Care Home: Kirkside House

What the care home does well People`s needs are properly assessed before they move into the home which makes sure their needs are known. The service communicates well with relevant people and carefully plans admissions, which makes sure people`s needs are met. A survey from a professional said, "They gathered information from all parties when assessing somebody before they moved in. They took all relevant needs into account and worked well with outside agencies." Another survey from a social worker said, "They have ensured the transition for my client has been smooth and easy. They have listened to the parents." People who live at the home are developing individual programmes that involve good community access. They are exploring different opportunities for people including college courses. One person who lives at the home said they have been looking at a computer course with their keyworker. People who use the service said staff ask them what they would like to do. One person said, "They ask me every morning." Relatives are satisfied with the service provided at Kirkside and said the care service helps everyone to keep in touch. One relative said, "All staff have been very welcoming and supportive to all family and friends and they have arranged visits home willingly and without a fuss. Another relative said, "The care staff are good and looking after (name of person) well." One relative said they were very pleased because staff have been providing very good support for accessing community services, and in the past this has been a problem. They said the service has made good progress in a short period of time. We received good feedback from professionals. Three surveys said people`s social and healthcare needs are always met; three surveys said they are usually met. One professional said, "Staff have always been amenable, helpful and act on any advice." Another professional said, "They respond very well to the needs of the person they support." People live in a home which is safe, well maintained and comfortable. The design and layout encourages independence. People are very happy with the environment. One person said, "Everyone knows it`s my room and I have my own key." People who live at the home and visitors were complimentary about the staff that work at the home. People described staff as `helpful` and `friendly`. A person who lives at the home said `staff are brilliant`. A relative said `staff are very nice`. Staff are properly recruited and trained, and work well together as a team. One staff said, "It`s a good place to work and everyone spends time talking to each other." Another staff said, "Team work is very good." The home is well managed and everyone feels supported. Staff said they thought the manager was focussed on providing a good service and was developing the service in the best interests of the people who live there. Staff also said the organisation is good. One person said they have a `good ethos and are sticking to it`. What has improved since the last inspection? This is the first inspection What the care home could do better: Care plans and assessments contain some good information but some people`s needs have not been fully identified. The care plans could provide more detail about people`s wishes and how their needs should be met. People who live at the home could be more involved in the care planning process. This will help make sure people are receiving the care they want and their wishes are taken into account. Staff and management talk to people about what they want to do but sometimes decisions are made on behalf of people without showing the reasons why this has happened. Any decision made could be agreed through a formal decision making and risk assessment process. This will make sure people`s rights are protected. In the main, the service is good at promoting independence but people who live at the home could be more actively encouraged to be involved in all areas of daily living in the home, which will further promote their independence. Meal planning has caused some difficulties but management are taking steps to address this. Meals served could be monitored more closely to make sure people are receiving a nutritious and varied diet. People could have a health action plan that has more information about how people`s health needs should be met. In the main, good systems are in place to make sure people receive the right medication. We checked a course of antibiotics but the number of tablets remaining was incorrect. Medication stocks could be checked to make sure the number of tablets administered is correct. On occasions staff may use use low level holds which are a form of restraint to prevent people from hurting themselves or other people. Staff said they have received appropriate training and are confident in using restraint but only use it after other diversion techniques have failed. Staff could improve the way they record any incidence of restraint and make sure there is sufficient detail to establish that the restraint is appropriate. The complaint`s procedure could be displayed and made available to people who use the service and other relevant people. This will make sure people know how to make a complaint if they are unhappy with the service. The manager could submit a registered manager`s application. This will make sure the home has a registered person that is in day to day control of the service. Key inspection report Care homes for adults (18-65 years) Name: Address: Kirkside House 1 Spen Lane Leeds W Yorkshire LS5 3EJ     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Carol Haj-Najafi     Date: 2 8 0 1 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 36 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) 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 Care Homes for Adults (18-65 years) Page 3 of 36 Information about the care home Name of care home: Address: Kirkside House 1 Spen Lane Leeds W Yorkshire LS5 3EJ 01132780361 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): office@woodleigh-care.co.uk Kirkside House Name of registered manager (if applicable) Type of registration: Number of places registered: care home 15 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is 15. The registered person may provide the following category 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: Service users with a Learning Disability - Code LD Date of last inspection Brief description of the care home Kirkside is registered to provide personal care and accommodation for up to 15 adults with a learning disability. The home is set within private grounds and is divided into six units. Each unit has a kitchen, dining and living area. The units vary in size and accommodate one, two or three people. All accommodation has en-suite facilities. The home is on the main bus route into Leeds city centre, approximately four miles away. It is close to local shops and a post office. Restaurants and leisure facilities Care Homes for Adults (18-65 years) Page 4 of 36 Over 65 0 15 Brief description of the care home including a cinema and bowling alley are within easy access. The home has a statement of purpose which tells people about the services they provide. The inspection report will be available at the home once it is published. The manager told us at the inspection on 28 January 2010 that the weekly fee ranges from £1600 to £2800. Care Homes for Adults (18-65 years) Page 5 of 36 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The Care Quality Commission (CQC) inspects care homes to make sure they are operating for the benefit and well being of the people who use their service. More information about the inspection process can be found on our website www.cqc.org.uk. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations- but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. The home was registered with us in September 2009 and this is their first inspection. Before this visit we reviewed the information we had about the home to help us decide what we should do during our inspection. Care Homes for Adults (18-65 years) Page 6 of 36 Surveys were sent out to people who use the service, their relatives, healthcare and social care professionals and staff. Twenty five surveys were returned, five from people who live at the home, five from relatives, nine from staff and six from professionals. Information from the surveys has been included in the report. One inspector was at the home for one day from 10:00 to 17:45. We spoke to people who live at the home, one visitor, staff and the manager. Some people have limited communication and cannot tell us if they are happy with the care they receive or if their needs are being met so we also observed interaction between staff and people who live at the home. We looked around the home and looked at care plans, risk assessments, daily records and staff records. Feedback was given to the manager at the end of our visit. Care Homes for Adults (18-65 years) Page 7 of 36 What the care home does well: What has improved since the last inspection? Care Homes for Adults (18-65 years) Page 8 of 36 This is the first 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. Care Homes for Adults (18-65 years) Page 9 of 36 The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 10 of 36 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 11 of 36 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. Peoples needs are properly assessed before they move into the home which makes sure their needs are known. The service communicates well with relevant people and carefully plans admissions, which makes sure peoples needs are met. Evidence: In the AQAA we asked what the home does well. The manager said, Our statement of purpose and the companys aims and objectives clearly define explain each of our services and define our vision for the standard of care we aim to provide. Prior to admission, we will meet with our prospective residents- often more than once- to complete a thorough assessment. We will spend time talking to them, their family and carers to ensure that we understand their condition, behaviours, risks, needs and aspirations as much as we can. This enables us to produce a comprehensive care plan prior to arrival, along with risk assessments which can then be revised or added to as we get to know them better. We have a very involved approach to transition planning, working with the client to facilitate whatever they feels works for them, be that day visits or overnight stays, with our staff or those from their current placement. If it is felt that they require support communicating their needs, then we will make Care Homes for Adults (18-65 years) Page 12 of 36 Evidence: arrangements for an advocate to be present. Maintaining clear and open channels of communication between all parties concerned with the individuals care is how we ensure that we meet there needs as appropriately and effectively as possible and ensure that they feel they are involved in the process. Once a service user has moved in, they will be given a contract and a guide, which explain the conditions of their residency, as well as what they can expect from us. The contract can also be tailored to address specific needs of the individual if they agree that this might help them to stay safe and happy. The structure of Kirkside (self contained apartments with 1-4 bedrooms) also lends itself extremely well to supporting individuals to live as independently as possible. Although some residents require considerable support, having their own lounge, kitchen and dining rooms reflects the sense of living in their own home rather than a larger property and we feel that this is hugely beneficial to their wellbeing and progress. We received five surveys from people who have recently moved into the home. Four people said they were asked if they wanted to move in; one person said they were not sure. Two people said they received enough information about the home before they moved in so they could decide if it was the right place; three people said they did not receive enough information. A survey from a healthcare professional said, They gathered information from all parties when assessing somebody before they moved in. They took all relevant needs into account and worked well with outside agencies. Another survey from a social worker said, They have ensured the transition for my client has been smooth and easy. They have listened to the parents. We talked to two people who have recently moved into the home. They told us they had settled in well and were very happy with the admission process. One person said a manager from Woodleigh Care visited them before they moved in and asked them what they would like to do. Then they visited the home a few times and sometimes stayed over. They said they got a brochure but it didnt have very much information about the home. We looked at two peoples care files. They had various assessments from other agencies that identified how their needs should be met, and correspondence from Woodleigh Care confirming that they had discussed the placement with the person and other relevant people, and completed their assessment. A summary of care was also provided. Each person who is moving into the home has a transition plan. At the time of the inspection the home still had some vacancies. The manager said Care Homes for Adults (18-65 years) Page 13 of 36 Evidence: they have assessed people who are wanting to move in but admissions have temporarily been put on hold so they can give people who have moved in chance to settle in. Care Homes for Adults (18-65 years) Page 14 of 36 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans identify some care needs well but other care needs have not been identified so we cannot be sure that peoples needs are being properly met. Evidence: In the AQAA we asked what the home does well. The manager said, With considerable assessment and transition work, we are able to determine the risks and educate staff prior to the arrival of a new resident, which helps improve the support provided during what can be a difficult time. Staff will have an idea as to the capabilities and behaviours of each prospective resident and can start to bring together thoughts and suggestions for supporting and developing their daily living skills as much as possible. Shortly after moving in, staff will spend time with the resident discussing how appropriate or appealing these ideas are. Between us, we can prepare something that encourages as much autonomy as possible, whilst managing associated risks and ensuring that they do not come to any harm. Decision making is a joint process and we recognise the need for them to understand the process of care planning as much as possible. At the same time, they also appreciate that the Care Homes for Adults (18-65 years) Page 15 of 36 Evidence: information we hold regarding their care is confidential and that all staff are trained to respect this. Residents meetings and an open door policy throughout the home which means that they are continually invited and encouraged to actively participate in the running of their home. Our residents cover a wide spectrum of abilities and we will always seek to empower them as much as possible by involving them in the day to day upkeep of the home, often focusing upon their individual apartment, which can help develop a sense of pride and ownership. We recognise the benefit of positive risk taking and understand that if at first something is unsuccessful (e.g. a car trip to go shopping) then we need to work with the resident to revise the approach and find an alternative way of achieving the same goal. In the AQAA we asked how they plan to improve the service. The manager said, As residents settle at Kirkside, we will actively involved them in helping to write their own PCPs (Person Centred Planning), as a separate document to their Care Plan. Additionally, we are hoping that they will be able to commence work on Life Diaries which document their daily activities while living at Kirkside. Establishing the PCPs will help to encourage service users to become more involved in their care and identify their goals. A survey from a healthcare professional said, They have got to know my client very quickly and have started to compile a support plan which meets her needs. We received nine surveys from staff who work at the home. Six surveys said they always given up to date information about the needs of the people they support.; three surveys said they usually receive up to date information. Staff had good knowledge about the people who live at the home and said they read care files on a regular basis. We looked at three peoples care files. Everyone had a personal details and background information sheet. The background information was very well written and provided a very good summary of their life so far. Some information in the care plans and risk assessments was good and gave sufficient information about potential risks and how individual needs should be met. One care plan described how the persons personal care needs should be met. Staff and the daily records told us that the care plan is followed. Other information in care files was vague and didnt really explain how peoples needs should be met. For example, one care plan said, Address emotional difficulties especially anger and anxiety issues. Care Homes for Adults (18-65 years) Page 16 of 36 Evidence: Some information was missing from care plans. One person has support with medication but they did not have a risk assessment or care plan for this. Another person talked about what they want to do and said they have been exploring options with their keyworker. The persons care plan contained no information about this. We could not see much evidence that people have been involved in the care planning process since they moved into the home. The care plans were not signed by people who could understand and sign the plans or a representative. One person said they read their file but didnt say what they want written in it. Another person said they were not sure if they have a care plan. The manager said they are developing the care planning process. Staff record information about people and what they have been doing. The records show how peoples needs are being met. We received five surveys from people who live at the home. Three people said they always make decisions about what they do each day; one person said they usually make decisions and one person said they sometimes do. Everyone said they do what they want during the day, on an evening and on a weekend. Part of the day was spent talking to people and observing the care being given to people. This included how staff interact with people at the home. We saw some very good practice, which included staff offering people choices, talking to everyone individually, giving them time and listening to what they were saying. Staff were respectful, kind and had some good banter with people. People who live at the home appeared to be very relaxed with staff and it was evident from their responses that they were enjoying the company of the staff on duty. People said they can choose when to get up and when to go to bed. One person said, We talk every day about what I want to do. There are no real rules. Another person said they can make some choices but did raise a concern because a decision had been made about them but they didnt agree. They said they had tried to get this changed but had not been successful. A record of the decision was in the care file but it did not say how or why the decision was made. The manager explained this was in place when the person moved in but acknowledged that it should be reviewed. The manager agreed to follow this up after our site visit. Care Homes for Adults (18-65 years) Page 17 of 36 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at the home are developing individual programmes that involve good community access. Meal planning has caused some difficulties but management are taking steps to address this. Evidence: In the AQAA we asked what the home does well. The manager said, We place great emphasis upon developing the daily living skills of our residents and encouraging them to be as self-sufficient as possible. This means they will be encouraged to help plan menus, shop for groceries and prepare food (with variable support needs) as often as possible. Similarly, we will support them to purchase clothing, toiletries and other items when required, helping them where appropriate to manage their money in the most appropriate manner. This approach will require that they leave the home and visit local amenities on a regular basis, taking public transport or the home vehicle (depending upon availability and suitability) in each instance. The layout of Kirkside Care Homes for Adults (18-65 years) Page 18 of 36 Evidence: with people living in self contained apartments, lends itself particularly well to supporting service users to maintain their home environment, from doing their own laundry to keeping the apartment clean and tidy. We find that they take great pride in the upkeep of their own apartments as the apartments are regarded as their own and staff respect their privacy and space at all times. Throughout their stay at Kirkside, we continually work very closely with families and ensure that regular communication is encouraged and supported, whether providing staff to facilitate home visits or helping residents to write letters such as change of address correspondence. At the same time, the staff themselves also maintain regular contact, so that we can keep family continually involved in the care process. In addition to this, identifying the interests and skills of residents is also very valuable, so that we can find appropriate local resources and help them to tap into these. For those who are less able, the focus may be more upon leisure pursuits, such as walking or sports activities. But for residents who have the capacity to attend college or some form of employment, we have supported them to apply or enrol as necessary. People who use the service said staff ask them what they would like to do. One person said, They ask me every morning. People have individual activity plans which are being developed. Staff said they are exploring different opportunities for people including college courses. One person who lives at the home said they have been looking at a computer course with their keyworker. Staff and management said staffing levels are good and they have enough staff to support people in the community. One person said they go out regularly and have been shopping, to the pub and the cinema. Every month keyworkers sit with people who live at the home and ask them if they are happy with the care they are receiving and look at what they would like to do. These meetings provide people with opportunities to plan future activities although they are sometimes not acted upon. One person said they would like to go to a football match in October 2009 and again in January 2010 but they have not yet attended. We talked to people who live at the home about daily living skills. They said they do some tasks, which includes cooking, laundry and cleaning their room. They said staff are responsible for cleaning communal areas. One person said they have someone to clean the home. Care plans did not identify where people should be involved in daily living around the home. We received five surveys from relatives and everyone was satisfied with the service Care Homes for Adults (18-65 years) Page 19 of 36 Evidence: provided at Kirkside. People said the care service helps everyone to keep in touch. One relative said, All staff have been very welcoming and supportive to all family and friends and they have arranged visits home willingly and without a fuss. Another relative said, The care staff are good and looking after (name of person) well. One relative said they were very pleased because staff have been providing very good support for accessing community services, and in the past this has been a problem. They said the service has made good progress in a short period of time. Two surveys from people who live at the home suggested food/meals could improve. One person said, Food needs to be sorted as some units run out and we could have more healthy options. Another person said, Food, Im sometimes hungry.Two staff surveys suggested the home could improve by offering more nutritious meals. We looked at the menus but these did not match what meals were being provided. In the AQAA we asked what they could do better. The manager said, With separate apartments, it is a challenge to manage catering in a manner which can be easily monitored. A number of our staff have excellent catering experience and we have recently sent some on a healthy eating course (to become the homes healthy eating champions), but we still feel that there is room for improvement in terms of managing diets and ensuring that our residents maintain an appropriate intake and weight. We talked to people about meals. Several people said the difficulties are because the service is new and it takes time to settle in but thought it had already improved. The manager has discussed meals, menu planning and shopping with people who live at the home and staff. A new menu was being introduced a few days after the inspection. Care Homes for Adults (18-65 years) Page 20 of 36 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. Peoples health and personal care needs are met. Health action plans should be developed to make sure peoples health needs continue being met. Evidence: In the AQAA we asked what the home does well. The manager said, All residents at Kirkside are registered with a local GP, which we will contact if ever they have any health requirements that need addressing. Should they need support in other areas, such as continence or dentistry, then we will contact the relevant services and make arrangements as required. A record of all appointments is maintained, so that we can be sure we are meeting their individual needs. We are building professional relationships with the local CTLD and Leeds wide severe challenging behaviour team to ensure that we work as partners to meet the needs of the vulnerable and challenging service users at Kirkside. Service users have individual healthcare support plans and receive staff support to ensure that their healthcare needs are met. Staff encourage service users to maintain a healthy lifestyle and diet and have staff support to attend healthcare appointments. All service users are supported to care for themselves as much as possible and to maintain an appropriate level of personal hygiene. A number of our residents require considerable staff support and some can be disinhibited at Care Homes for Adults (18-65 years) Page 21 of 36 Evidence: times. In supporting them, all staff are trained to respect their privacy and maintain their dignity at all times, guided by the behavioural support plans for each resident. Our policy on confidentiality also underpins their practice at all times. Residents are encouraged to make their own decisions about their daily routine and lifestyle, from deciding what clothes to wear to what time they go to bed. For those that are assessed as being capable of self medicating, this is risk assessed, care planned and continually reviewed, to be certain that it is in compliance with our administration of medication policy and the best interests of the resident. In the event that a resident should become unwell or worse, staff will be supported to help the residents and each other, through appropriate training, including bereavement skills if necessary. Staff said the home is good at meeting peoples personal and healthcare needs. We received six surveys from social or healthcare professionals. They all provided good feedback about the service and did not raise any concerns. Three surveys said peoples social and healthcare needs are always met; three surveys said they are usually met. One professional said, Staff have always been amenable, helpful and act on any advice. Another professional said, They respond very well to the needs of the person they support. One survey suggested that the service could be better if it provided more updates to the persons family. We looked at information that showed us healthcare professionals are involved in peoples care and people who live at the home regularly attend healthcare appointments. Individual records have good information about appointments and showed us that staff are vigilant and look for changes in peoples well-being. Peoples care plans identify some health needs but these are fairly basic. One persons health needs had not been identified in their care plan. The manager said they would be developing these as they develop the whole care planning process. We looked at the systems the service has for ensuring the safe administration, recording and storage of medication. We found that there is good medication storage in place and staff who administer medication have completed appropriate training. The medication administration records were completed correctly. We counted the medication for one person who was on antibiotics. The number of tablets remaining did not correspond with the number signatures on the medication administration record. The service does not have a system for checking the number of medicines held at the home. Care Homes for Adults (18-65 years) Page 22 of 36 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. Systems are in place to make sure people are safeguarded but recording systems are not always robust where restraint is used which could put people at risk. Evidence: In the AQAA we asked what the home does well. The manager said, We have a very open culture at Kirkside, which means that the senior staff are exceptionally approachable and others (both internal and external) feel at ease asking any questions or voicing any concerns. We maintain open dialogue with care managers, CQC and Adult protection and respond swiftly if any concerns are brought to our attention. All staff receive training with regard to safeguarding and regular, protected supervision sessions also provide a forum in which to raise any matters regarding the quality of care provided. Further to this, the company directors are accessible to both staff and service users and any concerns can be easily raised. We have a clear complaints procedure and this is also explained with the service user guide. We have produced a very accessible complaints procedure for service users. All complaints are taken seriously and treated with confidentiality and a prompt response ensures that complaints are acted upon as a matter or priority. The manager and other staff are encouraged to document both concerns and compliments so that these can be reviewed and the complaints procedure reviewed at regular intervals. We received five surveys from people who live at the home. Four people said they know who to speak to if they are unhappy and they know how to make a complaint. Care Homes for Adults (18-65 years) Page 23 of 36 Evidence: One person said they did not know who to talk to or how to make a complaint. All of the staff surveys we received said they know what to do if someone has concerns about the home. Two relative surveys said they know how to make a complaint; two relative surveys said they did not know how to make a complaint; one survey was blank. One relative told us that when they have made suggestions staff and management have always listened. Concerns and complaints are recorded but the complaints procedure was not displayed in the home. Staff we spoke to said they have received safeguarding training, and said they would report any concerns to the management team if they suspected abuse or had an allegation of abuse made to them. They were confident that the management team would deal with everything appropriately. The home has dealt with three safeguarding incidents since they opened. They have all been managed appropriately. On occasions staff may use use low level holds which are a form of restraint to prevent people from hurting themselves or other people. Staff said they have received appropriate training and are confident in using restraint but only use it after other diversion techniques have failed. CQC has guidance that states providers must record when restraint has taken place. The recording should be used to detail what actually happened, including when, who was involved, how long the restraint lasted. what form did the restraint take, were there any injuries, was there an impact on other people using the service and have the relevant people been informed. We looked at recordings where restraint had taken place but found they had not recorded enough detail. One persons daily record said the person had been in a safe hold when the staff member had arrived on duty but there was no other information and an incident report had not been completed. Another daily record said the person had been in a safe hold for one hour but again there was no detail and an incident report was not completed. Another record said the person had punched a staff member in the mouth but no other information or a separate report was completed. It is very important that enough information is recorded so proper monitoring can take place. Following the site visit we contacted the manager and went through our guidance for Care Homes for Adults (18-65 years) Page 24 of 36 Evidence: recording restraint. The manager was reviewing their systems and keen to make sure all the necessary information is properly recorded. The manager and staff discussed the system in place for looking after personal monies for people who live at the home. They all said the system is robust and protects peoples monies. Finances are checked three times a day and every transaction is checked by two staff. Care Homes for Adults (18-65 years) Page 25 of 36 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a home which is safe, well maintained and comfortable. The design and layout encourages independence. Evidence: In the AQAA we asked what the home does well. The manager said, As a new development, we are exceptionally proud of the environment we are able to provide service users. Located within mature and extensive gardens, the home is a conversion of an historic building within a conservation area and easy reach of local amenities and transport links. With fifteen beds over six apartments, all rooms comply with current regulations, providing modern, attractively appointed and homely accommodation, often retaining some of the buildings original features. Where practicable, most of the premises are suitable for wheelchair access as some of our residents do have significant mobility issues. Call points are located throughout the building. All rooms are en-suite and residents are able to lock their bedrooms and bathrooms to maintain their privacy. Residents are starting to personalise their own apartments and spending time stamping their individual mark on their rooms. The home has been newly decorated and all fixtures and fittings are new. The Manager does a weekly audit to ensure the condition of the property is maintained and all areas have cleaning schedules, which ensure that standards of cleanliness and infection control are consistently high. All staff are encouraged to make entries in the maintenance book, Care Homes for Adults (18-65 years) Page 26 of 36 Evidence: which are then signed off when carried out. Independent audits conducted by Head Office, also ensure adherence to Health & Safety law, Infection control policies and property maintenance. We received five surveys from people who live at the home. People who live at the home and visitors told us the home is comfortable, clean and tidy. One person said, Everyone knows its my room and I have my own key. When we looked around the units they were clean, tidy and well organised. People were walking freely around their unit. Some people spent time in the communal areas; others chose to spend time in their room. The home is well decorated and furnished. All rooms seen were clean, free of odour and maintained to a good standard. People have been able to furnish their rooms as they wish. Clinical waste is properly managed and staff wear protective clothing when attending to the personal care needs of people who live at the home. The home had a good supply of protective clothing and staff said they always have access to the supplies. Hand cleaning facilities are situated throughout the home. Care Homes for Adults (18-65 years) Page 27 of 36 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported by staff who are trained and properly recruited. Evidence: In the AQAA we asked what the home does well. The manager said, All recruitment is managed by dedicated staff at Head Office, ensuring that policies specific to the recruitment, induction and training of staff are adhered to, including those which relate to Equal Opportunities and anti-discrimination legislation. Job descriptions and person specifications are available for all roles and the Human Resources Manager ensures than two references, a SOVA and a CRB check are available for all staff prior to unsupervised resident contact. The interview process is used to help establish whether or not they have the right personality traits such as listening, empathy, patience and enthusiasm for the role. New staff are given a two week mandatory training course including a two day course on crisis physical interventions. Additionally, we regularly source additional training to further develop the skill of our staff and will also provide in house bespoke courses on identified areas for improvement (e.g. boundaries, assertiveness, healthy eating). Further to this, all homes have a considerable number of staff with NVQ qualifications and this consistently exceeds the 50 target. This is not yet applicable in Kirkside by virtue of being a new service, but steps are already being taken to ensure that they embark upon this once they have passed their probation period (where staff will commence Care Homes for Adults (18-65 years) Page 28 of 36 Evidence: NVQ after a successful probationary period). All staff receive supervision every two months which provides them with the opportunity to discuss concerns or identify areas for improvement, which can then be met through additional training and support. Kirkside and Woodleigh Care are recognised as investors in people and focus on identifying individual staff members personal and professional development. People who live at the home and visitors were complimentary about the staff that work at the home. People described staff as helpful and friendly. A person who lives at the home said staff are brilliant. A relative said staff are very nice. We received five surveys from people who live at the home. Three people said care staff and managers always treat them well; two people said they usually treat them well. Two people said care staff and managers always listen to what they say; three said they usually listen and act on what they say. One survey from a person who lives at the home said they would like more staff to help them go out more often. One staff survey said they always have enough staff to meet peoples needs; eight surveys said they usually have enough staff. We received some very positive feedback from staff about what the service does well. Staff told us the team works well together. One staff said, Its a good place to work and everyone spends time talking to each other. Another staff said, Team work is very good. Staff said they have received good training since they started working at the home. One staff said, They are investing in the team. We received nine staff surveys. Every survey said they are given training that is relevant to their role, helps them understand and meets individual needs and keeps them up to date with new ways of working. Eight surveys said they have been given training that gives them enough knowledge about healthcare and medication. One person said they had not been given enough training in this area. Six surveys said their staff induction covered everything very well; three said it covered most things well. Staff said they have a clear understanding of their role and know what is expected of them. Everyone said they their manager meets with them regularly/often and gives them enough support. We observed the staff handover, which was well organised. Important information was passed on and each staff was allocated duties for their shift. Staff complete a Learning Disability Induction Award when they start working at Care Homes for Adults (18-65 years) Page 29 of 36 Evidence: Kirkside. The manager said every staff attends a three day induction and then they start a workbook that has some modules which are specifically about working with people who have a learning disability. Staff surveys said their employer carried out checks such as a criminal records check before they started work. We looked at the recruitment process for two people who have recently started working at the home and found that all necessary pre employment checks had been completed. Care Homes for Adults (18-65 years) Page 30 of 36 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 home is well managed and everyone feels supported. Evidence: In the AQAA we asked what the home does well. The manager said, Kirkside is managed by an individual in good health, with more than seven years prior experience as a home manager and ILM membership. The home operates with an open door policy, allowing both staff and service users to contribute toward the general operation of Kirkside and voice any concerns or questions they may have. She is supported by two unit managers (making a total management team of three) who both have significant management experience with a comparable client group. This is also formally supported through regular staff supervision and meetings, resident questionnaires and meetings and monthly Reg 26 inspections by a company director. Additionally, complaints and grievances policies are also made readily available. Supported by a Clinical Service Manager and Company Directors, the manager of Kirkside has all available resources to ensure that the homes objectives and policies are available, clear, up to date and in compliance with current legislation. Staff must sign to demonstrate that they have read these and two Unit Manager plus several Care Homes for Adults (18-65 years) Page 31 of 36 Evidence: Team Leaders also oversee compliance. People said they thought the home was well managed and we received some good feedback about the manager. Staff said they thought the manager was focussed on providing a good service and was developing the service in the best interests of the people who live there. The manager said she is well supported by the organisation and is preparing her registered managers application and is hoping to submit this shortly. Staff also said the organisation is supportive. One person said they have a good ethos and are sticking to it. The home sent us their annual quality assurance assessment (AQAA) when we asked for it. The AQAA gave us very good information about the service. It gave us good examples of what they do well, what they could do better and how they plan to improve. Care records contained monthly reviews where staff have spoken to people who live at the home and discussed whether they are satisfied with the service. They have also reviewed daily records. In the AQAA the manager told us they have all relevant policies and procedures in place, and equipment has been tested as recommended by the manufacturer. We did not observe any unsafe working practices during our visit. We looked at some incident records. In the main, these had sufficient detail about incidents that had occurred and action points to help prevent a similar incident occurring again. However as identified in the complaints and protection part of the report some details which relate to restraint were not recorded properly. Care Homes for Adults (18-65 years) Page 32 of 36 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 33 of 36 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 6 People who live at the home should be more involved in the care planning process. This will help make sure people are receiving the care they want. The care planning process should be developed so people who use the service have a care plan that identifies their individual needs and wishes and how they should be met. Any decisions that are made on behalf of people should be agreed through a formal decision making and risk assessment process. This will make sure peoples rights are protected. People who live at the home should be more actively encouraged to be involved in all areas of daily living in the home. This will help promote independence. People should have a health action plan that identifies their personal healthcare needs. This will make sure their health needs are identified and met. Medication stocks should be checked to make sure the number of tablets administered is correct. The complaints procedure should be displayed and made Page 34 of 36 2 6 3 7 4 16 5 19 6 7 20 22 Care Homes for Adults (18-65 years) 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 available to people who use the service and other relevant people. This will make sure people know how to make a complaint if they are unhappy with the service. 8 23 Any incidence of restraint should be recorded in sufficient detail to establish that the restraint is appropriate. This will make sure people who use the service are protected. The manager should submit a registered managers application. This will make sure the home has a registered person that is in day to day control of the service. 9 37 Care Homes for Adults (18-65 years) Page 35 of 36 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). 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. 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