Care Home: John Charles House

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: John Charles House 132 Church Street Eastwood Nottinghamshire NG16 3HT two star good service The quality rating for this care home is: 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. Lead inspector: Tony Barker Date: 0 3 0 2 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. They reflect the things that people have said are important to them: 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 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 Commission for Social Care Inspection aims to:  Put the people who use social care first  Improve services and stamp out bad practice  Be an expert voice on social care  Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) 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. Internet address www.csci.org.uk Information about the care home Name of care home: Address: John Charles House 132 Church Street Eastwood Nottinghamshire NG16 3HT 01773535762 01332600602 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Blue Sky Care Ltd Name of registered manager (if applicable) Sara Crate Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 5 0 care home 5 learning disability Additional conditions: The registered person may provide the following categories of service only: Care Home only - code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Learning Disability - Code LD The maximum number of service users who can be accommodated is 5 Date of last inspection A bit about the care home John Charles House is a five bedroom detached house. It is surrounded by open countryside and is within walking distance of the town of Eastwood which is well served by a variety of shops and transport services. The accommodation is split into two levels, with two bathrooms on the ground floor and three bedrooms on the first floor, which are accessible, via a single stairway. Three bedrooms have en-suite facilities and two of these are located on the ground level. In addition, a family sized bathroom is located on the first floor. There is a good-sized enclosed garden to the front and rear of the property that is secure. The Service offers specialist residential services for adults who have learning disabilities and exhibit interactional challenges and challenging behaviour and specialises is the care provision of adults with autism. 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 How we did our inspection: This is what the inspector did when they were at the care home This is what we did when they were at the care home. This key inspection was unannounced and took place over one day. The Commission had requested the Service to complete an Annual Quality Assurance Assessment (AQAA) before this inspection. We had also received five completed survey forms from people who live at the Service and five from staff. The information provided in these documents is included in this report. The people living at the Service had high levels of dependency and most had limited ability to contribute directly to the inspection process, though they were observed working with and being cared for by staff. Two particular peoples experience of the quality of the service was focussed on, through their personal records and discussion with staff. The Manager and one care staff member were spoken with at this inspection and records were inspected. Care staff are known as development co-ordinators. There was also a tour of the premises. The weekly fees at the time of this inspection ranged from £1902 to £2139. What the care home does well Individual written needs assessments and plans of care were in place showing that peoples health, personal and social care need were being met. The Service provided activities, personal support and other services that were valued by people and promoted their independence in a person centred way Good procedures for handling complaints and abuse were in place ensuring people were fully protected. People were living in a homely, comfortable and safe environment that was furnished and maintained to a high standard. The Service had a good level of wellrecruited staff to ensure that people living there were safe and their needs were met. The Service was well managed so that people living there were protected and their best interests were promoted by the systems in place. What has got better from the last inspection What the care home could do better If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Tony Barker CSCI CPC1, Capital Business Park Fulbourn Cambridge CB21 5XE Tel: 01223 771300 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 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line - 0870 240 7535 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 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 . Individual written needs assessments were in place before people were admitted to the Service so that their diverse needs were identified and planned for. Evidence: The pre-inspection form completed by the Manager showed that the person most recently admitted had lived at the Service for 15 months. A full assessment of their needs was made prior to their admission, as confirmed by detailed examination of care records at the previous inspection. 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 had comprehensive and individual plans of care which demonstrated that their health, personal and social care needs were being met. Evidence: Care plans were comprehensive, holistic and person centred. They included peoples ethnic origin and were cross referenced to recorded risk assessments. In this respect the two requirements made at the previous inspection had been met. Care plans were also cross referenced to daily notes so making reviews of personal needs a well structured process. Daily notes were comprehensive and descriptive. There was evidence that the Service was encouraging people to be involved in their care plans: one will offer verbal comments for their daily notes and another will, at times, write in their care plan. Each person also had a separate person centred plan that included headings such as, Things you need to know to support me and, Things people find difficult about me. Care plans were being reviewed regularly, so ensuring that peoples changing needs were well monitored. The Manager said that people would each have a person centred review meeting starting in 2009. The Service is commended on the quality of its care planning system. The Manager described how people living at the Service are given a lot of choice on day-to-day matters. She said that, usually, two choices are given so as not to raise their anxieties over too much choice. She explained that these choices are not tokenistic and that pictures, as well as words, may be used depending on the persons needs. This reinforces our view that the Service is person centred in its approach. People are given the choice, at the start of each afternoon shift, as to who they would like to work with. Evidence: Recorded risk assessments were examined. These covered a wide range of topics and were well managed according to recorded risk scores. They were being reviewed on a regular basis to ensure that peoples changing needs were well monitored. The preinspection form completed by the Manager referred to parents, of people living at the Service, requesting a trampoline for their relatives. The Manager stated, A risk assessment ruled out a trampoline so we commissioned a bouncy castle. The latter was seen, at this inspection, in the rear garden. The development co-ordinator spoken with was asked for examples of how staff enable people to take responsible risks as part of their developing independence. She appeared to have some difficulty understanding the concept of responsible risk taking. However, it was clear that people are encouraged to take part in a wide range of activities that do entail some degree of risk. 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 . The Service provided activities and services that were age-appropriate and valued by people and promoted their independence. Evidence: One staff member, who completed our pre-inspection survey, stated The residents do lots of activities. Examples of these were given by the Manager in her pre-inspection form and were also observed during this inspection. There was evidence of staff providing one-to-one support for people living at the Service and the quality and range of activities were enhanced by this level of staffing. Care planning files contained Activity Planner sheets - one in text and one in pictures. Two people who live at the Service were keeping their own personal copies of these - providing further evidence of the good degree of peoples involvement in planning their daily lives. There was evidence of good use of community resources. These include shops, restaurants, pubs and the local gym and swimming pool. On the day of this inspection two staff accompanied two people they support out shopping in the Services mini bus and they stayed out for lunch. The pre-inspection form completed by the Manager stated, We have organised a regular day each week where all residents phone home...one speaks to their mum via a web cam. Care planning files contained records of telephone calls made to relatives by people who live at the Service. Evidence: The development co-ordinator spoken with provided examples of the Service promoting peoples independence through everyday routines such as shopping, use of public transport and personal hygiene. Regarding the meeting of peoples privacy needs she said that staff knock on bedroom doors and ask if its OK to come in. Also, she added, staff stand outside the shower room door when one particular person showers - reassuring them that someone is outside but not being intrusive within the room. The Services four-week rolling menu was examined and was found to provide people with a balanced and nutritious diet. An African/Caribbean meal is cooked every other Friday, to reflect one persons cultural needs, and Caribbean and African recipe books were seen. On alternate Fridays people are provided with a choice of two take away meals. Care planning files contained peoples recorded individual food preferences, with one actually written by the person themselves. All the people living at the Service were involved, to varying extent, in food shopping and meal preparation - with one person taking particular pleasure in this process. Food stocks were at a good level. The lunch time meal was observed being eaten: it was a relaxed affair, reinforced by relaxing music being played. Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The Service was providing people with personal support in the way they preferred and required and was meeting their physical and emotional health needs in a person centred way. Evidence: Sensitive, person-centred practices were observed between staff and the people who live at the Service, on the day of this inspection. One persons specific cultural needs were being considered through diet and the Manager spoke of staff undertaking training on an Equality and Diversity course. Peoples likes and dislikes were recorded on file. The development co-ordinator spoken with gave examples of alternate activities available for people if they wish not to take part in programmed activities. She also spoke of the multi-sensory room which was later seen and clearly provided a range of visual, tactile and audio stimuli. The Manager said that a representative from Speaking Up has visited to speak to staff about the use of advocates, including the role of Independent Mental Capacity Advocates (IMCAs). One persons care manager had been involved in discussions around the hazards of the main road and the gate onto it from the premises. A decision was made, in the persons best interests - under the Mental Capacity Act - to place a coded lock on this gate. This was seen to provide a suitable balance between the risks associated with traffic and the need to minimise physical restraint. A copy of the Mental Capacity Act Code of Practice was in place at the Service and Advocacy Alliance literature was available in the office. There was evidence of peoples sexual, emotional and physical health needs being met on an individualised level. Good recording practices were noted on Dentists/Doctors Appointment Monitoring Forms, used for any health professional. Records indicated a range of external health professionals involved with the people supported by the Service. People who live at the Service have been involved in choosing their room Evidence: colours, with consideration being made to colours that reduce stress. Medication was securely stored. Medication Administration Record (MAR) sheets were examined and found to be satisfactory. A record of staff signatures/initials was in place to cross-reference any uncertain entries on MAR sheets against. No controlled drugs were in use. The Manager stated that she undertakes a monthly medication audit to ensure good practice is being followed. She said that all seven staff who administer medicines have had accredited training in the safe use of medicines. Additionally, these staff have had an in-house competency assessment by the Manager. 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 . Good procedures for handling complaints and abuse were in place ensuring people were fully protected. Evidence: The Services complaints procedure was examined in the office. The Manager said this is usually displayed in the entrance hall. A further, pictorial, representation of the rights of people, living at the Service, to complain was examined. However, this was not actually in use and, if it was, it would allow for better understanding by the people living there. One complaint had been received by the Service within the previous 12 months. This, and its outcome, was recorded using a very good, robust complaints recording and investigation system. The Service had a comprehensive Safeguarding Adults Procedure. A copy of its Whistle Blowing Policy was examined in the Staff Handbook. It was dated January 2008 and needed reviewing. Copies of Derbyshire and Nottinghamshire Safeguarding Adults procedures were in place as well as reporting sheets. The development coordinator spoken with confirmed she had been provided with training on Safeguarding Adults to ensure understanding of adult abuse matters. However, she was not aware of the concept of whistle blowing or of the Services policy on this matter. The Manager said that all but six staff had had training on the subject of keeping vulnerable adults safe. Training for these six staff was programmed for 9th February 2009. The Manager added that staff had also been provided with training on nonabusive physical intervention - in order to ensure the safety of staff and the people living at the Service. 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 were living in a homely, comfortable and safe environment that was furnished to a good standard. Evidence: The accommodation was comfortably furnished and well decorated. Several photomontages were observed, around the premises, of activities in which people living at the Service were involved. The bedrooms, of the two people case tracked, were viewed and one of these two people proudly showed off their posters and play station. Both bedrooms were nicely personalised. All but one person had a television in their room. Two first floor bathrooms provided good levels of choice of bathing for people - both rooms were nicely decorated with appropriate wall images. Makaton sign language signs were displayed behind one bathroom door for use by one person who used this system of communication. During a tour of the premises the place was found to be clean and hygienic with no unpleasant odours. The development co-ordinator spoken with described good practice regarding the transportation of soiled materials such as wet bedding. A yellow wheelie bin was outside for soiled waste disposal. 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 . The Service had a good level of well-recruited staff to ensure that people living there were safe and their needs were met. Evidence: 12 of the 16 care staff had achieved a National Vocational Qualification (NVQ) to at least level 2. This met the National Minimum Standard to maintain a staff group with at least 50 of staff qualified to at least level 2. No agency staff were being used. The file of a development co-ordinator, very recently appointed, was examined. It was found to contain all of the elements, required by current Regulations, regarding recruitment practices, so keeping people safe. Several staff who completed one of our survey forms remarked positively on their induction training, as new workers, and on the good levels of on-going training provided to staff. One said, We are very well trained at John Charles House. They also confirmed that they had the right support, experience and knowledge to meet the different needs of the people who use the Service. The Manager said that four staff had been provided with training on the subject of Autism and that one staff member had been sponsored on a psychology course. The development co-ordinator spoken with said she had undertaken all required training within the past 12 months. Training records showed that all relevant staff had been provided with Basic Food Hygiene training but there was some shortfall in mandatory staff training... * half the staff group had been provided with no training in fire safety since November 2006. This puts all people at potential risk in the event of a fire, * seven staff had still to undertake Moving & Handling training. This puts people who use the Service, and staff, at potential risk of injury, and no date had been set for this training, * seven staff had still to undertake First Aid training. This puts people who use the Service at potential risk, and no date had been set for this training. 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 . The Service was well managed so that people living there were protected and their best interests were promoted by the systems in place. Evidence: The Manager had worked with people with learning disabilities for eleven years. She had managed John Charles House since June 2008. One member of staff who completed a survey said, I am very proud of what we have achieved...as part of a team...we have fantastic support from highly trained staff. The development co-ordinator spoken with said, It is a fantastic service...good teamwork...(the Manager) is very supportive. The Services 2008 Annual Report was in place. However, there was no Annual Plan, to indicate a systematic cycle of planning, action and review - to reflect the Services aims and objectives. There was plenty of evidence of the Service listening to the opinions of people they support. For example, a computer was provided, in a dedicated room, following one persons request. During the inspection, this person was seen using the computer to access the internet. The opinions of people, who live at the Service, are sought on a regular basis through Quality Tree Assessment questionnaires. Also, quality questionnaires are sent to relatives and external professionals. A selection of all these questionnaires was examined and was seen to paint a positive picture of the Service. Good food hygiene practices, and safe storage of cleaning materials, were observed. Product Information Sheets were in place in respect of the cleaning materials, as required by the Control Of Substances Hazardous to Health (COSHH) Regulations. The Evidence: Manager recorded on the pre-inspection questionnaire that equipment at the Service was being maintained and good Health and Safety practices followed. Are there any outstanding requirements from the last inspection? Yes  No  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 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 Description 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 Description Timescale for action 1 35 23 23(4)(d) All staff must be 01/05/2009 provided with fire training at least once a year. This will ensure that peoples safety is not compromised. 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 9 22 Staff training should reinforce the concept, and use, of responsible risk taking within the Service. The Services pictorial representation of the rights of people, living at the Service, to complain should be put into use. The Services Whistle Blowing Policy should be reviewed. Staff training should reinforce the concept of whistle blowing and the Services policy on this matter. First Aid training should be provided for all staff to ensure that any health emergency can be appropriately dealt with on any shift. 3 4 5 23 23 35 6 35 Moving & Handling training should be provided for all staff that work with people who have been assessed as having difficulty in moving themselves. An Annual Plan should be developed to reflect the Services aims and objectives. 7 39 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone : 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.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. - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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