Care Home: Knaresborough Road (151)

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What the care home does well Staff encourage people to be independent and to make their own decisions. This enables people to have control over their lives. Staff are respectful to people and sensitive in meeting their needs.This helps in making sure people receive care in the way they prefer.The way in which information is gathered and kept about people means staff can provide support in a way that people need and prefer. It also means staff have in depth knowledge and understanding about each individual person and so encourage them to develop skills and experiences safely. Comments received from the people who live at the home were positive. People made comments such as,"I came for a visit. I knew some of the staff"."Everything is ok,I like this house better"."I like to go out with staff"."I like to go out with staff. I get my hair done or go for a coffee or lunch out. We go shopping or to appointments"."I like it here now, the staff are very friendly and everyone is much happier"."Staff are kind and we have a laugh". What has improved since the last inspection? The introduction of more detailed care plans that focuses on the person and contains information about every aspect of the persons life. Care plans focus on achievement and improving opportunities for people.The document provided the reader with very good information,was easy to understand and gave a sense of the person.The homes environment has been re-decorated and re-furbished throughout to a high standard. Also one of the bathrooms on the first floor has now been made into a wet room.This has benefitted the people who live at the home. Alot of thought and consideration has been given by the organisation in how they could improve the environment for people and this was evident on the day of the site visit. What the care home could do better: There was nothing identified at this inspection that the home needed to improve upon,however the organisation is always looking towards improving the services they own. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Knaresborough Road (151) 151 Knaresborough Road Harrogate North Yorkshire HG2 7NW     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Irene Ward     Date: 1 8 1 1 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. 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. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 27 Information about the care home Name of care home: Address: Knaresborough Road (151) 151 Knaresborough Road Harrogate North Yorkshire HG2 7NW 01423546326 01423888222 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Homes Together Ltd Name of registered manager (if applicable) Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 8 Number of places (if applicable): Under 65 Over 65 0 learning disability Additional conditions: 8 Service users to have an associated sensory impairment. Date of last inspection Brief description of the care home 151 Knaresborough Road is registered to provide residential social and personal care for 8 adults who have learning disabilities and an associated sensory impairment. The home is a large well maintained property situated between Harrogate and Knaresborough and has good access to services and amenities. The registered provider is Homes Together Ltd. At the time of the site visit the fees for the home ranged from 778 pounds to 1,221 pounds per week and does not include costs for toiletries, hairdressing, transport, chiropody and reflexology. Care Homes for Adults (18-65 years) Page 4 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 3 star excellent. This means that people who use the service experience excellent quality outcomes. The Commission for Social Care Inspection inspects homes at a frequency determined by how the home has been risk assessed. The inspection process has now become a cycle of activity rather than a series of one-off events. Information is gathered from a variety of sources, one being a site visit. More information about the inspection process can be found on our website www.csci.org.uk.This is what was used to write this report. A review of the information held on the homes file since its registration. One visit to the home by one inspector which was unannounced that lasted for three and a half hours. Information asked for before the inspection, this is called an Annual Quality Assurance Assessment. Comment cards returned from one person who live at the home. Looking at two peoples care files Care Homes for Adults (18-65 years) Page 5 of 27 in detail. Some time was spent with some of the people who live at 151 Knaresborough Road. Time was also spent talking to one member of staff. The site visit took place on the 18th November 2008. However some people living at the home were out at various activities.The new manager and the care director were available to assist throughout the visit and available for feedback at the end of the day. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 7 of 27 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 8 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples needs are properly assessed prior to admission, this makes sure that 151 Knaresborough Road is the right place for them to live. Evidence: The manager confirmed that information is made available to anyone interested in moving into the home in the form of the service user guide before they move in. Five people have moved in from one of the other homes, 5 Park Drive, Harrogate that the organisation owns. The manager said that the home is now full with the maximum occupancy of eight people.But if they had a vacancy and someone was considering moving into the home they would be given the opportunity to visit the home and stay for a meal, overnight or whatever they were comfortable with. The registered manager is aware however of the need for comprehensive pre-admission assessments and explained that any such admission would be arranged via a planned introductory programme which would include visits to the home and a trial placement prior to this being made permanent. People who have recently moved into the home were consulted as were their Care Homes for Adults (18-65 years) Page 9 of 27 Evidence: families,advocates and local authorities before any move took place. People visited the home to stay for tea and to choose their rooms. Families and social workers were also invited to look around the home and some did visit the home before people moved.One person said in their survey,I came for a visit. I knew some of the staff. Care Homes for Adults (18-65 years) Page 10 of 27 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The care provided is of a high standard and encourages people to make their own decisions about how they wanted to live their lives. Evidence: People living at the home looked well cared for and staff were seen supporting people during the day and it was clear that they understood individuals needs. They supported people sensitively and supported people to make choices. Each person has an individual care plan detailing their individual needs and the actions that staff needs to follow to meet these. The care plan focuses on the person and contained information about every aspect of the persons life, they focus on achievement and improving opportunities for individuals. The care plans were very detailed and covered morning and evening routines and how people preferred their care to be provided. There were also mealtime routines recorded for some people. All areas of daily life such as peoples daily routines, activities were covered in the plans. The document provided the reader with very good information, was easy to understand and gave a Care Homes for Adults (18-65 years) Page 11 of 27 Evidence: sense of the person. The plans are reviewed regularly. People spoken with and from one survey we received told us they received the care and support they need,they said that they are always able to do what they want. Examples of comments made were,Everything is ok. I like this house better.I like to go out with staff. Also present were a range of risk assessments with the purpose of supporting people to live as independently as possible with safeguards in place,these were reviewed regularly. Through discussions with the manager at the time of the visit and the contents of care plans it was clear that people are able to make choices wherever possible. Care Homes for Adults (18-65 years) Page 12 of 27 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use this service are always able to make choices about their lifestyle and are supported by staff to carry these out. Evidence: People who live at 151 Knaresborough Road have the opportunity to attend specialist day centres. People also have days at home to participate in personal shopping, laundry and household tasks. People continue to have opportunities to pursue other interests outside of the home such as going out attending the gym, swimming, horse riding, shopping, going out for coffee, pub outings and walking. Some people attend Harrogate College and do various courses. Others attend Arts and Craft at Henshaws College or The Junction where they learn about computers. People who live at the home made comments via the surveys and said,I like to go out with staff. I get my hair done or go for a coffee or lunch out.We go shopping or to appointments. Menus Care Homes for Adults (18-65 years) Page 13 of 27 Evidence: were looked at and those seen were varied giving people plenty of choices. Menus are on a six week rotation and most of the meals are cooked by the staff.Some people living at the home are able to prepare meals with some assistance from staff. Comments made from the people who live at the home were,The food is very good here. Also all staff have now had some training in health and wellbeing.This helps staff to promote a better and healthier lifestyle for everyone,including staff. The home has worked with a health nutritionist who is returning to the home on the 1.12.08 to see if any further improvements can be made to the menus. Care Homes for Adults (18-65 years) Page 14 of 27 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples personal and healthcare is provided appropriately and sensitively according to individual needs. Evidence: Each person living at the home is registered with a General Practitioner. People receive support from staff in attending dental and other health care service appointments. Peoples health needs were recorded in their individual care plans with additional stepby-step instruction as to how they wished to be supported. Care plans also detailed of any other health care support people receive such as dentist, chiropodist, wharferin nurse, reflexologist, community resource team and psychologist visits and care manager visits recorded in peoples care plans. Harrogate District Hospital is used for Accident and Emergency service and most out patients appointments. The home operates a monitored dosage system. There is a policy in place for the storage and administration of medication for all staff working in the home to follow. The Medication Administration Records show that everyone receives their medication as prescribed. Records were up to date and well maintained. Medication seen in the home was securely stored in a locked cabinet. No controlled drugs are currently held. All staff Care Homes for Adults (18-65 years) Page 15 of 27 Evidence: that administers medication in the home have been provided with medication training. Care Homes for Adults (18-65 years) Page 16 of 27 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service have access to an effective complaints procedure and are protected from harm. Evidence: A comprehensive complaints procedure is followed and is made available to people and any other interested parties. The complaints procedure was on display in the home. People living at the home have regular meetings in which they can express any concerns.Where individuals are unable to verbalize concerns staff observe behaviours and body language to identify any dissatisfaction.There have been no complaint since the last inspection. No complaints have been received by the home or the Commision. People when asked were clear as to whom they would speak to if they had any concerns or worries. All said they would speak to either the manager or the staff. One person said,I would speak to staff or my keyworker or Sarah my manager, Sheila or Steve Jones the boss. There is a policy and procedure with regard to safeguarding adults and the procedure to take if there is a suspicion of abuse and staff demonstrated a good awareness of this. Staff receive training in adult protection and safeguarding issues during induction training and further training when required. The last safeguarding training was held in February 2008 and was organised by North Yorkshire Social Services department. There have been no allegations regarding safeguarding made to the home or to the Commission for Social Care Inspection. Appropriate recruitment procedures are followed, with references and Criminal Records Care Homes for Adults (18-65 years) Page 17 of 27 Evidence: Bureau CRB checks made to reduce the risk of unsuitable people working in the home. Peoples finances were not checked at this site visit. Historical evidence from previous reports gives evidence that their financial interests are safeguarded. Care Homes for Adults (18-65 years) Page 18 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience 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 clean, comfortable and safe home that is decorated and furnished to a high standard. Evidence: The home is a large Victorian property and provides spacious accommodation for people. This includes a kitchen, lounge and a further quiet lounge, dining room on the ground floor.The home has two bathrooms on the ground floor and two bathrooms on the first floor one of which is a wet room/shower room all were clean and well maintained. The home has recently gone through some major re-decoration and refurbishment which has been done to a high standard. People who use the service all have single bedrooms and one bedroom has en-suite facilities. Peoples bedrooms seen had been personalised with posters and their various possessions such as CD players, television and items they had collected and made. Rooms have been decorated and furnished appropriate for their age. People made comments about the home such as, Everything is ok. I like this house better. I like it here now. The home is set in private grounds which are accessible to people in wheelchairs. Outside the home there is paved areas for people to sit out. There is parking for up to several cars to the rear of the home and there is on street parking available which is also to the back of the home. All areas including the two lounges, dining room, kitchen and bathrooms were Care Homes for Adults (18-65 years) Page 19 of 27 Evidence: all clean, free from any odours and maintained to a good standard. A range of maintenance checks is completed on a regular basis to make sure that the house is safe and secure. Care Homes for Adults (18-65 years) Page 20 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Sufficient staffing levels, proper recruitment procedures and good staff training meant that peoples needs were met and their interests were safeguarded. Evidence: Staffing levels were sufficient for meeting the needs of people. The duty rota showed that there are usually three members of staff on duty both in a morning and afternoon. This includes the managers hours. This makes sure that peoples social activities are not compromised. At night there is one staff on waking night duty. The organisation operates an on-call system in case there is an emergency. The staff records of two staff one which was recently appointed were looked at. These showed that all the necessary pre employment checks had been carried out prior to the new workers starting in post. All records showed completed application forms, two written references, CRB (Criminal Record Bureau) checks had been obtained. A POVA (Protection of Vulnerable Adults) first check had also been carried out. The home provides all the mandatory training that is required. A range of other training has been completed by staff such as Health and nutrition, autism, safeguarding alerters, food health and hygiene, first aid, visual awareness, manual handling, fire, leadership and management. Two staff are completing National Vocational Qualification Level 2 and two staff are completing NVQ level 3. Staff confirmed when spoken to that they Care Homes for Adults (18-65 years) Page 21 of 27 Evidence: received regular supervision. Records of supervision were seen at the site visit to the home. Staff commented positively about the support they receive from the new manager. Staff meetings are held regularly and minutes of meetings were seen at the site visit. People living at the home made positive comments about the staff they said,I like it here now, the staff are very friendly and everyone is much happier.Staff are kind and we have a laugh. Care Homes for Adults (18-65 years) Page 22 of 27 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from a well managed home in which their needs and wishes are put first. Evidence: The manager previously worked at 5 Park Drive, Harrogate until everyone moved to 151 Knaresborough Road. She has worked for the organisation since November 2007 and is currently in the process of registering to become the registered manager for the home. She has a lot of experience in the care sector and once registered with the Commission she hopes to commence and complete the NVQ (National Vocational Qualification) Level 4 and the Registered Managers Award. The home has a good and effective management team in place. The ethos of the home is open and positive. People who use the service and staff all commented highly about the home. Regular house and staff meetings are held and minutes are taken. There are Quality Assurance systems in place and surveys were last sent to relatives and health and social care professionals in April 2008. All accidents are recorded as required and an accident book is maintained in line with the requirements of Data Protection. Peoples finances Care Homes for Adults (18-65 years) Page 23 of 27 Evidence: were not checked at this site visit. Historical evidence from previous reports gives evidence that their financial interests are safeguarded. Information provided from the AQAA (Annual Quality Assurance Assessment) form and the examination of selected health and safety documents show that regular checks to electricity and gas and fire safety equipment are regularly undertaken. Care Homes for Adults (18-65 years) Page 24 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 25 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 26 of 27 Helpline: Telephone: 03000 616161 or Textphone: or 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) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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