Care Home: Howbeck Close 2

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What the care home does well People live in a comfortable and safe environment with a range of aids to meet their needs. Peoples physical health care and emotional needs were met and supported by sufficient staff who are appropriately trained to meet peoples diverse needs. The home supports people with a range of communication systems to promote choice and interaction. It was also clear that this work was undertaken with the support of speech therapists. People at the home benefit from a competent and experienced manager who ensures systems and procedures are in place to protect peoples health and welfare. It was evident that relationships with families were supported by the service and feedback from relatives indicated that relatives very happy with the care provided comments included the home excel themselves, they take very good care of people and they have a very good and varied social and recreational activities. Very positive feedback was also received from from health care professionals that visit the home. What has improved since the last inspection? All requirements and recommendations made on the last key and Random inspection had been addressed. Staff had received medication training with system in place to ensure that staff receive yearly updates. Increase in staffing levels at mealtimes to ensure people are supported when eating and drinking. What the care home could do better: Continue with the good work. Key inspection report Care homes for adults (18-65 years) Name: Address: Howbeck Close 2 1 - 2 Howbeck Close, Off Howbeck Drive Edlington Doncaster DN12 1RE     The quality rating for this care home is:   three star excellent 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: Janet McBride     Date: 1 8 0 6 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 25 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 25 Information about the care home Name of care home: Address: Howbeck Close 2 1 - 2 Howbeck Close, Off Howbeck Drive Edlington Doncaster DN12 1RE 01709865755 F/P01709865755 patricia.lee@rdash.nhs.uk None South Yorkshire Housing Association Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Patricia Lee Type of registration: Number of places registered: care home 14 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 14 The registered person may provide the following category of service only: Care home only - Code PC to service users of the following gender: Either, whose primary care needs on admission to the home are within the following categories: `Learning disability - Code LD`, ` Learning disability over 65 - Code LD(E). Date of last inspection Brief description of the care home One and two Howbeck Close provides care for up to fourteen adult service users with learning disabilities. Eight service users can be accommodated at No 1 Howbeck Close and a further six at No 2. Both propertied are purpose built bungalows with the space, facilities and equipment to accommodate people with associated physical disabilities including wheelchair users. The home has an adapted minibus enabling access to the wider community. The accommodation is located in Edlington about four miles form Care Homes for Adults (18-65 years) Page 4 of 25 Over 65 14 14 Brief description of the care home Doncaster. Edlington has local facilities such as shops, library, health centres and a weekly market close by. The majority of people attend a range of day care provision that includes social education during the working week. Annual holidays, regular outings and social events take place. The service is provided by a partnership between South Yorkshire Housing Association and Doncaster Healthcare Trust, referred to SYHA and DHT in the report. SYHA own and operate the service with DHT providing the staff. All people within the home have a Licence agreement with SYHA. This partnership provides and operates three other such schemes in the Doncaster area. Current Scale of charges as of July 2009 from 369:53 to 879:62 per week.For any further information regarding the fees and addional charges please contact the homes manager. Care Homes for Adults (18-65 years) Page 5 of 25 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: three star excellent 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 quality rating for this service is three stars. This means that the people who use this service experience Excellent quality outcomes. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations, but only when it is is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. One inspector carried out this Key Unannounced Inspection, which took place on the 18th June 2009,starting at 10:45 and finished at 16:45 hours. Prior to this inspection an unannounced random Pharmacist inspection took place on the 27/05/2008. Summarized findings from this visit is within this report. The home submitted an Annual Quality Assurance Assessment (AQAA)this gives information regarding the Care Homes for Adults (18-65 years) Page 6 of 25 home and services provided.This document gave the manager opportunity to tell us what the home did well, what had improved and what they were working on to improve. Various aspects of the service were then checked during the site visit. Care practices were observed, a sample of records was examined, a partial inspection of the two units was carried out and service provision was discussed with the manager. Information was gathered from as many different individuals as possible that had contact with people within the home, discussion with the manager,three members of staff and three visiting professionals that visit the home on a regular basis. Three relatives were also contacted by telephone . They were asked to comment on the standard of care, staff skills, attitude, and how the needs of people using the service were met. Due to the nature of the people living at the home, it is difficult to obtain information directly from some people receiving services. Some judgments about quality of life and choices were taken from discussions with relatives, observation on the visit, followed by discussion with staff and examination of records held at the home. The inspector wishes to thank people living in the home, the staff and the manager for their assistance and co-operation. Care Homes for Adults (18-65 years) Page 7 of 25 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 8 of 25 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 9 of 25 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. Peoples individual aspirations and needs were assessed.Prospective people had the opportunity to visit the home for a trial visit. Evidence: Three care plans were case tracked to check the assessment procedure at the home. Assessments included detailed pen pictures, communication, health and social care needs and likes and dislikes. Risk assessments covered all key areas such as moving and handling, eating and drinking, medication and behaviour. The documents gave good detailed information in order to support peoples safely and in keeping with their needs. Discussion with the manager and staff showed that the service undertakes extensive assessments in partnership with health professionals before any new person moves into the home. Care Homes for Adults (18-65 years) Page 10 of 25 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. Person centered care plans and personal goals are reflected in individual care plans,this provided staff with sufficient information to meet the needs of people who use the service. The home ensures that appropriate communication systems are in place to support people to make decisions about all daily living needs. Evidence: Three service user care plans and assessments were inspected. Care plans were detailed and reflected each persons assessed needs. Detailed risk assessments were also in place that promoted peoples safety and quality of life. These documents were reviewed regularly with input from health professionals such as speech therapists, and physiotherapists . It was noted that care plans fully reflect peoples wishes and needs with regards to social and recreational activities. The Home supports people with a range of communication systems to promote choice and interaction. Communication systems included computers, communication passports, makaton and signs and symbols. It was also clear that this work was undertaken with the support of speech Care Homes for Adults (18-65 years) Page 11 of 25 Evidence: therapists. Staff respect confidentially information about each person this is handled appropriately in accordance with the homes policies and procedures. Care Homes for Adults (18-65 years) Page 12 of 25 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. Opportunities were provided and encouraged for the development of social and personal skills. This ensured that people had the opportunity to participate in leisure activities and live as part of the community. People were offered a wholesome and appealing balanced diet with a varied selection of food available to meet peoples tastes and choices. Evidence: Care plans showed each persons daily routines,some people within the home attend social education centre several days a week. People benefit from the home having two specially adapted vehicles to support access to the community and take people to day services. Therefore they have access to their local community,and evidence that trips out to concerts, cafes and day trips were undertaken. In addition people get the opportunity to go on holidays every year in past they had been to Butlins and a Barge holiday,this year people are going to a cottage in Kent. Staff work in small teams that Care Homes for Adults (18-65 years) Page 13 of 25 Evidence: meet monthly to look at opportunities for people and plan activities. Staff have planned birthdays and xmas and have considered all peoples specific needs and aspirations and ensure activities are appropriate. It was evident that relationships with families were supported by the home and feedback from people and families indicated that staff work in partnership with families to make decisions in the best interest of each person. Staff support and encourage people within the home to attend monthly community socials club meetings and one person attends regular advocacy meetings and speak up groups. Kitchen areas were found to be clean and tidy,the homes menus was examined and it was evident that a balanced diet was provided. Detailed eating and drinking programs were in place and it was evident that these had been developed with input from speech therapists. Mealtimes continue to be separated into two separate sittings for the evening meal to ensure people are not rushed and sufficient time is available to maintain safety and improve on the social aspect of meal times,with staffing levels increased to improve support to people on a 1:1 basis in line with their needs. Care Homes for Adults (18-65 years) Page 14 of 25 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People receive personal support in a way that they prefer and require,their health is monitored and arrangements for dealing with any issues were met with support from health professionals. Medication policies and procedures were well managed ensuring the safe administration of medication. Evidence: Discussion with the manager,staff on duty and other professionals on the day, including records viewed revealed that peoples physical and emotional health care needs were met by the involvement of other professional when required. Assessments and care plans provide evidenced of personal care and health needs and how these are met. Records showed evidence that staff monitor peoples physical and emotional health.This includes regular health checks and input from other relevant professionals when any issues are identified .Peoples relatives and advocates are consulted about their wishes relating to long-term illness and dying and these are recorded in their care plans. Peoples preferred routines and observation on the day indicated that these were adhered to and staff treat each individual with dignity and respect and interpret their needs according to individuals communication need. Care Homes for Adults (18-65 years) Page 15 of 25 Evidence: An audit by a local pharmacist on the day of the visit gave very positive feedback that records inspected indicated that appropriate record keeping was being maintained and that medication was being stored appropriately. Therefore only random records were seen along with staff training records and discussion with the manager and staff.This provided evidence that all staff that administer medication are appropriately trained to do so. Care Homes for Adults (18-65 years) Page 16 of 25 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. People who use the service and relatives were provided with information to enable them to raise concerns or complaints about the home and their care. Policies and procedures were in place on safeguarding adults, and staff had knowledge and understanding of adult protection issues. This promoted and protected people who use the service. Evidence: The home had an appropriate complaints system and communication systems for people within the home. The manager said all people receiving care and their representatives are made aware of the complaints procedure and encouraged to express their views if they are not happy about something.No complaints have been received in the last twelve months. The manager said the home had policies and procedures were in place regarding the protection of vulnerable adults.All staff had checks completed before being employed for example Criminal Record Bureau (CRB) Protection Of Vulnerable Adults (POVA) checks. All staff receive regular training on Safeguarding Adults Procedures and liaise closely with Care Co-ordinates if there are any concerns. Discussion with staff and training records seen showed that staff had the skills and training to protect people from abuse,staff spoken to were able to describe the action they would take on receiving any allegations. Care Homes for Adults (18-65 years) Page 17 of 25 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a comfortable,safe and accessible environment.They had a range of mobility aids and specialist equipment they require to maximise their independence. Evidence: A tour of the premises in both units was undertaken. The Home was purpose built and provides a spacious environment to accommodate people with wheelchairs and mobility aids. The Home is furnished and decorated to a good standard and was clean and free from offensive odours.Since the last inspection all communal areas,e.g.halls,lounges and dining rooms had been re-decorated including new curtains and blinds fitted. A new bath has been fitted in one of the bungalows and the bathroom completely refurbished. The Home has overhead hoist tracking systems in bathrooms and some bedrooms,since the last inspection they had fitted two further ceiling track systems in two further bedrooms. In addition the Home has mobile hoists and a range of mobility aids that were appropriate to peoples needs and are well maintained. Care Homes for Adults (18-65 years) Page 18 of 25 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. Staff had the skills and knowledge to fulfill their roles, and worked positively with people who use the service to improve their quality of life within the home. Recruitment policies are followed ensuring the safety and protection of people who live at the home. Evidence: Staff recruitment records are not held in the Home and are kept in the organisations central offices. Consequently the inspector did not view original recruitment documentation on this occasion. Instead the spoke to the care co ordinator at the organisation office who confirmed that all recruitment procedures were followed. Information in three records showed that appropriate recruitment procedures were being followed and discussion with three members of staff on the day confirmed they had completed an application form, been interviewed, Criminal Records Bureau and POVA checks completed, and two written references provided prior staff commencing employment. Each member of staff had an individual training file, training records seen and discussion with three staff showed that training was given a high priority in the service. Staff have undertaken appropriate mandatory training and specific training to meet peoples needs. Staff confirmed they had received induction training and then Care Homes for Adults (18-65 years) Page 19 of 25 Evidence: commenced learning disability qualification.It was also evidenced that over 50 of staff had obtained NVQ level 2 or 3 with other staff working towards this. Staff files showed that supervision was given on a regular basis,this was confirmed when speaking to staff. Both units are staffed separately and staffing was discussed with both the manager and staff members.Observation on the day of the visit and feedback from staff and records seen showed that staffing levels were sufficient to meet peoples care needs. Care Homes for Adults (18-65 years) Page 20 of 25 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a home that is run by a competent and experienced manager who ensures that people who use the service have their health, safety and welfare promoted and protected at all times. The service continue to make improvement in the provision of services and works hard to ensure the home is run to ensure effective outcomes for people who live there. Evidence: Management structure at the home consisted of a registered manager, who recently completed her fit person interview. Observation on the day, records viewed and discussion with staff evidenced that the manager his a very experienced and competent manager that delivered an effective service and had an in-depth understanding of peoples needs. Staff spoke highly of the manager and felt that she was very approachable and supportive. Evidence was seen that the home is visited on a monthly basis by a quality assurance officer .They talk to staff and people within the service to seek their views on the care provided. Periodic audits and checks of records and systems within the home was also Care Homes for Adults (18-65 years) Page 21 of 25 Evidence: completed for example care plans, health and safety and record keeping were a few that were seen. Regular supervisions and staff meetings were completed. Health and safety and safe working practice were discussed with manager and some members of staff during the visit. Records seen and observation showed that the homes practices are monitored appropriately. Risk assessments were in place to ensure the safety and well being of people who live in the home. Information taken from the homes AQAA showed the home was maintained appropriately.. Care Homes for Adults (18-65 years) Page 22 of 25 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 23 of 25 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 24 of 25 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. 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