residents. This is currently applicable to support staff numbers for the bungalows. Consideration will need to be given to specific laundry staff when the new build has been completed. Key inspection report Care homes for adults (18-65 years) Name: Address: Hothfield Manor Centre Church Lane Hothfield Ashford Kent TN26 1EL     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Susan Hall     Date: 2 9 0 9 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. 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. Care Homes for Adults (18-65 years) Page 2 of 34 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 34 Information about the care home Name of care home: Address: Hothfield Manor Centre Church Lane Hothfield Ashford Kent TN26 1EL 01233643272 01233611433 hothfield.manor@fshc.co.uk www.huntercombe.com Hothfield Manor Ltd care home 24 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) : Number of places (if applicable): Under 65 physical disability Additional conditions: The maximum number of service users to be accommodated is 24 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 service are within the following category : Physical disability (PD) Date of last inspection Brief description of the care home Hothfield Manor Centre is owned and managed by the Huntercombe Group, who are a part of Four Seasons Healthcare. The home is a care facility which provides personal care and support for up to 24 adults with physical disability, as the result of an acquired brain injury. It is situated in the village of Hothfield, which has a shop and post office within walking distance. The town of Ashford is five miles away, and has all of the usual town facilities and amenities. Accommodation is provided in two specific areas: the Manor House, which has 12 single bedrooms; and seven bungalows within the grounds which provide another 12 beds. Two of the bungalows are for single use; and five are for two people to share. Care Homes for Adults (18-65 years) Page 4 of 34 0 1 0 6 2 0 0 9 24 Over 65 0 Brief description of the care home These provide residents with the opportunity to further develop their independent living skills. The home is set within extensive grounds, which are well maintained. There is adequate car parking space within the grounds. The home has its own transport to take residents to nearby towns and places of interest. Current fee levels range from £906.00 to £1500.23 per week, and depend on the assessed needs of individual residents. Care Homes for Adults (18-65 years) Page 5 of 34 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 home is assessed as having a rating of Good, 2 stars. This was a key inspection, which includes assessing all the information obtained by the Commission, as well as a visit to the home. Information is obtained from phone calls and letters about the service; legal notifications which the home is required to send in; any complaints or safeguarding issues in which we are involved; and an Annual Quality Assurance Assessment (AQAA) provided by the home. This is a comprehensive document which the home is required to complete each year, telling us about ongoing developments in the home, and any changes. We did not request a separate AQAA prior to this inspection, as an AQAA had already been completed in March 2009. The last key inspection rated the home as poor, and we (i.e. the Commission) carried out this inspection to verify if the company had addressed the issues which were raised in that report. A random inspection was carried out in June 2009, to check that the Care Homes for Adults (18-65 years) Page 6 of 34 home had complied with some immediate requirements given. The random inspection found that these had been met. We were pleased to find at this inspection that the company and staff have worked hard to achieve a good result, in that they are meeting all requirements given at the last key inspection, and have made significant steps forwards in the delivery of care. We had commenced enforcement action after the previous inspection, by sending a notice to request that the home would not admit any more residents until the overall rating had been raised. As a result of this inspection, the Commission have now removed this restriction. The inspection visit lasted for over eight hours, commencing at 09:00 and finishing at 17:15. During this time, we talked with eight staff, as well as with the general manager, and the registered manager, who were both available throughout the day. We inspected documentation, including care plans, risk assessments, medication charts, maintenance files, staffing records and staff rotas; and viewed all areas of the manor house, and two of the bungalows. We also chatted with eleven residents, of whom eight are in the manor house and three are in the bungalows. We viewed the results of a recently conducted quality assurance survey which was carried out by the home, and this showed that residents and relatives mostly feel very positive about the quality of care which the home provides. The home has major building work being carried out at the rear of the manor house. This will create an adjoining unit which will be for residents requiring nursing care and rehabilitation; and is due to open during 2010. Care Homes for Adults (18-65 years) Page 7 of 34 What the care home does well: What has improved since the last inspection? What they could do better: The care planning could include more information to show how residents are being able to develop their independent living skills, using small goals. Some staff and residents were able to express how this takes place in practice, but documentation does not always support this. The home could provide additional kitchen staff in the afternoons and evenings, to Care Homes for Adults (18-65 years) Page 8 of 34 provide a better choice of food at tea times. A specified bedroom carpet needs replacing, and there is a requirement for this. There are no hand washing facilities in the laundry, and this does not promote good infection control. There is a requirement for this. The company need to keep staffing numbers under review in respect of the dependency levels of the residents. This is currently applicable to support staff numbers for the bungalows. Consideration will need to be given to specific laundry staff when the new build has been completed. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 34 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 10 of 34 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. The statement of purpose and the service users guide have both been re-written since the last key inspection, and accurately reflect the aims and objectives of the home. Residents have a comprehensive pre-admission assessment prior to making a decision about moving into the home. Evidence: The statement of purpose and service users guide have both been revised since the last key inspection in April 2009. They contain clear details about the aims and objectives of the home; and these objectives were verified throughout the visit as accurately portraying what actually happens in the home. Each resident is given a copy of the Welcome service users guide on admission to the home, and this includes the name of their allocated key worker, and the agreed room number. The guide has an index at the front so that it is easy to find the required information. It includes the arrangements for security in the home, transport, social activities, meals and special diets, receiving mail, making telephone calls, visiting and financial arrangements. Care Homes for Adults (18-65 years) Page 11 of 34 Evidence: All residents have a pre-admission assessment prior to moving into the home, to ensure that the home will be able to meet their individually assessed needs; and to identify if any special equipment is needed prior to admission. These assessments are carried out by the manager, with a team leader (a senior support worker) to accompany him. This ensures that one person can spend time talking with the prospective resident and give them their full attention, while the other one is writing. The assessment process uses a set format called the Care and Health Assessment Profile. These are extremely detailed, and the same format is then used on admission, and for comprehensive monthly assessments. We viewed four of these assessments, and found them to be very well completed. They include information about the persons previous medical history, medication, mobility, personal hygiene care (including oral care and foot care), medication, communication, mental health, orientation, sleep, pain, and social and development activities. Prospective residents and their families or advocates/social workers are invited to view the home, and to spend as much time as they need to make a decision about moving in. This may include overnight or weekend stays. The home has a room for respite use, and this room can be allocated between regular respite users for prospective residents to stay. All residents are provided with a contract which states the terms and conditions of residency, whether they are privately funded or funded by the local authority. After admission, residents stay for a trial period to ensure that the home can meet their needs, and to ensure they will fit in satisfactorily with other residents. Most are admitted to the manor house first, but may move into a bungalow for more independent living if their ongoing assessments show that this is suitable for them. Residents only move rooms or from the house to the bungalows (or vice versa) with their fully informed consent. Care Homes for Adults (18-65 years) Page 12 of 34 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. Care planning has been significantly improved, and care plans contain detailed and carefully assessed information about how to care for each individual resident. Residents are involved in all aspects of making decisions about their care and their daily lives. Evidence: Individual care plans are set up using the initial Care and Health Assessment Profiles from admission, and the Care Management Assessment. Care planning is fully discussed with the resident, their family members (as appropriate), key worker, manager, and social worker; and the resident or their representative sign to show their agreement. Every care plan is fully reviewed each month, and the manager also carries out care plan audits. There are six-monthly reviews with the resident, and their family or advocates. The care planning shows that significant improvements have been made in the home since the last key inspection. We viewed four care plans for residents in the manor house; and briefly viewed one Care Homes for Adults (18-65 years) Page 13 of 34 Evidence: care plan for a resident in the bungalows. The plans were found to be extremely detailed, and to include all aspects of the persons life and daily living arrangements. All residents have access to independent advocacy. Care plans show clearly if residents have the ability to make their own decisions, or if they need assistance. Some care plans state that residents can make non-complex decisions, such as what to wear, what to eat, and if they prefer a bath or shower; but may need assistance with more detailed decisions. The care plans contain good information to show that the staff understand and apply the implications of the Mental Capacity Act 2005, showing who is the agreed representative to assist the resident in complex decisionmaking. This may include family members or an advocate or IMCA representative. There are clear records to show if residents can manage their own financial arrangements, or if they need assistance with this, and who is responsible for helping them. Residents have the opportunity every day, to share their feelings about how the home is running, by talking with their key worker, or other staff members. They are also encouraged to share their views at their monthly care plan review meetings, and also at resident forum meetings. These are held every four to six weeks, giving residents the chance to discuss things together. There are increasingly good levels of communication between staff members such as support workers, the activities organiser, and the occupational therapist, so that staff can work together to assist residents in carrying out their preferred lifestyles. Residents are enabled to take risks in accordance with their individual risk assessments, and we were pleased to see how well these have been developed since the last inspection visit. Individual risk assessments are included in the care plans, and include risks such as leaving the building unsupervised, falling downstairs due to running, going out in a vehicle, and use of wheelchair or hoisting facilities. There are good explanations of the action to take to avoid risks. For example, a resident may be assessed as needing supervision when going out of the building, as they would get lost if allowed to wander, or may be at risk of an epileptic fit, or need assistance with mobility. Other risk assessments may show the importance of a lap strap for someone in a wheelchair; window restrictors in place to stop residents falling out of the windows; and two carers to assist with all use of the hoist. Residents are encouraged to carry out activities such as carriage-riding with horses, or swimming, within their individual risk assessments. Staff are trained in ensuring that residents are treated with privacy and dignity, and this was demonstrated by maintaining privacy when giving personal care, calling residents by their preferred names, and knocking on bedroom doors before entering. Care Homes for Adults (18-65 years) Page 14 of 34 Evidence: Information shared with staff is kept confidential, unless it would put the resident at risk if the information was not shared. Care Homes for Adults (18-65 years) Page 15 of 34 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. Residents are enabled to follow their own lifestyles and are supported with choosing suitable activities. The quality and choice of food has been improved. Evidence: Residents are assisted in their personal development, with carrying out personal tasks, improving their means of communication, managing their behaviours, joining in with activities, and learning new activities. This was assessed by reading care plans, chatting with residents, observing their interaction with staff, and talking with support workers, the activities organiser, and the occupational therapist. The development of individual living skills using small goals could be documented more clearly. The manager agreed with this observation, and stated that the staff are working towards better recording in this respect. Residents are supported with personal hygiene tasks, and household chores, Care Homes for Adults (18-65 years) Page 16 of 34 Evidence: encouraging them to have as much independence as possible. Some residents are able to wash and dress unaided, choose their own clothes, and help to keep their bedrooms tidy. They are encouraged to develop communication skills, explaining how they are feeling, either verbally or with use of non-verbal skills such as gestures, body language and facial expressions. They are able to decide when they wish to be alone, and this is respected; or they may respond to encouragement to join in with others. The home has a full time activities organiser, who spreads her hours out according to different activities and events throughout the week. This means that she promotes and takes part in evening and weekend activities as well as on weekdays. There is currently a weekly activities programme in place, and each resident has a copy of this. However, the activities organiser is working with other staff (i.e. support workers and the occupational therapist) to draw up individual activities programmes for each resident, showing the specific items that each person is interested in, and how this fits into the shared activities programme. The programmes are being reviewed each month, to see how well they work for each person, and if they provide them with the lifestyle that is right for them. There is a wide variety of activities available. These range from everyday indoor activities such as games, quizzes, jigsaws and television, to activities such as gardening, going swimming, short mat bowls, walking dogs (which belong to the activities organiser), and carriage-driving with horses. Residents who take part in carriage-driving have a second set of reins, so that they learn the skill, and are not just there for the ride. One resident is currently attending a college computer course, and the manager said that he hopes to obtain a computer for the home, so that it is available for all residents to use. The home has a separate kitchen on the first floor, and the staff use this to help residents to make drinks and snacks, and to carry out some cooking. This is all on a risk assessed basis, and the kitchen is kept locked when not in use. There are frequent outings for one or two residents at a time, to places such as Chatham dockyards, Headcorn air show, coastal walks, garden centres, Leeds Castle and Folkestone harbour. Residents can also have one to one aromatherapy and reflexology sessions, and relaxation DVDs; and can take part in items such as armchair exercises, music for health, a book club, and photography. Residents in the bungalows are encouraged in their independence. Some residents are involved in work in the community such as conservation, or attend support groups, and are able to go out and come back without supervision from staff. Care Homes for Adults (18-65 years) Page 17 of 34 Evidence: The activities organiser has obtained information about different church services and places of worship in the area, and staff ensure that residents are supported to attend these if they wish to do so. A garden party was held in the Summer, and this helped to forge more links with the local community. The activities organiser has also contacted Ashford volunteers to try and arrange one to one links for residents, and a possible buddy system. The activities organiser and occupational therapist are developing their own roles in the home, and have vision to increase the opportunities for residents activities in many other ways. Residents are supported in maintaining links with families and friends. People can visit at any time, in accordance with residents own wishes; and can stay for meals if they want to. The home has a full-time chef, and a relief cook, who is also a support worker. As the home will be increasing in size next year, the company will be employing more kitchen staff. Residents said that they have good food, and can choose what they want. There are usually two options at meal times, but the chefs often prepare other individual dishes as well. This is partly because some residents forget what they like or do not like, and may forget what they have asked for. Breakfasts are served until late morning, depending on the time that residents get up, and can include cooked items if wanted. Most tea time options are currently for cold foods, but the manager is aware that with changing seasons, residents might require hot food in the evenings. We discussed this, and CQC are confident that this will be addressed. The kitchen has been completely refurbished during the past year, and has industrial equipment. The environmental health officer awarded it five stars for hygiene and cleanliness. Care Homes for Adults (18-65 years) Page 18 of 34 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. Personal and health care is provided in accordance with residents individually assessed needs. There is evidence of additional staff training to ensure that staff can give effective care for all areas of health and welfare. Evidence: Each resident has a health care plan, and this shows details of how their personal care is managed, and how to oversee their diet, exercise, rest, sexual health, mobility, weight and medication. Residents are assessed for their nutritional needs, moving and handling, oral care, continence, and self care ability. Some residents may have a history of self harming or self neglect, and individually assessed care plans are put into place to show how staff can support them. All support staff are trained in moving and handling, and the staff training matrix shows that staff have been given updates with this training. Training was taking place over two days for all staff to attend training in de-escalation skills, to enable staff to have a clearer understanding as to how to diffuse situations, and manage challenging behaviour. The home employs an occupational therapist, and she carries out a detailed assessment for each resident as part of the admission Care Homes for Adults (18-65 years) Page 19 of 34 Evidence: process, and gives ongoing advice and support to staff with items such as hoisting, and use of wheelchairs and equipment. Care plans also show input from other health professionals as needed, including GPs, district nurses, continence nurse, speech and language therapist, physiotherapy, psychologists, neurologists and psychiatrists. Residents are supported in attending medical appointments, and this includes dental visits, opticians and chiropody. Ongoing checks such as monitoring of weight and blood pressure are carried out routinely. Some support staff are trained in epilepsy awareness, and know the different signs for residents to recognise when they are going to have a seizure. None of these residents currently have any additional preventive medicines, (e.g. for when residents are out in the community)and it may be applicable to discuss this again with their GPs. Medication is stored in a walk-in locked cupboard, and is mostly administered via the Boots monitored dosage system. Only the Team Leaders, who have had medication training, administer medication. The storage cupboards and medication trolley were seen to be clean and in good order. There is no overstocking of medication. No homely remedies are used. One tube of skin cream was found to be out of date. This had been brought in by a relative for a resident receiving respite care, and the Team Leader said that he would bring this to the attention of the relative concerned. The home has a controlled drugs cupboard which meets the specifications. There were no controlled drugs in use, or stored in the home, at this time. We viewed all of the Medication Administration Records (MAR charts) and found them to be well completed. Each one is accompanied by a photograph of the resident, and information about any allergies. There are clear directions for giving any as necessary medicines, showing when these are indicated. There are procedures in place for taking medicines out of the home when residents are going out. The manager and staff are working towards obtaining information from residents about their wishes if they are ill or dying. Some residents have no awareness of this, or are unable to discuss their feelings. The manager has written to close relatives or advocates where possible, to ask for their assistance with this information. Care Homes for Adults (18-65 years) Page 20 of 34 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. The complaints procedure is accessible to residents and visitors. There are plenty of opportunities given on a daily basis, to enable residents to voice any concerns. The home correctly follows the agreed Kent and Medway safeguarding protocols, for any allegations or concerns of abuse. Evidence: The complaints procedure is included in the service users guide, and all residents have a copy of this. It is also displayed on a notice board. The complaints procedure states that complainants will have a written acknowledgement of complaints within two days; and that a full response will be made within twenty days. A complaints log is kept on the computer, and this showed that there has been one complaint since the last inspection. The records show that appropriate action was taken to resolve this complaint. Residents are supported in expressing their thought and ideas, and several stated that they would know who to go to if they had any concerns or complaints. A residents and relatives survey was carried out in August 2009, and the results from this show that sixty-six per cent are confident they know how to make a complaint. Of the remaining thirty-four per cent, half were unsure, and half did not answer the question. There are good staff recruitment procedures in place, to ensure that staff are suitable Care Homes for Adults (18-65 years) Page 21 of 34 Evidence: to work with vulnerable people. All staff are trained in the recognition and prevention of abuse, and the training matrix shows that all staff are up to date with this training. Care plans include clear directions and guidelines to staff for residents who are at risk of exploitation and abuse, and how to prevent this. A safeguarding vulnerable adults alert was raised at the time of the last inspection visit. This was investigated by the Social Services Safeguarding Vulnerable Adults team, and they concluded that there was no substance to the allegation. Care Homes for Adults (18-65 years) Page 22 of 34 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. The premises have been improved with refurbishment during the last year. There are good maintenance procedures in place. Evidence: The home has had a complete refurbishment during the last year, since the Huntercombe Group took over this home. This has included new furniture, and new soft furnishings, as well as redecoration and new carpets. We viewed all communal areas, four bedrooms in the manor house, and two bungalows. The manor house has a large lounge and separate dining-room, and these are comfortable and furnished in a homely style. Residents are encouraged to personalise their own rooms, and this was evident with the rooms that we viewed. Residents also assist where possible, in keeping their rooms clean and tidy. One of the bedrooms had a new carpet, but due to high levels of incontinence, it was unfortunate that the carpet had a bad odour. The home has a carpet cleaning machine, but this has proved ineffective in dealing with this situation. The general manager stated that he was aware of this, and there are plans to replace the carpet with a different type of impervious carpet which will respond better to frequent cleaning. There is a requirement for this. Care Homes for Adults (18-65 years) Page 23 of 34 Evidence: The home has a sufficient number of toilets and bathing facilities. There is an assisted bath on the ground floor, and a wet shower room on the first floor. Some bedrooms have en-suite bathing facilities. A passenger lift provides access between floors. This is just large enough for one wheelchair. This is taken into account when new residents are admitted. The manor house currently has some restricted areas, as a large new building programme is in the process of completion. This will join on to the back of the current premises, and will provide a nursing and rehabilitation unit. The residents and relatives have all been informed about this, and there are good health and safety procedures to protect residents during the building programme. The manor house and bungalows are set in their own extensive grounds. These include lawned areas which are ideal for games and garden parties; a new allotment area; and other paths through non-formal areas, providing space for residents to wander. Several new ramps have been built in since the last inspection, enabling easier access for wheelchair users. A patio area contains very uneven paving slabs, and the general manager confirmed that this is already included in the ongoing refurbishment programme. Any residents who could be unsafe walking in this area, or using wheelchairs, are supervised by staff for their safety. The bungalows are set in their own area about two minutes walk from the main house. This is a block of seven adjoining bungalows, with two for single occupancy, and five for two people to share. One of the bungalows is used as a base for staff. The staffing and care arrangements for residents in the bungalows is kept separate from the staffing for the manor house. Residents are supported in managing their own personal care, budgeting, cooking, cleaning and washing. We viewed two bungalows with the agreement of the residents, and these are well designed with a lounge/kitchenette area, and separate bedroom and bathroom areas. Each bungalow is fitted with the necessary cooking and washing machine equipment. The laundry room in the manor house is situated on a corridor which can only be accessed via a keypad lock, for the safety of the residents. The laundry room contains two commercial washing machines and two tumble dryers. The laundry is currently carried out by the domestic and support staff. Consideration should be given to providing dedicated laundry staff in the future, when the new building area provides rooms for additional residents. There are no hand washing facilities in this room, and this is a requirement. We viewed equipment in different areas such as hand rails, hoisting facilities and fire Care Homes for Adults (18-65 years) Page 24 of 34 Evidence: doors. There is a nurse call system in the manor house, which was only being used by one resident at the time of the inspection. There are separate call systems in place for the bungalows. Some have an alarm to wear; and at night, most residents phone through to the staff bungalow if they require assistance. The home employs a maintenance man for all routine repairs and ongoing checks. We viewed two of the maintenance files, and noted that there are good records in place for fire safety checks and equipment; and ongoing checks for items such as hot water temperatures, cold water storage, window restrictors and PAT testing. Care Homes for Adults (18-65 years) Page 25 of 34 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. Staffing numbers are being increased in line with the dependency needs of the residents. There has been an increase in staff training opportunities. Evidence: The staffing levels are maintained separately for the manor house and for the bungalows, and there is a separate assistant manager for each of the two sites. The manor house has four support staff in the mornings, three in the afternoons and evening, and two at night. This was for ten residents at the time of the visit. There is always a team leader on duty for each day shift, and these are senior support workers who have carried out additional training. The bungalows currently have three support staff on duty throughout the day, and one who sleeps in at nights. The manager stated that the number of support staff would shortly be increased to four support staff in the mornings. This is because it is not possible to view all of the residents easily, as they are in bungalows; and also because there are some residents who request constant attention, or who want to go out most of the time with staff support. Whilst the management want to accommodate residents wishes as much as possible, staffing is not one to one throughout the twenty-four hours unless this is really needed. Care Homes for Adults (18-65 years) Page 26 of 34 Evidence: Support staff work together with the occupational therapist (who is employed parttime), and with the activities organiser. The staff are aware of their differing roles, and there are increasingly good levels of communication to work out how best to provide care for different residents. The home also has catering and domestic staff, and numbers will be increased in line with the number of new residents when the building work has been completed. The company support staff in training for NVQs, and eleven support staff out of eighteen have completed NVQ levels 2 or 3. This is 61 per cent, which is very good. Staff recruitment procedures are well managed. We viewed three staff files, and found that these contained the required checks, such as properly completed application forms with a full employment history; POVA first and CRB (Criminal Record Bureau) checks; two written references, proof of identity, and staff training records. One of the files contained a recent photograph of the staff, but the other two did not. The general manger stated that the company are fully aware of the requirement to have a staff photograph on file, but there is a problem with the homes camera, which is being addressed. We discussed other ways of dealing with this situation, such as requesting new applicants to bring in a passport size photograph. An interview record is retained, and applicants complete a health questionnaire. All successful applicants are given an employee handbook, which contains detailed staff information and relevant policies and procedures. All staff are provided with a contract, after completing a probationary period. We talked with several staff during the day, and they confirmed that new staff are taken though an induction programme, which includes shadowing other staff for one or two weeks, until assessed as competent to work on their own. We viewed the staff training matrix, and this showed that all mandatory training is being kept up to date. This includes first aid, basic food hygiene, fire safety, moving and handling, health and safety, infection control and POVA (protection of vulnerable adults). Other training subjects include medication management, epilepsy, and management of challenging behaviour. On the day of the inspection, all staff were having training in developing de-escalation skills. There are procedures in place for all staff to have monthly one to one formal supervision sessions, and yearly appraisals. We evidenced supervision in staff files for at least every two months. Supervision is carried out by other appropriately trained or senior staff. For example, the occupational therapist (OT) receives supervision from an Care Homes for Adults (18-65 years) Page 27 of 34 Evidence: OT at another Huntercombe establishment. Care Homes for Adults (18-65 years) Page 28 of 34 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 manager has implemented improved communication levels with staff and residents, and this has benefited the overall running and management of the home. Evidence: The manager has many years of experience in managing this home, and is a registered nurse. He has integrated the policies of the new providers into the life of the home, and has worked hard over the past six months to see an increase in staffing numbers, new recruitment, and additional staff training. As this home is being expanded to incorporate a large new nursing unit, the company have recruited a general manager who is overseeing all aspects of the running of the home, and setting up the new unit. This will enable the registered manager to spend more time concentrating on the delivery of care and staff training needs. We talked with eight staff during the day, and met others briefly apart from the manager and general manager. Most of the staff were extremely positive, and very motivated in carrying out their different roles. Three said that they love working here, Care Homes for Adults (18-65 years) Page 29 of 34 Evidence: it is a good place to work, and they want to help the residents as much as they can. Regular staff meetings are held to provide a forum for staff to express their views. The company have implemented new quality assurance procedures. These include monthly care planning reviews with residents, which provide a good opportunity for feedback; residents meetings every four to six weeks; monthly Regulation 26 visits by the registered person; and residents and relatives surveys. These were given out in August 2009, and were completed anonymously. The results have been collated and made available for people to view. They have also been used to develop some changes in the home. Questions included asking the views of people about care planning, knowing their key workers, the manager, expressing their views, food, complaints management, and the premises. Seventy-five per cent of those who responded rated the overall quality of care as good or very good. Staff training programmes confirm that there is suitable training in safe working practices. Health and safety management has been improved with the introduction of ramps and hand rails for providing access between the house and garden. Maintenance files are well completed, showing that routine checks for fire equipment, hot water temperatures etc. are reliably carried out. Accident and incident records are well documented within the home, and these are audited on a monthly basis. We did not assess the financial viability of the business. The manager stated that his requests for new equipment are always met with a positive response, and only occasional short delays. The manor house has been completely refurbished; and the company are building a large new addition to the premises. Care Homes for Adults (18-65 years) Page 30 of 34 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 31 of 34 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 26 16 To replace the carpet in a specified bedroom in the manor house; ensuring that suitable flooring is provided for maintaining cleanliness and hygiene. The registered person must provide suitable floor coverings in rooms occupied by service users. 31/10/2009 2 30 13 To provide hand washing 30/11/2009 facilities in the laundry room in the manor house. The registered person must make suitable arrangements to prevent infection, toxic conditions and the spread of infection at the care home. Care Homes for Adults (18-65 years) Page 32 of 34 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 33 of 34 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 34 of 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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