Care Home: Isabel Court Respite Care Unit

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What the care home does well This inspection tells us that Isabel Court continues to provide people with a consistent service. The staff do their best to accommodate the wishes of service users and their families regarding the timing of their planned respite stays, to fit in with family occasions and being with people they know and are able to take part in the same activities. A high priority is placed on meeting with service users, their families and the health and social care professionals who know them before they spend time at Isabel Court. This is to make sure people are confident about the service and staff before they spend the night and arrangements can be made to get any specialist equipment or staff training in place before people arrive. Isabel Court provides people with a bright comfortable home style place to be when away from home. The one person who completed our survey with support told us `There are nice staff, they also look after me well`. People are able to choose what they do and try out new things. Staff arrange the meals to suit the preferences and needs of the people who are staying. What has improved since the last inspection? The quality assurance systems put in place by Staffordshire County Council ensure that there is a continuous cycle of review and improvement that takes account of the views of people using the service their families and key professionals. A senior night worker role has been created to provider greater management experience and oversight throughout the 24 hour period. What the care home could do better: Consider providing staff access to alternative formats for creating documents so care plans and information for people using the service can be made more accessible to them. Look at the resources available to take people in wheelchairs out into the community so that staff feel more confident in this area and service users and their families know what is available and what the costs will be. Review the infection control procedures alongside changes in legislation and the national hygiene code so that an infection control audit can be put in place covering the required areas and needs of people staying at Isabel Court. Key inspection report Care homes for adults (18-65 years) Name: Address: Isabel Court Respite Care Unit 1-6 Isabel Court Isobel Court Respite Care Unit Walton Road Hoddesdon Hertfordshire EN11 0LQ     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: Sheila Knopp     Date: 3 1 0 3 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 27 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 27 Information about the care home Name of care home: Address: Isabel Court Respite Care Unit 1-6 Isabel Court Isobel Court Respite Care Unit Walton Road Hoddesdon Hertfordshire EN11 0LQ 01438737400 01992904354 cath.sharples@hertscc.gov.uk www.hertsdirect.org Hertfordshire County Council Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Manager Post Vacant Type of registration: Number of places registered: care home 3 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability physical disability Additional conditions: Date of last inspection Brief description of the care home Isabel Court Respite Care Unit for younger adults is a self-contained 3-bedroom ground floor flat within a purpose built development for younger adults. The spacious bedrooms have en-suite provision. Overhead tracking hoists are provided in two of the bedrooms and bathrooms. Service users have a lounge, kitchen diner and assisted bathing and shower facilities. There is a shared garden with patio areas and seating to the rear of the building. Hertfordshire County Council HCC runs the service. The building is owned and managed by Aldwyck Housing Association. It is in a residential area of Hoddesdon. Limited designated parking is available at the front of the building. Information about the service provided at Isabel Court can be obtained from the Care Homes for Adults (18-65 years) Page 4 of 27 Over 65 0 0 3 3 Brief description of the care home welcome pack and Statement of Purpose. These and a copy of the most recent inspection report can be obtained from the manager. Charges for the service are included as part of the total care package put in place by Hertfordshire County Council for each individual. Care Homes for Adults (18-65 years) Page 5 of 27 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 information in this report is based on an unannounced visit to Isabel Court by one inspector between 14:00 and 18:40 hours. Where this report refers to we it is recognised that it is written on behalf of the Care Quality Commission. Our visit was planned to meet with the people using the respite service as they arrived from their day care arrangements. The last inspection of Isabel Court took place on 30th October 2007. Our assessment of the service at that time was that Isabel Court was providing excellent outcomes for people who use the respite service. This means we carried out Annual Service Reviews (ASRs) during 2008 & 2009. ASRs do not include a site visit but are an assessment of risk based on the information we have received. To review the experience of people staying at Isabel Court we observed how people spent their time and the quality of the interaction they had with staff during the Care Homes for Adults (18-65 years) Page 6 of 27 afternoon, early evening and over supper. We had discussions with the manager and staff on duty. We also reviewed relevant care, personnel and health and safety records. We have also looked at the information we have received about this service since our review on 13 October 2009. We made survey forms available to residents and staff so the views of a wider group of people could be included in our assessment of the service. Responses were received from 1 resident and 3 staff. We have not received any complaints about this service between our reviews. We have also looked at the managers Annual Quality Assurance Assessment (AQAA). The AQAA is a self assessment that focuses on how well outcomes are being met for people using the service. It also provides us with numerical data. Care Homes for Adults (18-65 years) Page 7 of 27 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 Care Homes for Adults (18-65 years) Page 8 of 27 order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 27 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 27 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident booking respite stays at Isabel Court because lots of people who understand how they wish to be supported and what their needs are will be involved in making sure the service is right for them. Evidence: Considerable time and effort is spent with families and their social workers before people spend their first night at Isabel Court. This includes a multi-disciplinary assessment of their needs so that any specialist equipment or training can be organised. People are invited to visit before their first stay so they can meet staff, other service users and get to know the unit. Some people may make many tea visits before they feel confident to spend the night away from home. The visits provide staff with the opportunity to observe each persons needs, assess any risks and put individual care plans in place detailing how each person prefers to be supported. A new leaflet about the service has been produced. The information indicates it can be made available in different formats. Care Homes for Adults (18-65 years) Page 11 of 27 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 can be confident that they will be involved in decisions about how they spend their time during their respite stays at Isabel Court. Evidence: Each person who stays at Isabel Court has a personal support plan that they and key people in their lives, who know what their preferences are, have been involved in developing and agree. The manager received a compliment from the parent of a service user who was pleased with the plan that had been put in place. All areas of the service are kept under review and regularly audited. The manager told us that in relation to providing a fulfilling lifestyle staff are clear about their roles in enabling people to maintain their everyday skills and encourage users to learn new skills if they wish. Risks affecting individual service users are identified in their support plan. Specialist advice and training is available from other key health & social care professionals. The Care Homes for Adults (18-65 years) Page 12 of 27 Evidence: focus is on enabling the service user rather than restricting them. Currently the support plans do not have any pictorial information or symbols, which may assist service users to be more involved. We discussed this with the manager as an area for further development as staff do not currently have access to th resources to support this. Care Homes for Adults (18-65 years) Page 13 of 27 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 are able to make choices about how they spend their time and are encouraged to try new activities and take part in the daily routines of the service. Peoples preferences and nutritional needs are taken account of when staff do the shopping and menu planning so the meals service users have when they stay reflect their individual choices. Evidence: The respite stays at Isabel Court are part of a wider care package put in place to support each individual and the level of support and frequency of stays are part of the multi-disciplinary review meetings that take place and involve the service users and their representative. Staff from Isabel Court also attend and update the service users plan in repose to any changes agreed. Most people attend their regular day service with over night or weekend breaks at Isabel Court. Care Homes for Adults (18-65 years) Page 14 of 27 Evidence: Respite stays take into account the preferences of the people concerned and try and match people who have similar interests or needs, which enable staff to organise activities. Staff reported difficulties arranging activities for people in wheelchairs due to lack of access to suitable transport in the area and the financial costs, which are the responsibility of the service user and their family. Staff do use their own cars and a vehicle is available from the supported living service within the same complex. The team leader reported that supporting staff to think creatively about activities and accessibility had been identified. She planned to put information together to guide service users and staff and teach staff how to use wheelchair accessible buses. As costs are covered by the service user we discussed updating families and social workers on the cost of activities so everyone is aware of the impact of these. People are able to choose how and where they spend their time. Staff get their rooms ready before they arrive and make any individual arrangements necessary. People are able to have a key to their room. The manager told us that the internal audit covering fulfilling lifestyles confirmed service users could make choices about how they spent their time and had the chance to try out new things. Staff tell us that the shopping is planned to take account of the people staying in the unit at any time. Peoples individual preferences, nutritional needs and support required to eat their meals and maintain a good fluid intake are recorded in their care plan. Meals are freshly prepared and the cupboards indicate a variety of snacks, fruit and breakfast options are available. Staff have access to a dietitian if they need additional support or advice. Care Homes for Adults (18-65 years) Page 15 of 27 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. People can be confident that their personal and health needs will be supported while they are staying at Isabel Court because detailed care plans are in place that health & social care professionals they know in the community have been involved in and staff receive the training they need to support people with a wide range of care needs. Evidence: Each person staying at Isabel Court has a detailed person centred care plan that sets out how their personal and health care needs are to be supported during their stay. Staff are involved with each individuals family and health & social care professionals before they start staying at Isabel Court. This means any specific issues, training needs or equipment can be provided. The staff from Isabel Court continue to attend reviews with the Community Learning Disability Teams. This means staff and key workers are kept up to date with any changes in a persons health or care needs and care plans can be updated to reflect this. Staff provided details of innovative action they had taken to solve particular issues with the support of an occupational therapist. There are safe systems in place to give service users the medicines they need. Care Homes for Adults (18-65 years) Page 16 of 27 Evidence: Detailed records of the medicines brought from home by each person are recorded as they arrive and leave. Although not currently in use we have advised the manager to get a controlled drug record book, which meets the requirements of the Medicines Act. Care Homes for Adults (18-65 years) Page 17 of 27 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 can be confident that their rights will be protected when they stay at Isabel Court because staff listen to them and receive training on the procedures to follow to keep them safe. Evidence: Comments and complaints are welcomed and managed sensitively within the timescales set out in the complaint procedure. The managers self assessment told us that the service had received one complaint in the last year. We have not received any complaints about this service between our reviews. Staff have regular meetings with representatives of the service users who book respite stays so issues related to their experiences at Isabel Court can be discussed and any issues identified at an early stage. The manager has a good understanding of her responsibilities under the Hertfordshire Safeguarding Vulnerable procedures and staff receive training on their roles and responsibilities to prevent, recognise and report any concerns they have. There are procedures in place to record any money or personal items people bring in with them and details of any transactions made during their stay are recorded. This is to make sure peoples property and money is looked after appropriately. People are able to lock things away in their rooms. Care Homes for Adults (18-65 years) Page 18 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who spend time at Isabel Court can be confident that their rooms will be freshly prepared for them as they arrive and the unit is well maintained and has specialist equipment to support their needs. Evidence: Isabel Court has a bright modern feel. Staff prepare the rooms for each service user as change overs take place. They add equipment and personal items they know the individual likes or needs. The unit is well maintained and the manager reported that it is due to be decorated to address the everyday wear and tear that has occurred over time. The respite unit and gardens are accessible to people in wheelchairs. Overhead tracking hoists are provided in some rooms and the assisted bathing and shower facilities enable people with complex problems to receive the personal care they need. Two bedrooms have profiling beds, which support peoples comfort, positioning and moving and handling needs. Risks associated with use of equipment such as bed rails are recorded in individual risk assessments. The manager reported that service users, their families and staff are asked for Care Homes for Adults (18-65 years) Page 19 of 27 Evidence: feedback on the feel and safety of the building as part of the quality audits that are in place. There is a small laundry with appropriate equipment to manage personal laundry and soiled items. Staff have access to the personal protective equipment they need to prevent the spread of infection and liquid soap and hand towels are provided in all key areas to promote good hand hygiene. We have asked the manager to raise the subject of including a more formal infection control audit within the current procedures for the service as part of their review of the new regulations and hygiene code coming into place shortly. This is to raise awareness but also to ensure the needs of people with complex problems, some of whom have indwelling medical devices, are kept under review when planning respite stays, transferring people to and from hospitals and staff training. Care Homes for Adults (18-65 years) Page 20 of 27 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident in the service because they will be supported by experienced staff they know who receive regular training and updates to work safely and within a person centred framework. Evidence: Robust recruitment checks are carried out before people start work to make sure they are suitable to work with vulnerable people. The information we have from team leaders and the manager indicate the staff rota takes account of the needs and dependency of the people receiving respite care. Senior staff roles have been created at night to strengthen the management function at this time. Hertfordshire County Council have an extensive induction and training programme. Additional training to support the specific needs of people using the service is arranged so staff have the skills they need. Staff tells us they receive regular supervision. The managers self assessment refers to the appraisal and performance management systems in place to support and monitor staff practice. The manager said Staff have a good Understanding of the philosophy Care Homes for Adults (18-65 years) Page 21 of 27 Evidence: and aims of the home and work hard to achieve this with every service user. A high percentage (92 ) of staff have achieved National Vocational Qualifications (NVQ) at level 2 or above in health & social care. This is well above the national 50 benchmark standard set out for social care services. On occasions staff may be needed to share their skills or provide support within the respite and supported living services at Isabel Court. We have asked the manager to clarify arrangements with staff so they understand the need to balance staff numbers if they are assisting people within the other service. This was because staff told us on some occasions numbers have been reduced. Care Homes for Adults (18-65 years) Page 22 of 27 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 can be confident that the service is being run in the best interests of people who spend time at Isabel Court because the service is well managed by experienced staff and the quality of the service is kept under review. Evidence: There has been a change of manager since our last review of Isabel Court. The current manager has achieved the qualifications set out for the role of registered manager but needs to submit a registration application to us so we can formally assess this. The managers self assessment (AQAA) was provided within the timescales we requested. It provided clear information about the service and future planned developments and improvements. The information told us that there is a strong focus on promoting equality and diversity issues supported by polices and procedures. The rights of individuals to receive person centred care, which supports their cultural and social needs is clearly understood. The views of service users and the people who support them in the community are used to look at peoples experience of staying at Isabel Court and plan further developments to improve the service. Care Homes for Adults (18-65 years) Page 23 of 27 Evidence: Hertfordshire County Council has detailed quality and review process in place that are regularly audited. Timescales are set for achieving any follow up action required. Senior managers make regular visits to the service and provide the manager with reports on their findings. The information in the managers self assessment and our spot check of fire and hot water safety records and review of staff training information confirmed that their are appropriate systems in place for monitoring the health & safety of service users and staff. Care Homes for Adults (18-65 years) Page 24 of 27 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 25 of 27 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 26 of 27 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). 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