Care Home: Juniper House

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What the care home does well The service continues to ensure that it provides a homely environment with a family atmosphere. Juniper House has achieved what many services strive to accomplish with its homely setting and care being delivered effortlessly by supportive staff. Because of the small number of people who live there the home achieves a family setting. Staff have an excellent understanding of people who use the service’s needs: they work together to ensure people who use the service go out and pursue their hobbies, attend day care and manage household tasks. People who use the service go away on holiday despite having complex medical needs and have recently stayed in a hotel in Blackpool. The manager ensures that healthcare professionals are available at their holiday destination which enables people’s medical needs to be met whilst they are away from home. Juniper House DS0000015013.V377070.R01.S.doc Version 5.2 What has improved since the last inspection? One person’s needs have changed and additional waking night support has been secured for specific nights, although on a temporary basis. Some of the requirements made at the previous inspection have been met. Any change to care delivery determined at reviews have been incorporated into care plans. Both people who have diabetes now have care plans to reflect how their needs are met – only one person had a care plan at the previous inspection. Medication records now accurately reflect accurate instructions about the dose and route. Copies of prescriptions are also kept which act as a receipt of medication. The service users’ guide has been translated into symbol format to enable it to be more user friendly and easily understood. Bedroom carpets have been replaced by domestic style vinyl flooring. What the care home could do better: Recruitment records need to be more detailed and information supplied must be scrutinised. This will ensure that people who use the service are protected. The manager is aware that areas of the home need to be updated but is currently experiencing financial constraints which they plan to address. Although care plans have improved care is being delivered which is not documented. One person went in for an exploratory operation and although letters were in place evidencing the appointment there was no associated care plan. There were no details of any aftercare, findings of the operation or any follow up appointment and management of the condition. The manager receives feedback about the service in residents’ meetings and from one to one discussion but this is not formally recorded in a quality assurance report. This would evidence that people who use the service are satisfied with the support that they receive. The kitchen is kept locked at night to ensure that specific needs can be met for one person who uses the service but the agreement that is in place is informal. The manager plans to ensure the agreement is recorded under the Deprivation of Liberty aspect of the Mental Capacity Act.Juniper HouseDS0000015013.V377070.R01.S.docVersion 5.2Insulin is stored in the domestic fridge in a locked container. A fridge solely for the storage of medication must be purchased which is lockable or stored in a locked room to ensure medication can be stored safely and appropriately. Key inspection report CARE HOME ADULTS 18-65 Juniper House 159 Strathmore Avenue Luton LU1 3QR Lead Inspector Angela Dalton Key Unannounced Inspection 15th September 2009 2.10pm Juniper House DS0000015013.V377070.R01.S.doc Version 5.2 Page 1 This report is a review of the 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. 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 home adults 18-65 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. Juniper House DS0000015013.V377070.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Juniper House DS0000015013.V377070.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Juniper House Address 159 Strathmore Avenue Luton LU1 3QR Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01582 419923 albute.3@ntlworld.com Mrs Audrey Greer Mrs Audrey Greer Care Home 3 Category(ies) of Learning disability (3) registration, with number of places Juniper House DS0000015013.V377070.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 16th September 2008 Brief Description of the Service: Juniper House is a small home for three service users with learning disabilities. The home was owned and managed by Mrs Audrey Greer. A small staff team are employed and work closely with service users. The home is situated in a residential of Luton, close to shops and other amenities. The building is a detached house with four single bedrooms, one of which is used by staff as an office and sleep - in room. The ground floor has a lounge, dining room and the kitchen with washing machine. An enclosed garden with a patio is accessible from the kitchen. The home charges between £600 and £700 per week for the care, depending upon the individual needs of the service user. Juniper House DS0000015013.V377070.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. One inspector conducted this unannounced site visit on 15th September 2009 between 2.10pm and 6.10pm. As this is a small service two of the three people who live at the home were case tracked. There have been no new admissions to the service and although new staff have been recruited some have since left and only one new staff member has been employed since the last inspection. The inspector followed the care of people who use the service to ensure the care they receive is reflected in the care plan and meets their individual requirements. The case tracking process cross-references all the information gathered to confirm that what Inspectors are being told is actually happening and reflects the Statement of Purpose, which contains the aims and objectives for the service. It included discussion with service users and the manager who was working the late shift. We also received surveys from people who use the service and one day care provider. These indicated that people who used the service received good support. People who use the service are well cared for and staff focus upon individual needs and ensure that people develop their skills and independence. As there have been so few changes since the previous inspection it was noted that the home is able to provide consistency to people who use the service. What the service does well: The service continues to ensure that it provides a homely environment with a family atmosphere. Juniper House has achieved what many services strive to accomplish with its homely setting and care being delivered effortlessly by supportive staff. Because of the small number of people who live there the home achieves a family setting. Staff have an excellent understanding of people who use the service’s needs: they work together to ensure people who use the service go out and pursue their hobbies, attend day care and manage household tasks. People who use the service go away on holiday despite having complex medical needs and have recently stayed in a hotel in Blackpool. The manager ensures that healthcare professionals are available at their holiday destination which enables people’s medical needs to be met whilst they are away from home. Juniper House DS0000015013.V377070.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Recruitment records need to be more detailed and information supplied must be scrutinised. This will ensure that people who use the service are protected. The manager is aware that areas of the home need to be updated but is currently experiencing financial constraints which they plan to address. Although care plans have improved care is being delivered which is not documented. One person went in for an exploratory operation and although letters were in place evidencing the appointment there was no associated care plan. There were no details of any aftercare, findings of the operation or any follow up appointment and management of the condition. The manager receives feedback about the service in residents’ meetings and from one to one discussion but this is not formally recorded in a quality assurance report. This would evidence that people who use the service are satisfied with the support that they receive. The kitchen is kept locked at night to ensure that specific needs can be met for one person who uses the service but the agreement that is in place is informal. The manager plans to ensure the agreement is recorded under the Deprivation of Liberty aspect of the Mental Capacity Act. Juniper House DS0000015013.V377070.R01.S.doc Version 5.2 Page 7 Insulin is stored in the domestic fridge in a locked container. A fridge solely for the storage of medication must be purchased which is lockable or stored in a locked room to ensure medication can be stored safely and appropriately. 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. Juniper House DS0000015013.V377070.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Juniper House DS0000015013.V377070.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 2, 5 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective service users are able to visit the home and have the information needed to help them make an informed choice about moving into the home. EVIDENCE: The home had a statement of purpose and a service user guide. This is reviewed annually to ensure information about the home is p to date. The manager has transferred information into a more user friendly format. All the people using the service had contracts and these were in picture format. Information on fees charged by the home was recorded in their files. No new admissions had occurred since the July 2007. When someone moves into the service the manager undertakes an assessment and where possible an advocate is involved in the process. The manager has previously visited people in to gather information and to discuss information about Juniper House. The manager stated that she would not admit any person to the home unless she and the staff felt that they would be able to meet their needs. It was also emphasised that they would not admit any one Juniper House DS0000015013.V377070.R01.S.doc Version 5.2 Page 10 to the home unless they were able to get on well with the other people living in home. Evidence showed that the three people in the home were observed to be getting on well together. One person has shared a wish to move out with day care staff and their community nurse. The manager will support them in their transition when an alternative is found. Juniper House DS0000015013.V377070.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are the focus of the service and individual choices are actively encouraged and implemented but some development is needed. EVIDENCE: All three people who use the service had care plans and we examined two of them. Improvements have been made since the previous inspection and any changes in care or changes following a review are now incorporated into the care plan. This was not previously occurring. The manager is planning to develop the main parts of the care plans into a more user friendly format. Although care plans have improved care is being delivered which is not documented. One person went in for an exploratory operation and although letters were in place evidencing the appointment there was no associated care plan. There were no details of any aftercare, findings of Juniper House DS0000015013.V377070.R01.S.doc Version 5.2 Page 12 the operation or any follow up appointment and management of the condition. Changes to amounts of insulin are not incorporated into care plans and there is no supporting information as to why the changes have taken place or if any review of diabetes is taking place. Missing person forms were in each care plan but not completed. This was identified at the previous inspection. The manager told us that people who live at Juniper House did not have a history of leaving the house unaccompanied and that the missing person forms would be completed as part of the next risk assessment review. Staff have comprehensive knowledge that ensures people’s well being is maintained and that they are content. An example being that one person prefers to wear a specific style of clothing. This prevents the person from becoming upset and illustrates that a high standard of care is delivered. Risk assessments were in place for road safety and kitchen safety and they have recently been reviewed. More comprehensive risk assessments are in place to illustrate how potential risks are managed. The kitchen is kept locked at night to ensure that specific needs can be met for one person who uses the service. An informal agreement is in place and the manager plans to ensure the agreement is recorded under the Deprivation of Liberty aspect of the Mental Capacity Act. Both people who have diabetes now have care plans to reflect how their needs are met – only one person had a care plan at the previous inspection. All the people living in the home had annual reviews by their funding authorities including a review of day care. The reviews reflected that professionals were pleased with the level of care people were receiving and that their quality of life continues to improve. The manager has been involved in person centred planning with day centres and each person has a copy of a person centred plan to illustrate how their needs and aspirations are going to be met. Some work has commenced but the documents have yet to be completed. The manager and staff regularly talk to people who use the service to ensure that they are happy with the care that they receive. This is a natural part of daily life in the service as there is a homely atmosphere and a family environment. People who use the service meet as a group and on an individual basis. Outcomes of the meetings are recorded and incorporated into care plans. People who use the service use their meetings to make decisions about where to go on holiday, what to eat and are involved in any changes to their home. Staff’s knowledge of people who use the service ensures that they do not wholly rely upon verbal communication to ensure that individual wishes are met. Juniper House DS0000015013.V377070.R01.S.doc Version 5.2 Page 13 Juniper House DS0000015013.V377070.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): This is what people staying in this care home experience: 12, 13,15,16,17 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Daily living activities are tailored to the individual requirements of people who use the service. EVIDENCE: On the day of the inspection the people who use the service were all out at day care but the inspector met with them on their return. As stated earlier the service achieves a homely atmosphere: people who use the service return home and are able to relax before eating their evening meal. There is no regimented approach and the staff team and manager have successfully achieved a sense of belonging for people who use the service. Juniper House DS0000015013.V377070.R01.S.doc Version 5.2 Page 15 People who use the service had recently enjoyed a holiday at a Blackpool hotel. The manager ensures that local health services are available as daily medical intervention is required for two people who use the service. This entails a lot of work but the manager successfully ensures an annual holiday takes place despite the challenges that are in place. Mealtimes are an opportunity for people who use the service to meet up with each other and staff to discuss their day and make plans for the week. Even if staff are not eating with people who use the service they will sit down together which reinforces mealtimes as a social occasion. The menu is changed regularly and people who use the service ensure that their preferences are reflected. Two of the people using the service attend day care five days a week incorporating attendance at a day centre and college and work placement at a fashion store. One person attends day care two days a week and spends the rest of the week developing daily living skills with staff. All of the people who use the service have one to one time with staff and are able to pursue activities that they enjoy such as shopping, bowling and going to the cinema. Staff also ensures that people who use the service are able to attend events that their peers are going to such as discos and club and pub nights. People who use the service attend the Mencap disco if they wish. The home welcomes friends and families of the people living in the home. The manager has previously used an advocacy service when family have not been involved and is forging links to restart this support. Juniper House DS0000015013.V377070.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20, People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are assured of individualised care but medication requiring refrigeration must be stored appropriately. EVIDENCE: Medication records now accurately reflect accurate instructions about the dose and route. Copies of prescriptions are also kept which act as a receipt of medication. Staff have an excellent knowledge of people who use the service’s needs. There are occasions when toiletries may be excessively used or toilet paper is blocking the toilet but staff are creative in ensuring that toiletries are available and appropriately used so that dignity is observed and people do not have to go without. Staff are sensitive to the individual needs of people who use the service. They assist individuals to express their sexuality and personality through dress: this may be challenging for staff but the manager ensures that staff are skilled to deal with meeting personal preferences. Juniper House DS0000015013.V377070.R01.S.doc Version 5.2 Page 17 The service only employs female staff and has legal exemption to ensure that this can continue. Staff accompany people who use the service to church should they wish to attend. This service reflects the diverse needs of people who use the service and is able to cater for a wealth of requirements: gender identity, race, religion and disability are all needs that staff facilitate. As stated earlier health needs are met. The manager ensures that medical needs do not prevent people form enjoying holidays and ensures daily medical attention is in place when people who use the service are away on holiday. There was evidence to show that support from professionals is sought if required. One person has recently had an outpatients’ appointment due to sleep disturbances. The recording of medication administration has improved: handwritten Medication Administration Record Sheets (MAR) reflect what the prescribed route of medication is (e.g. oral) and what amount is to be given at each time. Copies of prescriptions are kept in the home so the manager can refer to what the doctor has prescribed. A medication fridge has been purchased but a lock cannot be fitted. The manager plans to purchase a suitable fridge to store insulin as it is currently stored in a locked container in the domestic fridge. This must be addressed to ensure medication is stored safely and appropriately. The manager has a protocol to follow in the sad event of a person who uses the service dying but no individual wishes have yet been recorded. The manager has requested information from people’s relatives. Juniper House DS0000015013.V377070.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A recording system for complaints is in place. EVIDENCE: The home has a complaints policy and a complaints book is available to record any concerns or compliments received and the action that has been taken. This would assist staff to deal with any concerns that are identified and prevent them from escalating into complaints. The service has not received any complaints since the previous inspection. Surveys completed by people who use the service reflected that they were aware of who to talk to if they were unhappy with their care or support. As stated earlier, the size of the service facilitates ongoing communication between people who use the service and staff. Minutes are recorded of monthly meetings and examples of positive outcomes are stated earlier in the report. Staff are aware of the local safeguarding policy and the manager has previously attended local authority safeguarding training. Financial records reflected that regular checks were made regarding individual finances. Juniper House DS0000015013.V377070.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 24,30 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service provides a homely environment, which meets the needs of people who use the service but the practice of locking the kitchen at night is not formally recorded. EVIDENCE: In light of the recent swine flu pandemic the manager has placed hand sanitizers at strategic points throughout the home and posted requests for visitors and staff to observe good hand hygiene on arrival and departure. A poster was displayed on the outside of the front door but the manager agreed that this appeared institutional and moved it to the visitors’ book. The home was clean, tidy and odour free. Juniper House DS0000015013.V377070.R01.S.doc Version 5.2 Page 20 Each bedroom reflects the personality and needs of people who use the service. The manager has replaced bedroom carpets with domestic style flooring to better meet individual needs. There are plans to refurbish the bathroom but this is currently hampered by financial constraints. The manager would like to replace the bath with a shower to enable easier access. There are also plans to investigate the purchase of a computer for people who use the service to use. The kitchen is kept locked at night to ensure that specific needs can be met for one person who uses the service but the agreement that is in place is informal. The manager plans to ensure the agreement is recorded under the Deprivation of Liberty aspect of the Mental Capacity Act. The manager told us that they had sought advice and been informed that as it does not currently affect other service users because the kitchen is only locked at night that the practice could continue. Alternative arrangements are in place to provide food or drink at night should they be required. All people who use the service take a jug of drink to bed with them to ensure that they will not be thirsty. Juniper House DS0000015013.V377070.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 36 People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The recruitment processes do not ensure that people who use the service are adequately protected from risk. EVIDENCE: There was evidence that staff team and manager attend frequent training that is offered by social services and health trust. The manager told us that the staff team know people who use the service well and work hard to maximise individuals’ independence. All staff receive a rolling programme of mandatory training. Additional support and training is provided by members of the multi disciplinary team who support people who use the service. Staff have received training to ensure they are able to meet individual needs e.g. diabetic training from the district nurse. Staff are encouraged to obtain their National Vocational Qualification (NVQ) and complete the induction and foundation components of Juniper House DS0000015013.V377070.R01.S.doc Version 5.2 Page 22 the Learning Disability Qualification accredited training (LDQ). One staff has obtained an NVQ 2 Award since the previous inspection. Staff receive supervision every two months. The service currently has staff vacancies of a senior support worker and a part time support worker. This results in the manager working additional hours. The home positively discriminates and employs only female members of staff. Despite new staff having been appointed since the previous inspection only one remained in place. We inspected two recruitment records. Person A had 2 references from one person in different handwriting - one style of handwriting matched the handwriting on the application form. A senior support worker’s name had been reflected as a manager. Two other referees had been cited – the application form did not reflect the role of one referee. The other referee was a lecturer but the application form did not reflect college attendance. The application form reflected only 8 years work history despite the applicant being aged nearly 50. The application form disclosed only one conviction and the CRB reflected that there were six. The manager still appointed the person despite the fact that they would be working alone with vulnerable adults. The person also left a shift before it had ended 2 months ago without notifying the manager. They have since not turned up for work and have been uncontactable. The manager no longer considers them employed. Person B had also recorded a minimal work history of 6 years. References cited were not from managers and the most recent employer. A copy of the passport reflected that the member of staff had limited leave to remain in the country but the manager had not explored this issue. They had not seen evidence of when leave to remain expired. The manager told us that they would ensure that full checks were conducted. The application form does not ask for a full employment history and the dates that staff were employed. The manager plans to devise an application form to ensure that a full employment history can be sought. Juniper House DS0000015013.V377070.R01.S.doc Version 5.2 Page 23 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager ensures the needs of people who use the service are fulfilled but must ensure that the home is run competently. EVIDENCE: The manager clearly has a passion for caring for people but needs to combine this with successfully addressing the areas that need attention. The emphasis is upon providing a home for people with a family atmosphere and this has been achieved but the manager must be able to balance their time between meeting the needs of the service users and meeting the National Minimum Standards. Juniper House DS0000015013.V377070.R01.S.doc Version 5.2 Page 24 The views of people who use the service are formally and informally sought as the manager and staff regularly talk to people who use the service to ensure that they are happy with the care that they receive. This is a natural part of daily life in the service as there is a homely atmosphere and a family environment. People who use the service meet as a group and on an individual basis. Outcomes of the meetings are recorded and incorporated into care plans. An advocacy service has previously been involved in using user friendly documentation to conduct formal quality assurance surveys but this has not been done recently. There is no formalised system currently in place to canvas people who use the service’s opinions on an annual basis. Views are sought at resident meetings’ but a formal quality assurance system would demonstrate that the service was successful in meeting the needs of the people who use the service. The manager has submitted an Annual Quality Assurance Assessment (AQAA) which is a document sent by the Commission which requires the manager to demonstrate what has improved within the last twelve months. Health and safety risk assessments are in place for environmental risks within the home and the manager had a meeting planned with the Health and Safety Company that they use in the coming weeks. Juniper House DS0000015013.V377070.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 1 35 X 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 2 X 2 X X 3 X Version 5.2 Page 26 Juniper House DS0000015013.V377070.R01.S.doc No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA6 Regulation 12 15 13(2) Requirement Care plans must reflect how health and care needs are monitored, managed and met. Timescale for action 31/10/09 2. YA20 Medication requiring refrigeration 31/10/09 must be suitably and safely stored. Records must reflect that professionals have been involved in the decision to lock the kitchen at night. The recruitment process must be robust and ensure that service users are not placed at risk of harm. The registered manager must demonstrate fitness by meeting the identified requirements. A formal quality assurance system must be implemented. 31/10/09 3. YA24 16(2)(i) 4. YA34 13(4) Schedule 2 9 30/09/09 5. YA37 31/10/09 6. YA39 24 30/11/09 Juniper House DS0000015013.V377070.R01.S.doc Version 5.2 Page 27 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard YA9 YA27 Good Practice Recommendations Missing person forms should be completed. The bathroom and toilet should be modernised. Bedroom carpet should be replaced to better meet the needs of people who use the service. Juniper House DS0000015013.V377070.R01.S.doc Version 5.2 Page 28 Care Quality Commission Eastern Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries.eastern@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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