Care Home: Ingleby Care

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What the care home does well Ingelby Care offers a respite service for up to three people with a learning disability. Ingleby Care call the respite unit a hotel, as it takes bookings from individuals for differing periods of time, to meet the needs of the individual, or their family and carers. People who use the service can stay for up to a few weeks at a time, but the usual stay is either during the week, Monday to Friday or over a weekend, Friday to Monday. People staying in the unit have their needs assessed before the first visit, this is to make sure the home can meet their needs. People are re-assessed during subsequent visits, this means staff have up to date information about the needs of people who stay there. There is a good care planning process in place. Plans are person centred, which means they are based on the individuals strengths and needs, and provide staff with good information, about the support people need, and the way they like this carried out. There continues to be a positive approach to risk management, people are encouraged and supported to do things for themselves where possible. Individual risk assessments we looked at included, accessing the community, personal care routines, and cleaning around the home. People who stay in the unit continue to experience a meaningful lifestyle, that reflects their individual needs. Clients can continue with activities, they usually attend during thier stay, including day services, and youth clubs. Comments we received included " I get treated well and I get to go out and do activities. I love it here and am looking forward to my caravan holiday with the hotel in June." People who use the respite service can be confident that staff have completed training in safeguarding vulnerable adults, and are able to recognise and respond to suspicions of abuse, so people are protected from harm. The home provides an excellent environment for people who stay in the unit. All rooms are decorated and furnished to a high standard. The home is spacious, clean and well maintained. There is a team of consistent staff and the client staying in the unit was observed interacting very well with the staff member on duty and the manager. What has improved since the last inspection? A manager has been appointed since the last inspection. The manager has the necessary qualification to manage the unit, and is experienced working with people with learning disabilities. The care planning process has been improved to include more photographs and pictures, to help people who are unable to read understand what is written. The medication procedure has been improved, a list of medication is now copied from the prescription during the assessment process, and a copy of the prescription is kept on file. A record of the medication to be administered is now entered onto a Boots MARS sheet, which makes it easier for staff to record. A lockable filing cabinet has been provided to store confidential information, and staff records are now kept in the unit. There was evidence available to show that staff have completed the training required to work with people safely. Staff files contain training certificates, and a training matrix shows what training staff have completed, and when updates are due or have been arranged. What the care home could do better: No requirements were made following this inspection, there are 5 good practice recommendations. The medication policy should be revised to accurately reflect the responsibilities of the respite unit. References to, managing prescriptions, ordering medication and disposing of unused medication, should be removed as these tasks are not carried out by the home. The manager should put into place, the plan to increase the staffing in the home at core times, as this will offer clients more flexibility to do individual activities, as well as provide more support if clients need assistance with personal care routines. Staff working in learning disability services should complete the learning disability qualification training (LDQ), to provide underpinning knowledge of the client group they work with. The quality monitoring systems should evidence that the provider carries out Regulation 26 visits, at least monthly, to ensure that the service is managed in accordance with regulations and legislation. Calls made to clients or their relatives, after they have stayed in the home, should be logged if they are part of the quality monitoring procedure. Key inspection report Care homes for adults (18-65 years) Name: Address: Ingleby Care 66 Plough Hill Road Warks CV109NY     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: Brenda Smart     Date: 2 4 0 5 2 0 1 0 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 33 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 33 Information about the care home Name of care home: Address: Ingleby Care 66 Plough Hill Road Warks CV109NY 01827370202 01827370201 gavin.miller@inglebyltd.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Ingleby Care Limited Name of registered manager (if applicable) Mr Gary Ratcliffe Type of registration: Number of places registered: care home 3 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum numbers of service users who can be accommodated is 3 The registered person may provide the following categories of service only Care Home only 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 LD Date of last inspection Brief description of the care home Ingleby Care is a respite unit for up to 3 people with a learning disability. People can stay for a weekend or for a maximum of two weeks at a time. The home opened in April 2009, most referals come through Warwickshire Social Services but they also take referals from private clients. The respite unit is a three bedroom bungalow, situated in Galley Common, Nuneaton. People staying in the unit use all the local amenities for shopping and leisure activities. While in respite clients are able to pursue their usual hobbies and interests, but this may need support from families for transport. People who use the service are Care Homes for Adults (18-65 years) Page 4 of 33 Over 65 0 3 0 9 0 9 2 0 0 9 Brief description of the care home supported with their daily routines and are encouraged to do things for themselves. Care Homes for Adults (18-65 years) Page 5 of 33 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The focus of inspections undertaken by the Care Quality Commission (CQC) is upon outcomes for people living in the home and their views of the service provided. This process considers the care homes capacity to meet the regulatory requirements, minimum standards of practice and focuses on aspects of the service provision that need further development. The visit to the home was undertaken by one inspector, on Monday 24th May, between 2.30pm and 6.40pm. The manager, and a member of care staff were available to assist in the process. There was only one person due to stay in the home on the day we visited, and this person arrived around 4pm. Information for this inspection was gathered by speaking to, and observing the person who was staying in the respite unit. We looked in detail at the care and support this person receives, we call this case tracking. We did this by observing staff working with Care Homes for Adults (18-65 years) Page 6 of 33 the client and by talking to them. We looked at their care and support plans, medication records and any risk assessments or guidelines that where completed to keep people safe. We also walked around the home and looked at bathrooms and bedrooms as well as the communal areas that people use, to make sure these are clean and well looked after. The case tracking process helps us understand what its like for each person that stay in the unit. In addition a range of documents were looked at including staff rotas, staff files, training records, quality monitoring procedures, and discussions took place with the manager and the member of staff on duty. Prior to the inspection the manager completed and returned an Annual Quality Assurance Assessment (AQAA). This tells us how the service thinks they are performing and gives us information about their achievements through improvement and their plans for further development. We also sent surveys to people who stay in the respite unit, and staff to who work there. The AQAA and surveys were taken into account as part of this inspection process. At the end of the visit general feed back was given to the manager about areas that were working well, and where improvements are required. Ingelby Care refer to people staying in the unit as customers, or clients. We have chosen to use clients within this report. Care Homes for Adults (18-65 years) Page 7 of 33 What the care home does well: What has improved since the last inspection? A manager has been appointed since the last inspection. The manager has the necessary qualification to manage the unit, and is experienced working with people with learning disabilities. The care planning process has been improved to include more photographs and pictures, to help people who are unable to read understand what is written. The medication procedure has been improved, a list of medication is now copied from the prescription during the assessment process, and a copy of the prescription is kept Care Homes for Adults (18-65 years) Page 8 of 33 on file. A record of the medication to be administered is now entered onto a Boots MARS sheet, which makes it easier for staff to record. A lockable filing cabinet has been provided to store confidential information, and staff records are now kept in the unit. There was evidence available to show that staff have completed the training required to work with people safely. Staff files contain training certificates, and a training matrix shows what training staff have completed, and when updates are due or have been arranged. 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 9 of 33 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 33 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 support needs are assessed before respite stays, to ensure that individual needs can be met. Information about the home is provided to prospective clients so they can decide if they want to use the respite service. Evidence: The AQAA told us, All of our customers participate in a thorough needs assessment prior to their first stay. We ensure their individual aspirations and needs are assessed using our customer friendly forms. Individual care plans are agreed with customers and regularly reviewed. At all stages we are inclusive to ensure people feel part of their care planning process. Customers are supported to visit the hotel to decide whether they want to use the service and individual induction packages are agreed at what ever pace is right for the customer. All customers have comprehensive assessments identifying all needs and the ways in which customers want their needs met. All service provision and care plans are person centred with particular attention paid to individual choice and control. Family members or advocates contribute to this Care Homes for Adults (18-65 years) Page 11 of 33 Evidence: if the customer requires or chooses it. Assessments include time with the customer at their own home to enhance our understanding of the customers needs, preferences and individual routines and culture. Ingleby Respite Hotel has developed a reliable and skilled care team who are committed to providing a quality service to customers which promotes dignity & choice and which meets customers individual needs and contributes to customers personal development. Rotas are designed to ensure consistency and continuity for customers. There has been no change to the admission process since our last visit. The unit offers a respite service and has a procedure for assessing the needs of people before they come to stay, so they can make sure their needs will be met. Ingleby Care call the respite unit a hotel, as it takes bookings from individuals for differing periods of time, to meet the needs of the individual, or their family and carers. People who use the service can stay for up to a few weeks at a time, but the usual stay is either during the week, Monday to Friday or over a weekend, Friday to Monday. Clients funded by social services are allocated their amount of respite on a yearly basis. The unit discusses preferred dates with clients and tries to accommodate preferences. At present, due to the current staffing levels, the unit is unable to accept clients with high support needs, as there is usually, only one member of staff on duty. There was only one person staying in the unit the day we visited. We looked at this persons file, which showed that an assessment of need had been completed before the clients first respite stay. The file also contained copies of the Social Services assessment of need, and care plan. This client had stayed at the unit several times and the assessment had been reviewed during each stay so carers had up to date information about their support needs. The plan seen was of good quality and included all elements of the persons social, health, communication and personal care needs. The plan was person centred which means based on the individuals strengths, needs, preferences and choices. The support worker on duty had a good understanding of the clients individual needs, and was observed interacting with the client in a positive way, and understood the persons specific communication skills. Comments in staff surveys included Ingleby care meets the needs of the individuals. Everyone has their own package of care and support plans. There has been no change to the Service User Guide since the last inspection in August 2009. Information from surveys indicate that prospective clients, or their Care Homes for Adults (18-65 years) Page 12 of 33 Evidence: relatives/carers are provided with good information about the home. Care Homes for Adults (18-65 years) Page 13 of 33 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. People who use the respite service, can be confident that their needs will be safely met, and they will be supported to make choices and take reasonable risks. Evidence: The AQAA stated, All customers have comprehensive assessments identifying all needs and the ways in which customers want their needs met. All service provision and care plans are person centred with particular attention paid to individual choice and control. Family members or advocates contribute to this if the customer requires or chooses it. Assessments include time with the customer at their own home to enhance our understanding of the customers needs, preferences and individual routines and culture. Ingleby has developed a reliable and skilled care team who are committed to providing a quality service and in ensuring customers have maximum choice and control and opportunities for personal development. Staff at every opportunity encourage customers to participate in the day to day running of the hotel and steps to ensure maximum inclusion with this are being taken by close working with SALT. Involving customers in the running of the hotel during their stay includes Care Homes for Adults (18-65 years) Page 14 of 33 Evidence: meal planning, shopping, cooking, cleaning, laundry etc. Some customers participate in activities they are restricted in at their home environment. We have found this is sometimes in the most basic of areas including choosing meals getting up at their own preferred times, choosing when they bathe (ensuring this does not compromise duty of care). We support service users to make their own decisions and choices and also support them to develop this skill. We have managed to improve and add finer detail to individuals care and support plans including detailed preferences and choices of individuals we could only get to know through building trusting relationships. We have continued to develop user friendly formats for care & support plans. We looked at the support plan for the person staying in the home. The plan described the support the person needed, in relation to daily living, and included personal goals, hobbies and interests as well as personal care support. The manager has devised a new format for support plans since the last inspection and is in the process of implementing this. The new format contains more pictures, to assist people who are unable to read, understand what is written. The manager told us, the unit is continuing to work with the speech and language therapist to develop plans further by using picture exchange and flash cards. The plan we looked at included a What is important to me section, which detailed things like, keeping in touch with Mum, and using my camera. There continues to be a positive approach to risk management, where people are encouraged and supported to do things for themselves where possible. Individual risk assessments we looked at included, accessing the community, personal care routines, and cleaning around the home. Comments from service user surveys included They look after me while Im there, nothing is to much trouble for them. I think they are brilliant at their job. Staff surveys included the following comments, Helps our service users in everyday living, very person centred. Very understanding and sorts out recognised needs very quickly and then quickly puts this into place. I am very happy how we work. The hotel has a person centred approach, Good at matching service users with staff they like. Care Homes for Adults (18-65 years) Page 15 of 33 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. People who stay in the unit continue to experience a meaningful lifestyle, that is reflective of their individual needs. Evidence: Information in the AQAA included, The assessment is used to inform the individual care and support plans which are agreed individually, with customers having full involvement. The individual plans will include all areas of someones life so that people can be supported to maintain and develop work, college courses, leisure interests, social contacts, family relationships etc. The hotel is part of valued residential area and customers are supported to use local facilities and develop relationships wherever possible. Local social events are well attended by customers and it is pleasing that the hotel is specifically included in invites to local events and festivities. As previously mentioned, customers are visited at home to ensure we understand their home routines and preferences, these are maintained where chosen by the customer. Care Homes for Adults (18-65 years) Page 16 of 33 Evidence: Equally, some customers have restricted involvement in routines within the home and appreciate establishing new more independent routines during their respite stay. Meals continue to be a focal point for choice and involvement with the whole process from menu planning, shopping, preparation, eating & clearing away being a time for enjoyable team work and skill development. Meal times are sociable and relaxed. Overall the standard of accommodation and facilities is very high and appropriate for the needs of all customers. Getting to know our customers has resulted in greater understanding of their chosen lifestyles enabling us to support people appropriately. In addition to this, being able to secure additional support for people means that this is more easily achieved. The plan we looked at included information about hobbies and interests, things recorded included, likes to take photographs, enjoys watching television, going to the cinema, and bowling. There was a daily plan in the clients file to show daily activities, including attending day service. Both the manager and the support worker told us that the unit tries to match people with similar needs, and where possible have met each other before, to come into the unit together. On the day of our visit the client arrived at the unit about 4pm. He came into the kitchen and was greeted by the staff member. The client knew the names of the support worker, and the manager, and asked about other members of staff by name. The client was shown the bedroom he was allocated, they then went into the lounge and watched television. The client was told he was the only person there that evening and that two other people would be joining him tomorrow. He knew the names of the people mentioned, as they had stayed together before. He asked what was for dinner, and was asked what he would like to eat. He chose pizza. He was asked if he wanted to cook, or go out for one. He chose to go out , with the staff member, and buy one from a local pizza take away. During the time we were in the unit the client had access to all areas of the home. We asked to see the menu plan, although there is a menu, mainly used to assist with shopping, the menu is flexible and clients can choose from the food in the home, or often choose to go out to eat. A meal record is recorded in each clients file to show what they have eaten that evening. Comments from surveys included I get treated well and I get to go out and do activities. I love it here and am looking forward to my caravan holiday with the hotel in June. Care Homes for Adults (18-65 years) Page 17 of 33 Evidence: Another survey said, I want Ingelby to buy a trampoline. Care Homes for Adults (18-65 years) Page 18 of 33 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. Each person can be confident that their personal and healthcare needs are met and that medication is managed safely. Evidence: The AQAA told us, Each customer of the hotel has a personal care & support plan outlining all areas of personal support including healthcare and how needs should be met. This is reviewed for each respite stay to ensure that it remains appropriate and responds to any change in need or preferences in how needs should be met. Dignity in care is paramount to us and is embraced by all staff. Care practices are observed and monitored. Care practices are also examined via supervision. We have found that customers routine/regular healthcare appointments are supported, (by choice) by family members, however the hotel would be able to support with this if necessary. We regularly update records regarding peoples healthcare needs. improvement to our medication systems were highlighted earlier in this document. We respond to healthcare needs arising for customers during their respite stays and ensure appropriate advice and if necessary, treatment is provided by the appropriate healthcare professional. Care Homes for Adults (18-65 years) Page 19 of 33 Evidence: The personal and healthcare needs of clients are assessed before their first visit, and recorded in the plan of support. The file we looked at had a person centred plan devised, that included how the person prefers their personal care provided, and what support they need with this. The file included a personal care chart, to record what personal care has been given, so this can be easily monitored, and if people need prompting to shower or bathe, they can be reminded to do this. Since the last inspection, the assessment process includes more information about the healthcare needs of clients. Although health needs are assessed and recorded in the support plan, due to the nature of the service, the involvement the respite unit have with health appointments is minimal. As there were no clients in the home when we arrived, there was no medication kept in the home. We asked to see the medication cupboard, which is situated in the kitchen, secured to the wall. This was locked and when opened, showed to be empty. We asked about medication training for staff, and the support worker told us she had completed training, we looked at her training records, which confirmed this. Since the last visit a competency assessment has been compiled by the manager. This was recommended at our last inspection, as staff work on their own, and the manager must make sure that they understand a safe procedure for assisting and recording medication. We were shown a completed competency assessment, this was based on a pharmacists competency, and was not relevant to a support worker role. The manager said she will amend this to reflect the role of the carer. We looked at the medication policy for the unit. Although this is headed Ingelby Care Respite Hotel medication policy, the policy included, managing prescriptions, ordering medication, and disposing of unused medication, these tasks are not the respites homes responsibility. Clients usually stay for a weekend or mid week visit so medication is sent in by parent/carers. A list of medication is now copied from the prescription during the assessment process, and a copy of the prescription is kept on file. The process for recording medication sent into the unit has also improved. A record of the medication to be administered is now entered onto a Boots MARS sheet, which makes it easier for staff to record. Care Homes for Adults (18-65 years) Page 20 of 33 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 respite service can be confident that concerns will be listened to and that staff are able to recognise and respond to suspicions of abuse, so people are protected from harm. Evidence: The AQAA stated, All staff are required to attend training on recognising and responding to adult abuse and are aware of their responsibilities under the safeguarding adults framework. All staff carry a safeguarding adults pocket guide. Staff are mindful of the security and safety of customers whilst at the hotel and when in the community and appropriate risk assessments are in place. Customers are encouraged to, and staff are required to, report to the line manager any potential risks or vulnerability. Our complaints procedure is widely publicised and is available in easy read and audio versions. The procedure itself is designed to be transparent and straightforward, encouraging comment. Ingleby promotes a culture which is open, non defencive, non stigmatising and responsive to complaints. We have invested in working with individuals and families to demonstrate our open & honest approach to complaints to ensure that people are not worried about making complaint or representation. Records show staff complete safeguarding awareness during induction, and additional safeguarding training has been booked for July 2010, for staff who require an update. Staff have recently been issued with a safeguarding pocket guide, devised by Care Homes for Adults (18-65 years) Page 21 of 33 Evidence: Warwickshire Social Services, that provides good information about what they should do if they have any concerns, and the telephone numbers to contact. We asked to see the complaints log, this showed, no complaints have been received since our last visit. The unit also keeps a log of minor concerns raised by clients, or their families, these are dealt with promptly so they dont escalate to complaints. Information in surveys show people who use the service have been provided with complaints information, and staff surveys indicate, they know what to do if someone is unhappy with anything. Care Homes for Adults (18-65 years) Page 22 of 33 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. The home provides an excellent environment for people who stay in the unit. Evidence: Information in the AQAA included, The hotel is spacious & well appointed throughout, with a modern, neutral theme. All areas of the hotel are accessible to all customers including wheelchair users and people with restricted mobility. Fixtures and fittings are stylish & of the highest quality. There are exacting standards of housekeeping, hygiene & cleanliness in place which is attended to daily. There is a maintenance contract in place to ensure that all facilities and equipment are kept in good repair. Customers choose their bedroom at point of booking or on arrival and can choose from an en-suite facility with a shower or a luxury bathroom with both bath & shower available. Each bedroom has all the necessary furniture as well as a double bed a flat screen TV. As the hotel was newly refurbished prior to opening we have maintained rather than improved the internal environment. We have have spent time improving the garden areas. We looked around the home during our visit. We looked at all the communal areas, including the lounge, kitchen/ dining room, bathroom, and laundry. We also looked at all three bedrooms and the en suite shower room. All rooms are decorated and furnished to a high standard. The home is spacious, and provides a pleasant Care Homes for Adults (18-65 years) Page 23 of 33 Evidence: environment for people who use the service. Bedrooms are equipped with television/dvd players. There is also a large wall mounted television in the lounge. The garden has a decking area, with patio furniture, and the front access is block paved. On the day of our visit the home was clean throughout. The store cupboard for cleaning materials is situated in the laundry room, this has a magnetised locking system installed, as does the drawer where sharp knives are kept. This safeguards people staying in the home from accessing potently dangerous equipment. Care Homes for Adults (18-65 years) Page 24 of 33 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. People who use the respite service are supported by a competent, staff team who are properly checked and complete the necessary training to support them in a safe way. Evidence: The AQAA told us, Ingleby Care takes great care in the recruitment and selection of staff. Interviews are held to determine the attitude, aptitude, skills & knowledge of candidates and if successful at interview robust pre-employment checks are completed before appointments are offered. The hotel has created a cohesive and skilled team who are able to meet the needs of customers and instill confidence in carers. All new staff have an induction and shadow experienced/senior staff before providing direct care and are then supervised until they have demonstrated their competence. All staff are required to undertake training in Common Induction Standards and all of the care team have individual training & development plans and are encouraged and supported to undertake a variety of learning opportunities. All staff are supported to undertake NVQ. All personnel are clear about their roles and responsibilities and are supervised regularly. We observed the staff on duty working with the person staying in the respite unit. Interactions were friendly, and the carer was able to communicate easily with the client, as she understood his language skills. Care Homes for Adults (18-65 years) Page 25 of 33 Evidence: We asked the manager about the usual staffing arrangements in the home and were told, there is usually one carer on duty. The manager is supernumerary to the rota, but does offer support to clients if needed. We were told that staffing is increased to support organised activities. We asked for a copy of the last 3 weeks rota, as the network was unavailable, this was emailed to us the morning after the inspection. Rotas showed the staffing compliment as stated, it also showed that staff on induction, work shadow shifts with more experienced staff. The manager told us that she is intending to increase the staffing at core times in the unit, between 7am to 10am and 3pm to 7pm, and hopes to have this implemented by the beginning of August 2010. It is recommended this is pursued as it provides clients with more flexibility to do individual activities, as well as provide more support if clients need assistance with personal care routines. We were told, at present most clients using the respite service are able to do things for themselves, with minimum support. Staff also said they do have one client who needs more support due to behaviour, and when this person is in the unit additional staffing is arranged. Comments on staff surveys indicate this does not always happen. We asked what could be improved, and were told The hotel would work well with double cover when certain service users are staying. One service user survey said There is only one staff member at a time. I would like at least 2. At the time of our visit the home employed five support workers, on the day we visited the staffing levels in the home were sufficient for the one client staying in the home. We looked at the personal files for the last two staff recruited. This showed there is a consistent recruitment procedure, and staff have the appropriate checks and references completed before they start working in the unit, this includes ISA first checks, CRB checks, and two written references. We were told that new staff complete a structured induction, but there was no evidence in files to confirm this. The manager told us that both staff had completed their induction and their booklets were waiting to be assessed and verified. We looked at the file of a staff member who has worked in the home since it opened, this file contained a completed induction booklet. We received surveys from 4 staff members, all indicated that carers complete an induction that equips them to do their job. Since the last inspection a lockable filing cabinet has been obtained to store confidential information, including staff files. We looked at the training record for the staff member on duty, this showed that Care Homes for Adults (18-65 years) Page 26 of 33 Evidence: mandatory training has been completed and updates arranged in moving and handling and safeguarding vulnerable adults. There was also a certificate for completion of NVQ 2 qualification. We asked to see the training matrix for the home. The manager advised this is stored on the computer and the network was unavailable. The manager agreed to email a copy of the matrix to us, which we received the next morning. This showed that training is completed in all health and safety areas during induction, including food hygiene, first aid, and safeguarding. All staff have completed medication training. The matrix shows 3 out of the 5 staff have completed NVQ training, and the manager said, the two staff on induction will be referred for NVQ training after 6 months with the organisation. Only one person has completed LDQ, which is the recommended qualification for staff working with people who have a learning disability, and this could be improved. Records show that staff have training in client related areas, including epilepsy, and autism awareness. Comments from staff surveys included, All staff have training to enable them to support service users on a day today basis. Staff files show that support staff receive regular supervision from the manager, and staff surveys indicate that the staff have good support from the manager. Care Homes for Adults (18-65 years) Page 27 of 33 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. People who use the respite service benefit from a well managed service that is operated in their best interests. Evidence: Information provided in the AQAA included, The hotel is friendly and fit for purpose. The team leader has a proven track record in effective management of the hotel and is currently applying for registered manager status with CQC. The team leader has created a modern, viable and highly valued respite service which is part of the local community. A robust, committed and skilled staff team has been created which is able to reliably meet the needs of all hotel customers by adherence to care plans and appropriate policies and procedures. All policies and procedures are regularly reviewed and are kept electronically and in paper files which are accessible to all staff. Policies include a Complaints policy which all customers are aware of. All policies and procedures have been reviewed. A satisfaction survey has been completed and action taken as a result of the feedback given. Ingleby has appointed an Operations Manager to support the team leader and to develop, improve and maintain systems and processes. Care Homes for Adults (18-65 years) Page 28 of 33 Evidence: A manager has been appointed since the last inspection. The manager was previously the team leader in the respite unit who is qualified, and experienced in the day to day running of the unit. The manager has been in post 6 months and is in the process of applying to be registered by the commission. Quality assurance systems are in place. Clients, or their relatives are asked to complete a satisfaction questionnaire at the end of their respite stay, and the manager said she also phones people following their stay to make sure everything was satisfactory, and, any concerns can be quickly rectified. The manager said these calls are not recorded, so there was no evidence they are taking place. Follow up calls to clients should be logged, if they are part of the quality monitoring procedure of the unit. Information we received from clients surveys show people who use the service are very happy with the service and the support they receive. We asked what the service does well, comments included, Every area of support is excellent. I would always recommend Ingelby to any parent or carers. They make me very welcome. The home is very good. The hotel makes sure I get regular breaks. I would like to stay for longer periods of time. Comments from staff included The home runs very well and its a pleasure to work there. Staff comments also included If we had transport we would be able to go to more places and more staff sometimes would be good, mostly at weekends when we like to do day trips. There was no evidence that the organisation complete Regulation 26 visits, these are visits that the provider is required to undertake to ensure that the service is managed in accordance with regulations and legislation, and should take place at least monthly. The manager said that senior management visit the respite unit regularly, and that the organisation has just appointed an operations manager, who is the line manager for the service, we met the operations manager during our visit. The manager said she feels well supported by the operations manager. The provider can delegate the responsibility of completing Regulation 26 visits to another member of the homes management team, if they so wish. There is a clear policy and procedure in relation to Health and Safety, and checks of equipment are undertaken as required to ensure that they are safe to use. For Care Homes for Adults (18-65 years) Page 29 of 33 Evidence: example, water temperatures, electrical certificate, lighting and fire records were checked and all were up to date, and consistent with the information provided in the services aqaa. Care Homes for Adults (18-65 years) Page 30 of 33 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 31 of 33 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 1 2 20 32 The medication policy should be revised to accurately reflect the responsibilities of the respite unit. The manager should put into place the plan to increase the staffing in the home at core times this will offer clients with more flexibility to do individual activities, as well as more support if clients need assistance with personal care routines. Staff working in learning disability services should complete the LDQ training to provide underpinning knowledge of the client group they work with.` There should be evidence in the home that the provider carries out Regulation 26 visits, at least monthly Follow up calls made to clients or relatives after their stay, should be logged if they are part of the quality monitoring procedure of the unit. 3 34 4 5 39 39 Care Homes for Adults (18-65 years) Page 32 of 33 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. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. 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