Care Home: Houghtons

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What the care home does well Families described the home as being clean, comfortable and pleasantly decorated. This was observed on the day of the inspection. The expressions and the behaviours of the people living in the home showed that they like living at the home. The families spoken to say that they feel the people living in the home are well cared for by staff and they treat them well. They say their privacy and dignity is respected. One family stated that they were very impressed with the facilities provided by the home and the person living in the home `seems very happy and settled`. They like the food and activities they do with help from staff. The manager and staff enjoy working at the home. They attend training to help them meet the needs of the people living in the home. The staff have meetings with their manager to look at how they are meeting the needs of the people living in the home. The staff and people living in the home were observed interacting well with each other. They were also talking to the people living in the home in a positive and caring manner. The staff have build up good relationships with relatives of the people using the service and involve them in meetings and care planning. What has improved since the last inspection? All the requirements were met from the last inspection. Medication was being appropriately stored and recorded. Full information on staff recruitment was being obtained. Fire alarm checks were being carried out on a weekly basis. Full staff names were being recorded on the staff rosters. What the care home could do better: The home offers a very personal service to the people using the service. An annual audit of the home is required and the manager stated that this was being looked at by the organisation. CARE HOME ADULTS 18-65 Houghtons 6 Sandy Road Bedford Bedfordshire MK41 9TH Lead Inspector Ansuya Chudasama Unannounced Inspection 11th December 2007 11:30 Houghtons DS0000014918.V349604.R01.S.doc Version 5.2 Page 1 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 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Houghtons DS0000014918.V349604.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Houghtons DS0000014918.V349604.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Houghtons Address 6 Sandy Road Bedford Bedfordshire MK41 9TH 01234 351248 F/P 01234 351248 elaine.taverasvicioso@aldwyck.co.uk www.aldwyck.co.uk Aldwyck Housing Association Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Ms Margaret McNally Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Houghtons DS0000014918.V349604.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 8th March 2007 Brief Description of the Service: Houghtons is a purpose-built detached bungalow located in a residential area of Bedford. The home is owned and managed by Aldwyck Housing Association. And provides long term care for adults between 18 years of age and over 65 years of age with learning disabilities and physical disabilities. The purpose built home is close to a bus route on the A428, and there are shops, pubs, churches and leisure facilities within easy reach. The building has six single bedrooms, one for each person living there. All areas of the home are accessible for people requiring the assistance of a wheelchair. There are a number of other rooms that everyone can use; these include a lounge, snoozelan, kitchen/diner, shower room, bathroom and toilet. The home has a large garden area, with summerhouse. At the time of the inspection work was underway to improve the garden for the benefit of residents. People who live at the home use a number of social and leisure activities. Current fees are £1036.28 each week. Additional costs include those for meals out, hairdressing and aromatherapy. A copy of the inspection report is available at the home or via the CSCI website. Houghtons DS0000014918.V349604.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspector visited the home without telling any one that she was going to visit on the 11th December 07 The inspector spoke to the acting manager and staff who were on duty. She talked to the people using the service, and asked staff about those people’s needs. She also looked at the medical records and daily notes for one of the people living in the home. This is called case tracking. She watched the staff and the people living in the home do activities together. A tour of the home was also carried out. At the time of the inspection there were six people living in the home. The home did not have any vacancies at the time of the visit. The information from two relatives spoken to on the phone and the completed Annual quality assurance Assessment (AQAA) form sent to the CSCI have been used in this report. The inspector would like to thank the manager, staff, and the people living in the home for their time in helping with this inspection. This inspection report should be read alongside the National Minimum Standards for Younger Adults (18-65). What the service does well: Families described the home as being clean, comfortable and pleasantly decorated. This was observed on the day of the inspection. The expressions and the behaviours of the people living in the home showed that they like living at the home. The families spoken to say that they feel the people living in the home are well cared for by staff and they treat them well. They say their privacy and dignity is respected. One family stated that they were very impressed with the facilities provided by the home and the person living in the home ‘seems very happy and settled’. They like the food and activities they do with help from staff. Houghtons DS0000014918.V349604.R01.S.doc Version 5.2 Page 6 The manager and staff enjoy working at the home. They attend training to help them meet the needs of the people living in the home. The staff have meetings with their manager to look at how they are meeting the needs of the people living in the home. The staff and people living in the home were observed interacting well with each other. They were also talking to the people living in the home in a positive and caring manner. The staff have build up good relationships with relatives of the people using the service and involve them in meetings and care planning. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Houghtons DS0000014918.V349604.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Houghtons DS0000014918.V349604.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4,5 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Good quality information is gathered prior to anyone moving into the home to ensure that the person moving in can be confident that the services provided can meet their needs. EVIDENCE: The home had a service user guide and the recent inspection report displayed at the front of the entrance. Since the last inspection, one new service user had moved into the home. The manager discussed the admission process for the person that was admitted to the home. This included visiting the person in their own environment to gather information needed to meet the persons needs. The family of the person who had moved to the home also discussed this process. It was stated that their family member had visited the home and had tea visits and overnight stays before moving into the home. The family also stated that they were very impressed with the facilities offered for the people the home cared for. Evidence of this assessment process was seen in the file of the person that was being case tracked. Another family spoken to also Houghtons DS0000014918.V349604.R01.S.doc Version 5.2 Page 9 stated that the home was very good in helping their family member move in to the home gradually and involved them in the process. The families spoken to stated that they had signed a contract and had a copy of this. Houghtons DS0000014918.V349604.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9,10 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The people using the service make decisions with assistance to ensure their needs and goals are met. EVIDENCE: Discussion with two relatives showed that they were informed about care planning documents for the people living in the home. It was also stated that the home kept them informed about the changing needs of the people living in the home and of any changes that occurred in the home. The file of the person who had recently been admitted to the home was inspected in detail. Evidence showed that the information needed to meet the needs of the person was fully recorded with risk assessments. The staff on duty were spoken to regarding how they met the needs of the new person that was admitted to the home and another person that had been Houghtons DS0000014918.V349604.R01.S.doc Version 5.2 Page 11 resident for a longer period. Evidence showed that the staff had very good understanding of how they were meeting the needs of the people living in the home. This was also confirmed by families spoken to regarding how well staff were caring for the people living in the home. One staff spoken to stated that she was completing passport booklets for people using the service in picture format that they understood. For example one was completed for lunch and medication for one of the people using the service. Families of people using the service noted that they attended review meetings with social services to review how the persons needs were being met. . The information about people living in the home was being kept locked in the office. The staff had good understanding about confidentiality and this was also discussed in their training. Houghtons DS0000014918.V349604.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15,16,17 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The people using the service have opportunities for personal and social development by engaging in appropriate leisure activities. EVIDENCE: The activity of the person that was case tracked was looked at in detail. The person attended day care centre four times a week. One day of the week the person had a ‘chill out day’ where they did what they wanted to do. The person had aromatherapy and used the snozelan in the home. They also enjoyed listening to music and liked watching the big TV in their room whilst sitting in their bed. It was stated by staff that the people in the home attended a variety of activities including going to parties of other sister homes, walks to the park, the local shops, and shopping to buy food or clothes. Some of the people in Houghtons DS0000014918.V349604.R01.S.doc Version 5.2 Page 13 the home enjoyed watching the staff prepare the meals. One person in the home enjoyed tasting the food, and another person enjoyed touching or smelling dough mixture. One person in the home helped put vegetables in a bowl. The food prepared each day was freshly cooked and staff had good understanding of the food that the people in the home enjoyed. The people living in the home were observed eating their evening meal with staff providing support in a supportive manner. The music man visited the home every two weeks, and people in the home enjoyed this session. It was also stated that the people in the home enjoy going out on the mini bus. The people living in the home also go on holidays with staff. It was stated that some of the families of the people living in the home visited the home. Also some of the people living in the home went home for weekend stay. The manager stated that all families were welcomed any time, however it was important for relatives to ring before visiting just to make sure that the person being visited was not out for the day. Families spoken to state that they are made to feel welcomed at the home and the staff are always pleasant and very helpful. Houghtons DS0000014918.V349604.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20,21 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The staff and the manager ensure that the health care needs of the people are met by involving the appropriate professionals to ensure they are kept healthy. EVIDENCE: The staff on duty were able to give clear details in how the people living in the home had their personal and health care needs met. This information was confirmed by case tracking one of the people using the service. The information on health care was well recorded. It was stated that this person also chose their own clothes with support from staff. Staff stated that they ensured that the privacy and dignity of the people living in the home was maintained at all times when giving out personal care. An example of how this was carried out was explained. The records case tracked had information on their medical diagnosis, medication profile and, how the person took their medication. A ‘service user Houghtons DS0000014918.V349604.R01.S.doc Version 5.2 Page 15 agreement’ form for medication was seen and signed by relatives. Families spoken to stated that they were being kept informed of the ‘service users conditions’. The medication records seen were being completed satisfactory. The staff were recording the temperature of the medication cupboard and this was satisfactory. The home did not have any controlled drugs but they had a record book and a metal cupboard to store the drugs. All staff who gave out medication had the accredited training on this. Information on burial arrangements was kept in the files of the people living in the home. All the staff had completed the death, dying and bereavement training. Houghtons DS0000014918.V349604.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The staff training on safeguarding vulnerable people ensures that the people using the service are protected from any abuse. EVIDENCE: The home had a complaints policy and this information was given to the relatives of the people using the service. The home had not received any complaints. The relatives spoken to knew how to make a complaint if they were not happy about any thing. However it was stated by relatives that they had no problems and were very happy with the care provided. It was also stated by one relative that their family member was always happy when they went to visit them at the home. This was by understanding the person’s behaviours and body language. Another relative also stated that their family member had settled in well and seemed very happy. The staff spoken to stated that they had attended the training on safeguarding of vulnerable adults. It was also stated that they signed the adult protection document to state that they understood and had read this. The training records showed all staff had received this training. It was also stated that the manager also discussed this in their staff meeting. The staff spoken to were able to give examples of how they would know if a person living in the home were unhappy. Examples were given of behaviours and body language that the people in the home used to show when they are happy and when they are Houghtons DS0000014918.V349604.R01.S.doc Version 5.2 Page 17 not happy. This showed that the staff had very good understanding of the knowledge of the people living in the home. The personal finances of one of the people being case tracked were looked at and records checked were correct with the correct balance. The finance officer for the company also checked all the money of the people using the service on a fortnightly basis. How the person’s money is being managed needs to be recorded in their care plan. The manager stated that she would complete this. Houghtons DS0000014918.V349604.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24,25,28,30 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The people using the service live in a homely environment, which meets their needs. EVIDENCE: The home is a purpose built bungalow that is accessible for people who are wheelchair users. The whole house including the kitchen, hallway, snoozelan, office, toilet, and one bedroom had been decorated. The home was very clean and looked very pleasant with the Christmas decorations. The home offers a range of communal areas including a sensory room, and a comfortable lounge area. The bushes in the front and back garden had been cut back. The home had purchased two big umbrellas and a table and chairs for the people to use in the summer months. The pathway was nice and clear for people using Houghtons DS0000014918.V349604.R01.S.doc Version 5.2 Page 19 wheelchairs. The manager and the people living in the home had put in shrubs and other plants in the garden to make it look attractive. A risk assessment of the garden had been undertaken and all risks had been minimised for the people using the garden with staff support. The manager stated that the garden was being put out to tender to have it landscaped. The bedrooms of the people seen were decorated very pleasantly and had equipment and the rooms were individualised to meet their needs. Houghtons DS0000014918.V349604.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,34,35,36 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Competent and well supervised staff ensure that the care needs of the people using the service are met. EVIDENCE: One staff spoken to stated that they started work as a relief staff and now works as a permanent member of the staff team. This was because they enjoyed working at the home. It was stated that the home has a nice atmosphere and all staff care very much for the people living in the home. It was stated that the training provided from the organisation was excellent. This was confirmed by looking at staff training records. The inspector was informed that 7 staff had NVQ level 2,3 or 4. Three staff were completing this NVQ level training. However the home had five new staff on induction training. One member of staff was retiring and it was felt that this training would not be appropriate for them at this stage. The new staff are given an induction package that they complete before working on their own with the people living Houghtons DS0000014918.V349604.R01.S.doc Version 5.2 Page 21 in the home. This included, reading care plans, risk assessments, shadowing staff, and looking at health and safety issues. The home had an induction package for when using agency staff and this was good. The inspector was informed that a new induction package, which was very detailed, was being put in place by February 2008. The staff spoken to stated that management was very supportive and offered encouragement and they are thanked for the work they do. Evidence also showed that supervision was being carried out every six weeks for staff. The home had vacancies for three full time staff and two staff were on maternity leave. The homes relief staff were covering these vacancy hours. Agency staff were used for covering holidays and staff sickness. The inspector was shown guidelines for induction for senior staff who had been away for a long period. This was very good at inducting them back to work. The staff files inspected showed that all the information required was undertaken by the organisation prior to staff starting work at the home. Houghtons DS0000014918.V349604.R01.S.doc Version 5.2 Page 22 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,38,39,42 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The management approach of the home ensures that the people using the service benefit from a well run home to meet their needs. EVIDENCE: The acting manager has been managing the home since June 2007. This was whilst the registered manager was undertaking another project within the organisation. The acting manager had NVQ level 4 in care and the registered managers award. She also had a foundation degree in care management. It was stated that the acting manager enjoyed working at the home and received good support and supervision from her management. The staff spoken to state that the management support received was very good. Houghtons DS0000014918.V349604.R01.S.doc Version 5.2 Page 23 Observation on the day of the inspection showed that the home was being managed well and in an open and transparent way. Staff and relatives spoken to confirmed this. The acting manager had developed an annual development plan and this was good but more information was needed to be included. The manager was going to do this for the next plan. On a monthly basis the care services manager visits the home by completing regulation 26visit records. The inspector was informed that management was looking at a yearly annual audit being completed by the organisation. The home had quarterly stakeholders meetings to discuss how the needs of the people using the service were being met. The Fire Officer had visited the home and was pleased with how the home was managing the fire training. The weekly fire testing and monthly emergency testing was being maintained. All the fire extinguishers were tested on the 11/09/07. All the staff had one day Guardian fire training and it was stated that this was very good. The staff were having fire drills on a 3 monthly basis. The incident report forms were being completed satisfactory. Houghtons DS0000014918.V349604.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 3 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 4 26 X 27 X 28 3 29 3 30 3 STAFFING Standard No Score 31 3 32 3 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 x 3 3 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 3 3 3 2 X X 3 x Houghtons DS0000014918.V349604.R01.S.doc Version 5.2 Page 25 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Houghtons DS0000014918.V349604.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Bedfordshire & Luton Area Office Clifton House 4a Goldington Road Bedford MK40 3NF National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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