Care Home: Little Ewell

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What the care home does well Little Ewell provides a very comfortable, homely place for people to live. They are valued as individuals and their changing needs are responded to. People have opportunities for activities which are stimulating and age appropriate. People are encouraged to make choices and decisions for themselves, as much as possible enabling them to have a sense of control over their lives. What has improved since the last inspection? A new bedroom with special equipment has been provided for one person to meet their changing needs. What the care home could do better: There are no formal requirements from this inspection. Within the AQAA, the responsible individual has identified the following things for improving or building on:to work on and improve care plans to make them more accessible, including having them in residents` own rooms; to continue to work on health action plans; to complete refurbishment of one bathroom; to continue to use Personal Training Plans effectively, to identify and monitor areas of development for staff. Policies and procedures should be reviewed to ensure they are still relevant. We would expect the application for registration of the new manager to be submitted by the end of June 2009. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Little Ewell Little Ewell Barfrestone Dover Kent CT15 7JJ     The quality rating for this care home is:   two star good 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: Christine Lawrence     Date: 0 7 0 4 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. 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 26 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 26 Information about the care home Name of care home: Address: Little Ewell Little Ewell Barfrestone Dover Kent CT15 7JJ 01304830930 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : kent@larche.org.uk L`Arche care home 7 Number of places (if applicable): Under 65 Over 65 0 learning disability Additional conditions: 7 The maximum number of service users to be accommodated is 7. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning disability (LD). Date of last inspection Brief description of the care home Little Ewell is one of the houses within the LArche (Kent) Community. It is a large detached property set in its own grounds. The main house has accommodation on two floors, with five single rooms for residents. There are a further two rooms in an adjacent property, known as the flats. Some of the staff are permanent but others come from many different countries to be part of the community within the home and within the area for a specific period of time. The home is located in a small village with limited access to public transport or amenities. There is a church and public house nearby, although the nearest bus service and railway station, shops and post office are a few miles away. The home has a minibus and cars for residents transport needs. There is off road car parking and extensive well maintained gardens which are Care Homes for Adults (18-65 years) Page 4 of 26 Brief description of the care home accessible to residents. Information about the home, including the previous inspection reports will be made available on request. The fees are between £650.00 and £1400.00 per week. Care Homes for Adults (18-65 years) Page 5 of 26 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 inspection visit was notified to the home a few days before to ensure someone would be available. We, that is the Care Quality Commission, (CQC) looked at various records in the home and also used information sent to the Commission by the responsible individual, Eddie Gilmore, before the visit, the Annual Quality Assurance Assessment (AQAA). Information from the previous inspection of 10/04/07 and the annual service review of 10/04/08 was also referred to. We spoke with several residents and also to various members of staff. A tour of parts of the building was undertaken. We made observations of staff interacting with residents, noting residents responses. Care Homes for Adults (18-65 years) Page 6 of 26 Care Homes for Adults (18-65 years) Page 7 of 26 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 8 of 26 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 9 of 26 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents individual aspirations and needs will be assessed. Evidence: The AQAA stated that residents will only be admitted after a detailed assessment. We noted that the assessment (application form) of the newest person to move into Little Ewell was detailed, covering a range of topics including what the person was expecting of the placement. It was clear that other relevant people had been involved. Care Homes for Adults (18-65 years) Page 10 of 26 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can be confident that their changing needs will be noted in their individual plans and that they will be supported to make decisions and take risks to enable as independent lifestyle as possible. Evidence: We looked at the care plans for three of the people living at Little Ewell. These are called reference person files and contain information for staff to enable them to support people and also to enable them to encourage people to make choices and decisions. These plans are based on an assessment of peoples needs and wishes. We saw examples of care plans being updated both routinely and when particular things change. The resident is supported to complete an evaluation form about what they think about living at Little Ewell as part of their formal yearly review. Other people will be involved in reviews and one example we noted included the residents family, staff from Little Ewell and the LArche workshops and the care manager. Care Homes for Adults (18-65 years) Page 11 of 26 Evidence: We saw, or read lots of examples of people making decisions about their daily routines and other things including refusing a flu jab, attending/not attending a workshop, attending church, what time to go to bed, choosing to be in own room or communal space, what food to eat, what to spend money on, where to go for holidays etc. Some people have been supported with Person Centred Active Support to enable more independence and participation in meaningful activities. We saw risk assessments within a risk assessment folder, both general and specific to the individual, which reflected that people are encouraged to do things as safely as possible rather than not doing something at all. Care Homes for Adults (18-65 years) Page 12 of 26 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. Activities and involvement in the local community, as well as support for personal relationships will be provided for residents. They will benefit from having a healthy diet. Evidence: Residents are provided with opportunities to attend workshops operated by LArche (Kent), as well as day services provided by other organisations (one person goes regularly to a farm based activity). During this visit we saw some residents attending their chosen workshops such as gardening, art and computer work. Residents are all on the electoral roll and they have opportunities to use community facilities both locally, further afield (such as local shops, sports facilities, local transport, library, cinema, theatre, restaurants, pubs, discos and local churches in the community) and through their workshops. The manager and staff enable residents to maintain contact Care Homes for Adults (18-65 years) Page 13 of 26 Evidence: with family and friends and there are often celebrations within the house that involve inviting friends and family. As noted in the previous standard residents are encouraged and enabled to make decisions and be as independent as possible. Their rights are respected and there is also an expectation that they will be involved in personal and communal housekeeping tasks. Residents have time when they can carry out their laundry and cleaning of their rooms with appropriate staff support or help. The inspector saw that residents could choose to be with everybody or spend time on their own. It was noted that the menu is varied and nutritious, offering choices. The evening meal is a sociable occasion and the furniture in the dining room allows for everyone to be together on one table. Information about any preferences or special needs is contained within the care plan under diet. We saw that the menu is varied and nutritious, offering choices. Different people cook at different times and this adds to the variety. We saw a meal being prepared during our visit which was of chicken breasts, with carrots, mushrooms and a salad. We were informed that home-made cakes and bread, organic vegetables and eggs produced in their garden project (one resident feeds the chickens at the weekend) are quite often included in meals. Care Homes for Adults (18-65 years) Page 14 of 26 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. Residents are protected by the homes policies and procedures regarding medication and their physical and emotional needs will be responded to. Their preferences and requirements for support are respected. Evidence: Residents seen during this inspection were individual in their appearance and the inspector was informed that individuals make choices about their clothes and hairstyles. Residents needs with regard to the level of support they require for personal care varies according to their abilities for instance one person might need lots of help and another might only need encouragement. Information about personal hygiene preferences as well as information about morning routines is provided within the individual plan. Wherever possible, and that is most of the time, a male assists a male and a female assists a female. There are male and female staff within the home. The records seen indicate that residents health care needs are identified and responded to with attention from dentists, opticians, general practitioner, community nurses, dietician, continence advisor, physiotherapists, speech and language therapists and the wheelchair service. One persons needs have become more complex and the Care Homes for Adults (18-65 years) Page 15 of 26 Evidence: records showed, as well as observations during this visit, that the home are meeting these changing needs. Medication is appropriately stored and administration is properly recorded. The person resonsible for managing the medications has achieved the national vocational qualification at level three and has also attended a medication training course. She confirmed this with us and showed her certificate. Some of the other staff have received training regarding medication. There are in-house procedures for medication. Work is progressing on the individual health action plans. The AQAA states that the medication procedure was last reviewed in 2003. The deputy manager showed us some updates that she has done in the last year. The responsible individual agreed to review this policy. Care Homes for Adults (18-65 years) Page 16 of 26 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. Residents views are listened to or ascertained, and acted on. Evidence: The individual planning, key worker system and regular house meetings are used to ensure that residents views and concerns are noted. There are policies and procedures in place regarding complaints. A poster, using pictures, is on display for residents to assist them in knowing who to talk to if they have a problem. One resident we spoke to said he would tell Eddie (the responsible individual) if he had any problems. There are policies and procedures relating to safeguarding, aggression, disclosure of abuse and bad practice (whistle blowing) and physical intervention. Some of these policies have not been reviewed for some time. We asked the responsible individual to ensure that they were all either still relevant and just needed to be re-dated or that they needed to be reviewed an amended. Records showed that staff receive training regarding managing difficult behaviour and what constitutes abuse. Care Homes for Adults (18-65 years) Page 17 of 26 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from living in a home which is homely and comfortable as well as clean and hygienic. Evidence: The communal areas (two lounges, a dining room and a chapel) are bright and cheerful areas. There are lots of plants around and attractive paintings and prints on the walls, some done by past and current residents. The home has a comfortable, lived-in feel about it. The kitchen, as well as the dining area, has a large kitchen and there is a walk in pantry. There is a television in one lounge and a piano in the other. The house is situated in the same campus as some of the LArche workshops and the garden area is well tended, including a conservation walk and a secret garden. There is a car park. The home has access to a minibus and two cars to enable residents to get out and about. A handyman is employed part time to carry out basic repairs etc. We were able to see a few of the residents rooms which were personalised and clearly met the needs and wishes of the residents. The laundry is a spacious area and is satisfactorily fitted out. There are polices regarding infection control and the home was clean and fresh on the day of the visit. Care Homes for Adults (18-65 years) Page 18 of 26 Care Homes for Adults (18-65 years) Page 19 of 26 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. Sound recruitment procedures and training already provided and training planned, will have a beneficial impact on residents. Evidence: We spoke to the Assistants Coordinator, (the person responsible for coordinating recruitment and training) who gave information relating to the training programme in place for people working at the LArche homes in Kent. The programme allows for supporting staff members who are working for short periods of time as well as those who continue to work within the LArche community. Induction training is provided. The programme includes national vocational qualifications. We looked at the records of three people currently working at Little Ewell and talked with the Assistants Coordinator. The recruitment procedures include application forms, references, terms and conditions of employment and criminal record bureau checks. Local police checks from the country of origin of the prospective member of staff are also sought where appropriate. The policies and procedures which the organisation has in place cover relevant aspects of recruitment. We observed various members of staff interacting with the people living at Little Ewell. They were polite and respectful and responsive to people. They were also seen to be sensitive when offering physical support. Care Homes for Adults (18-65 years) Page 20 of 26 Care Homes for Adults (18-65 years) Page 21 of 26 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. Residents benefit from a well run home and their health and safety is promoted and protected. Evidence: There is currently no registered manager at Little Ewell. A person has been appointed. The management of the home is being overseen by the responsible individual Eddie Gilmore. He is the LArche Kent community leader and has previously been a registered manager. Mr Gilmore stated that the new manager would be applying for registration. Residents complete evaluation forms as part of their annual review, saying what they think about living at Little Ewell. Training is provided to all staff regarding moving and handling, fire safety, first aid, infection control and food hygiene. This training forms part of the induction process for all new staff across the organisation. They include health and safety guidelines, dealing Care Homes for Adults (18-65 years) Page 22 of 26 Evidence: with body fluids and a hand-washing guide. Information provided by the manager prior to the inspection relating to maintenance and servicing indicates that everything is appropriate and up to date. We spoke to the member of staff who has particular responsibility for monitoring health and safety and he discussed the various systems and checks in place to ensure health and safety issues are monitored and appropriate checks made. Care Homes for Adults (18-65 years) Page 23 of 26 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 24 of 26 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 25 of 26 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. 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