Care Home: Houndstone Cottage

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What the care home does well The Grahams have been providing directional care for one person for over a decade. The person is settled and feel safe and comfortable living at the Graham`s home. The individual has a strong emotional attachment to the Grahams. The home is immaculately kept and provides a pleasing environment in which to live. Home cooked meals are good with the choice of menu being discussed daily with the residents. Mrs Graham ensures that the individual has access to relevant health and medical professionals as necessary. The resident has access to community facilities such as the day centre and community activities with the Graham family. Both the resident was very satisfied with the care and attention they receive from Mr and Mrs Graham. The home provides a very high standard of care by its practice of treating the individual as family members. What has improved since the last inspection? There have been no physical changes to the home since the last inspection or changes in staffing or persons living at the home. What the care home could do better: The registered person must not admit another person into the home until a Statement of Purpose and Service User`s Guide is produced. Key inspection report Care homes for adults (18-65 years) Name: Address: Houndstone Cottage Houndstone Cottage Brympton Yeovil Somerset BA22 8TF     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: Justine Button     Date: 0 9 1 2 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 23 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 23 Information about the care home Name of care home: Address: Houndstone Cottage Houndstone Cottage Brympton Yeovil Somerset BA22 8TF 01935421236 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mrs Hilary Mary Graham care home 3 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: Registered for 3 persons in categories OP, LD (E), MD and MD (E) Date of last inspection Brief description of the care home Houndstone Cottage is a family home providing up to three places for adults with mental health related needs. Mr and Mrs Graham, with support from their daughter, provide all the care and support. The service user has lived at the home for approximately fourteen years and regards it as her home. The home is situated on the Western fringes of Yeovil within walking distance to shops and amenities. Houndstone Cottage is an old building of pleasing character, which is well maintained and decorated. The home also provides pleasant garden space for service users to access. Care Homes for Adults (18-65 years) Page 4 of 23 Over 65 3 3 3 0 3 0 1 7 1 0 2 0 0 8 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: We conducted the Key Inspection visit over one day. At the time of the inspection the care home providing a service to one person. There is one vacancy at the home, although the proprietors have no plans to admit into this bed. One registered room is below size requirements for national minimum standards. Prior to the inspection an Annual Quality Assurance self-assessment was sent to the home to complete. This was completed in parts and returned to the Commission. Care Homes for Adults (18-65 years) Page 5 of 23 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details 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 6 of 23 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 7 of 23 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The person living at the service knows the home well and is involved in the daily routines. A Statement of Purpose and Service Users Guide would not provide additional information about the home for them. The current resident is cared for well, receiving individual care and close supervision of care needs. Evidence: Houndstone Cottage does not have a Statement of Purpose or Service Users Guide. The person living in the home was admitted prior to the Care Standards Act 2000 and the requirement to produce these documents. A Statement of Purpose and Service Users Guide will need to be produced if the home intends to admit any new residents in order for them to make an informed decision whether to move into the home. Fee levels at the home are accepted at social services rates. The indivdual who lives at the home said they value the care and attention given at the home. The indvdual has lived at the home for more than a decade. Care Homes for Adults (18-65 years) Page 8 of 23 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home does not have written records in relation to risk taking or care planning. Although the value of such is limited when the Graham family provide the care having no written care plans may place the indivdual at risk, if care has to be provided by additional staff, for example as a result of illness at the home. Written records would demonstrate professional accountability and provide an audit trail of care delivery at the home. Evidence: The indivdual living at the home has a file containing relevant letters and other pertinent care information such as consultant Doctor reviews or social worker correspondence. There are no structured, formalised care plans. Mrs. Graham was able to give a full and detailed verbal account of management of care for the people at the home over the last 12 months. This included sourcing relevant community health and social care support for ongoing chronic or acute health needs for people at the home. A feedback card from the GP for residents indicated satisfaction with care management by the home. Care Homes for Adults (18-65 years) Page 9 of 23 Evidence: Members of the Graham family provide care at the home. One person who resides at the home is currently receiving hospital treatment as an inpatient. The residents are consulted daily regarding their participation for the routine of that day. Assessing risk of harm to the residents is done by thinking about issues and talking through strategies with residents. Community health care specialists are also consulted if a problem arises or a review is needed. Community health care reports of consultations and visits provide some records of risk management strategies. Care Homes for Adults (18-65 years) Page 10 of 23 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. are involved in the daily routines and day planning for the home. This provides selfesteem and value to them. Mrs. Graham works hard to support the indivdual in maintaining their independence. Evidence: The inidvdual living at the home enjoys the activities and social contact at the day centre a couple times a week. Mrs. Graham provides home and community activities for rest of the time that the person is at home. The indivdual spoke of their satisfaction with the care they receive and of the kindness of the Graham family members. Activities are provided both in and out of the home, although residents choices are currently self-limiting. Care Homes for Adults (18-65 years) Page 11 of 23 Evidence: Regular days out are offered and an annual holiday was taken in the summer. The indivdual living at the home has a private lounge, although they are treated as a family member. They have unrestricted access to shared areas in the home and grounds. Meals are home cooked and the indivdual choose meals that they like. The kitchen and dining room facilities at the home are of a high domestic standard. Care Homes for Adults (18-65 years) Page 12 of 23 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The indivdual values the care and support provided at the home. They feel in safe hands. Health care needs are monitored by Mrs. Graham and she has sought appropriate community health care support where needed. Evidence: The owners provide care support and th eindivdual can express preference to whom delivers care. The person living at the home confirmed the owners respect their privacy. In discussion with Mrs. Graham and from a recent care management review it was established and confirmed that community health care professionals have been contacted for advisory visits, assessment of care needs and treatment where necessary since the last inspection. Letters from community health professionals were seen stored in the individual residents personal file. Mrs. Graham has managed the medication for the indvidual since admission and the person living at th ehome has previously said that they are happy for her to do so. Medication is stored securely. It is managed in the same way as in a domestic Care Homes for Adults (18-65 years) Page 13 of 23 Evidence: situation. Mrs. Graham has arranged for appropriate review of peoples prescribed medicines over the last 12 months. Care Homes for Adults (18-65 years) Page 14 of 23 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The atmosphere at the home is relaxed and open to suggestions or expression of concerns by the person living there. The individual reported that they could express concerns to the Grahams at any time. Problems are discussed in the home daily, if needed. Evidence: No formal complaints have been made to the home since the last inspection. Mrs. Graham has a local policy on the Protection of Vulnerable Adults, should she need to refer to a procedure manual in ensuring the safety of the individual. Care Homes for Adults (18-65 years) Page 15 of 23 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residential care is delivered in a home where the owners have pride in the quality of accommodation provided for all who live there. There have been no changes to the premises since the last inspection. This is a domestic property and any checks are in line with this. Evidence: Houndstone Cottage is a property of character on the western fringes of Yeovil. It is specifically used for physically able residents and affords a very high quality of accommodation. Of the three registered rooms, one is situated on the ground floor with two others on the first floor. The person who lives at th ehome curently lives on the ground floor. One of the three rooms is small. The quality of furnishings in bedrooms and throughout the property is high. All registered bedrooms include seating and televisions. There is one ground floor bathroom, separate first floor shower room and separate toilet. All are decorated pleasingly and all were clean. The indivdual living at the home has a choice of exclusive use of one lounge or to share other communal sitting spaces, including a conservatory. The garden is well Care Homes for Adults (18-65 years) Page 16 of 23 Evidence: maintained and is fully accessible. The home currently meets the physical needs of residents without adaptations. The home was presented to an excellent domestic standard on the day of the inspection. Care Homes for Adults (18-65 years) Page 17 of 23 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Family members who know the resident well currently staff the home. This provides continuity of care by familiar faces. Evidence: Mrs and Mr. Graham are the primary care givers with their daughter assisting occasionally. This is a family run business where residents are part of the family arrangements. None of the family has formal care qualifications but have years of experience with working with a range of residents. Individual attention is provided for the indivdual . Care Homes for Adults (18-65 years) Page 18 of 23 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Mrs. Graham manages her home and the needs of the person living at the home in an effective way without formal qualifications. The indivdual have spoken highly of the personal qualities of Mrs and Mr Graham. The home produces very few records in keeping with the type of family run service. . Evidence: Mrs. Graham has many years experience in the running of her care home. She demonstrates an open and honest approach to the management of her service. She is not formally qualified but is managing the current needs of her residents effectively. To date she has sourced appropriate health care support for her residents as their needs fluctuate. An extended training course in mental health or a professional mental health qualification would give her additional skills and confidence in caring for residents with mental health needs; but Mrs. Graham has previously said that she has not any plans to undertake this level of commitment to a training course. The home does not have written policies and procedures. The home holds a copy of the Somerset guidance document on safeguarding vulnerable adults. On request the Care Homes for Adults (18-65 years) Page 19 of 23 Evidence: home returned an Annual Quality Assurance Assessment to the Commission. This document was completed in part. Smoke alarms are fitted and tested appropriately by Mr and Mrs Graham. The environment is clean and the standard of fixtures and fittings is high. Care Homes for Adults (18-65 years) Page 20 of 23 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 21 of 23 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 22 of 23 Helpline: Telephone: 03000 616161 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 23 of 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!