Care Home: Howson Care Centre

What the care home does well At the inspection in November 2008 people who live at the home all said they enjoyed living there. The people we spoke with made comments such as `I can choose what I want to do` and `They look after me well`. The staff are supportive to people and treat them with respect. People are able to make choices about their daily lives, such as what they want to eat, how and where they want to spend their time and what activities they want to pursue. Incidents involving residents wellbeing are reported promptly to us and social services. What the care home could do better: The content of care plans need to be more person centred so that they provide comprehensive details about resident`s individual preferences, as well as their goals and aspirations for the future. They should also demonstrate that residents have been involved in the planning of their care, if this is not possible the reason should be recorded. Reviews of the planned support need to be more meaningful so that they fully evaluate changes in the persons condition, such as any improvements or deterioration and if the plan is working. Information about potential risks recorded in risk assessments and care plans needs to be improved so that staff have clearer information about what might trigger challenging behaviour and how to minimise identified risks. Each resident needs to be consulted about his or her social interests, this information should then be included in person centred care plans which outlines how staff will support them to have the lifestyle they wish. This information can then be used to formulate a programme of activities that meets the needs of people currently living at the home. Although staff have attended essential training such as health and safety and protecting people from abuse, it needs to provide specialist training to meet the individual needs of the people who live there. This may include topics such as challenging behaviour, mental health, risk assessment, dementia awareness and medical conditions, such as diabetes. Other areas that would benefit from some attention include the following. Care plans should contain information about recent legislation that is designed to protect people`s rights and choices. This is so the home can show they have looked at the effects the legislation has on the resident`s lives and planned their care accordingly. The number of staff on duty should be formally assessed using information gathered about peoples dependency levels to make sure that enough staff are on duty to meet peoples changing needs. Inspecting for better lives Random inspection report Care homes for adults (18-65 years) Name: Address: Howson Care Centre Howson Care Centre Willingham by Stow Gainsborough Lincolnshire DN21 5JZ two star good service The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed inspection. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Dawn Podmore Date: 2 0 0 2 2 0 0 9 Information about the care home Name of care home: Address: Howson Care Centre Howson Care Centre Willingham by Stow Gainsborough Lincolnshire DN21 5JZ 01427788283 01427787567 lous@howsoncare.fsbusiness.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Howson Care Centre Limited care home 78 Number of places (if applicable): Under 65 Over 65 0 0 0 25 dementia learning disability mental disorder, excluding learning disability or dementia old age, not falling within any other category Conditions of registration: 9 44 44 0 Residents admitted in the DE category must be fifty years of age or over. The maximum number of people who can be accommodated is 78. The Registered Person may provide the following category of service only: Care Home with Nursing to service users of the follwoing gender: Either, whose primary care needs on admission are within the following category: Dementia - code DE (Maximum number 9) Learning Disability (Maximum number 44) Mental Disorder ( Maximum number 44) Old age not falling within any other category code OP. The registered persons may provide the following category of service only: Care home with nursing - Code N to service users of the following gender: Either whose primary Care Homes for Adults (18-65 years) Page 2 of 11 care needs on admission are within the following category: Dementia - code DE Learning disabilities - Code LD Mental Disability - Code MD. Old Age not falling within any other category - code OP. Date of last inspection Brief description of the care home Howson Care Centre is situated at the edge of the village of Willingham By Stow and is set in landscaped grounds with car parking spaces to the front of the building. The home is owned by Howson Care Centre Limited and is managed by Mrs. C. Horne. The accommodation comprises of four areas; The Flat offers first floor accommodation for up to 8 service users who have a Learning Disability and who are working towards supported living placements. The Main House, provides services for up to 22 people with Mental Health problems. The Wing provides accommodation for up to 7 older people and 2 younger adults with a Learning Disability. The Court provides both nursing and residential services for up to 25 older people. The newly registered unit, known as The Laurels, is a separate, two-storey, purposebuilt unit for up to 15 people with a learning disability. Each unit is self-contained with a kitchen, bathroom and lounge/dining facilities. The kitchen in the main house area provides all meals, and drinks and snacks can be prepared in two smaller kitchen areas. The majority of the accommodation with the exception of The Flat area is situated on ground level comprising single and double bedrooms, some of which have en-suite facilities, 9 toilets, 4 bathrooms and 1 shower unit. At the time of the inspection the home confirmed that the weekly fees ranged from 351 to 500 pounds, depending on the assessed needs of the resident. Additional charges are made for services such as chiropody and hairdressing. Information about these costs as well as the day-to-day operation of the home, including a copy of the last inspection report is available in the administrators office. Care Homes for Adults (18-65 years) Page 3 of 11 What we found: This was an unannounced random inspection. This type of inspection can take place between key inspections for various reasons, such as to check that requirements have been addressed or to look at areas of concern. This visit was carried out jointly with social services following 12 notifications about incidents between people living at the home over a 5 week period. We spoke to the manager, her deputy and the nurse in charge, but on this occasion no residents were interviewed. We also looked at various documentation including, care plans, risk assessments, the accident and incident records, the owners monthly reports, staffing rotas and training records. The main findings of the visit are set out below under the standard headings we looked at. Choice of Home We looked at the assessment record for one of the newer residents and found that it reflected his needs on admission in satisfactory detail. It identified potential risks and gave staff some good information about potential risks associated with his care. Individual Needs and Choices We looked at the care plans for the people involved in the incidents reported to us by the home. The plans we saw outlined the residents assessed needs but they varied in the information recorded about the level of support they required and how they preferred their care to be delivered. For example one file said that the resident could exhibit unpredictable behaviour, but it did not tell staff if there were any triggers they could watch for so they could minimise incidents. Risk assessments were in place, but they did not contain enough information about minimising and management strategies. This meant that staff did not have access to comprehensive information about how to best support people. Some care plans referred to staff completing an ABC form to monitor residents behaviour, however none were seen on files. The deputy said these had been discontinued due to duplicating information, but plans had not been updated to reflect this. The majority of the plans we looked at did not tell staff about peoples likes and dislikes or how they preferred their care delivering. There were no social plans to tell staff about the residents individual hobbies or what they liked to do in their leisure time. A separate file contained details about what activities had taken place and who had been involved, but there was no evidence that these were the things that people wanted to do. None of the files highlighted peoples individual goals and aspirations. The manager said that there was no audit system in place to monitor the content of care plans to assess if they contained sufficient information. Some files contain old information, such as a plan from 2003 about introducing the resident to the home, therefore files did not give staff easy access to current information. Care Homes for Adults (18-65 years) Page 4 of 11 Care plan reviews were spasmodic and did not always evaluate the effectiveness of the planned care. For example one plan identified that the resident suffered from constipation, but the evaluation continually said no change. It did not say whether the planned care was effective or not. Another plan had been formulated to help the resident lose weight but it did not identify a goal weight. In one file there was evidence that the home had considered the content of the Mental Capacity Act, which is aimed at protecting people rights and choices. However this was not included in any of the support plans examined. The manager said that they were planning to include this information and confirmed that training in this subject had been provided. The staff we spoke to demonstrated a good awareness about the management of peoples needs and potential risks, but acknowledged that the documentation in care plans could be more comprehensive. Complaints and Protection The home has procedures concerning the protection of vulnerable adults. Records showed that they had followed these procedures by reporting incidents to Social Services and the Commission promptly. Most staff had received training in this subject and the manager said that further training was planned. Staffing On the day of the visit there were 64 people living at the home. We looked at the staffing rota to evaluate the number of staff on duty during the day and night. The staff we spoke to said that the current numbers were adequate to meet peoples needs. The manager said that she monitored the numbers of staff needed against the dependency levels of the people living at the home. However she could not provide any information to evidence that this was being formally monitored. Some residents are funded for one to one support, but this was not highlighted on the rota. The deputy manager said that this was arranged on a day to day basis rotating staff round so they did not become tired. We looked at the staff records and found that most staff had completed training in mandatory subjects such as protecting people from abuse and health and safety. However there was minimal evidence of specialist training being provided in subjects such as mental health issues, medical conditions, challenging behaviour and risk management. The manager said that two challenging behaviour sessions were to take place in the near future. Conduct and Management of the Home We looked at how the home recorded and reported accidents and incidents. The accident book detailed incidents between residents and these had been recorded in care plans. However the section pertaining to recommendations for avoiding further incidents had not been completed in any of the ones we checked. The manager said that they did monitor incidents but this was not documented. The home has informed us of incidents that have occurred but when we cross checked the notifications against Care Homes for Adults (18-65 years) Page 5 of 11 the care plans although they were recorded the content of the management strategies were inconsistent. A monthly visit by the home owners had been carried out and a report provided which outlining their findings. The content highlighted areas that had been considered but lacked detail about who had been spoken with and any actions needed to address any issues. The manager was advised to consult the guidance we provide on our website. We discussed the management of incidents at the home and minimising strategies used with the manager and her deputy. They demonstrated a good understanding of managing people with very unpredictable needs, but acknowledged that current documentation was inadequate. What the care home does well: What they could do better: The content of care plans need to be more person centred so that they provide comprehensive details about residents individual preferences, as well as their goals and aspirations for the future. They should also demonstrate that residents have been involved in the planning of their care, if this is not possible the reason should be recorded. Reviews of the planned support need to be more meaningful so that they fully evaluate changes in the persons condition, such as any improvements or deterioration and if the plan is working. Information about potential risks recorded in risk assessments and care plans needs to be improved so that staff have clearer information about what might trigger challenging behaviour and how to minimise identified risks. Each resident needs to be consulted about his or her social interests, this information should then be included in person centred care plans which outlines how staff will support them to have the lifestyle they wish. This information can then be used to formulate a programme of activities that meets the needs of people currently living at the home. Although staff have attended essential training such as health and safety and protecting people from abuse, it needs to provide specialist training to meet the individual needs of the people who live there. This may include topics such as challenging behaviour, mental health, risk assessment, dementia awareness and medical conditions, such as diabetes. Other areas that would benefit from some attention include the following. Care plans should contain information about recent legislation that is designed to Care Homes for Adults (18-65 years) Page 6 of 11 protect peoples rights and choices. This is so the home can show they have looked at the effects the legislation has on the residents lives and planned their care accordingly. The number of staff on duty should be formally assessed using information gathered about peoples dependency levels to make sure that enough staff are on duty to meet peoples changing needs. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Adults (18-65 years) Page 7 of 11 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 8 of 11 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, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 6 15 Care plans must fully reflect peoples individual preferences and abilities, as well as their aims and aspirations. This will help to make sure that staff have access to detailed information about how people prefer to be supported. 01/06/2009 2 6 13 The assessment of potential risks must be recorded in more detail. So that staff have a clearer picture of their role in managing and minimising any highlighted risks. 27/04/2009 3 16 16 Records must demonstrate 04/05/2009 peoples daily routines and recreational needs and what support staff need to provide to meet these needs. This will help to make sure that staff know what people want to do and their role in supporting them Care Homes for Adults (18-65 years) Page 9 of 11 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, 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 4 35 18 All staff must receive specialist training to meet the needs of people living at the home. This will help to make sure that staff have the knowledge and skills to meet the needs of the people living at the home 07/09/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 6 Support plans should include reference to the Mental Capacity Act, 2007 and the effects it has upon the service users lives. This is to ensure that their rights and choices are protected. Information about residents dependency levels and the layout of the home should be used to assess the number of staff needed on each shift. This will help to demonstrate that adequate staffing levels are being maintained. Staff should have regular supervision and appraisal sessions to help to make sure that they have the right level of support to carry out their role. The homes audit system should be reviewed to ensure that it includes the satisfactory completion of care plans. This will help the management team evaluate if staff are including sufficient detail so that peoples needs can be fully met. 2 27 3 36 4 39 Care Homes for Adults (18-65 years) Page 10 of 11 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report CSCI General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or got 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 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 11 of 11 - 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!