Care Home: Meadows

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What the care home does well Staff know the needs of the people living in the home and can therefore provide the `right sort of support` in the way that it is wanted. It is written down in a care plan.There is good communication between the staff, relatives and health professionals which means people are able to get the right help and advice to maintain their health, safety and well being.People do lots of different activities both inside and outside the home which they enjoy. The home has a car so people can get out and about easily.Each person is encouraged to personalize his or her individual and shared space. The main areas of the home also present as a homely,and cosy environment, for everyone to share. What has improved since the last inspection? There has been alot of work completed in the home since the last inspection. The bathroom has been decorated and there is a new bath and flooring.Some people have had new curtains and bedroom furniture.Everyone has a medication cupboard in their bedroom to store their own medication. What the care home could do better: The paperwork could be better with important documents being made available in pictorial format. Key inspection report Care homes for adults (18-65 years) Name: Address: Meadows Fairy Hall Lane Rayne Braintree Essex CM77 6SZ 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: June Humphreys Date: 0 2 1 0 2 0 0 9 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should:  Be safe  Have the right outcomes, including clinical outcomes  Be a good experience for the people that use it  Help prevent illness, and promote healthy, independent living  Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home:  3 stars – excellent  2 stars – good  1 star – adequate  0 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. They reflect the things that people have said are important to them: This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement Care Homes for Adults (18-65 years) Page 2 of 29 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 29 Information about the care home Name of care home: Address: Meadows Fairy Hall Lane Rayne Braintree Essex CM77 6SZ 01376340714 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) : a.ohene@btinternet.com Mr Alex A Ohene care home 6 Number of places (if applicable): Under 65 Over 65 0 6 1 0 learning disability physical disability Additional conditions: One named person, over the age of 65 years, who requires care by reason of a learning disability and who also has a learning disability Persons of either sex, under the age of 65 years, who require care by reason of a learning disability who may also have a physical disability (not to exceed 6 persons) The registered person is required to undertake training with regard to adult protection policies and procedures and ensure that staff employed at the home are trained in this area, within three months of the date of registration. All new staff appointed must receive training in adult abuse as part of their induction. The total number of service users accommodated in the home must not exceed 6 persons Date of last inspection 2 7 1 0 2 0 0 8 Care Homes for Adults (18-65 years) Page 4 of 29 A bit about the care home Meadows is a fully detached, domestic style, single storey bungalow situated on the edge of Rayne village. The property is fully in keeping with other properties around it. The home is registered for six people with learning and physical disabilities, accommodated in four single and one shared rooms. Communal space comprised a lounge, with a dining area at one end, and a separate kitchen with a second dining area. The fenced rear garden was large, well maintained and accessible to residents. There was also an enclosed patio area at the rear of the home. Limited visitor car parking is provided on the driveway. Regular community access is provided to residents by the use of a vehicle based at the home. There was also a public transport link available in the centre of Rayne, via an hourly bus service to Braintree. Information from the home confirmed that weekly fees vary according to the care package agreed with the placing agency. Past inspection reports are available from the home, and from the CSCI internet website. Care Homes for Adults (18-65 years) Page 5 of 29 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 Care Homes for Adults (18-65 years) Page 6 of 29 How we did our inspection: This is what the inspector did when they were at the care home The quality rating for this service is 2 stars. This means that the people who use this service experience good quality outcomes. One Inspector June Humphreys visited the home unannounced on Friday 2nd October 2009. They looked around the home, to check that it was safe, and a comfortable place to live. A sample of records kept in the home was looked at to ensure staff record important information. This included two care plans, accident records, rotas and medication records. The Manager completed and returned the Annual Quality Assurance Assessment (AQAA) which is an important document that tells us how well the home is doing. As part of the inspection there was the opportunity to speak with service users, relatives and staff. Care Homes for Adults (18-65 years) Page 7 of 29 What the care home does well Staff know the needs of the people living in the home and can therefore provide the right sort of support in the way that it is wanted. It is written down in a care plan. There is good communication between the staff, relatives and health professionals which means people are able to get the right help and advice to maintain their health, safety and well being. Care Homes for Adults (18-65 years) Page 8 of 29 People do lots of different activities both inside and outside the home which they enjoy. The home has a car so people can get out and about easily. Each person is encouraged to personalize his or her individual and shared space. The main areas of the home also present as a homely,and cosy environment, for everyone to share. What has got better from the last inspection Care Homes for Adults (18-65 years) Page 9 of 29 There has been alot of work completed in the home since the last inspection. The bathroom has been decorated and there is a new bath and flooring. Some people have had new curtains and bedroom furniture. Everyone has a medication cupboard in their bedroom to store their own medication. Care Homes for Adults (18-65 years) Page 10 of 29 What the care home could do better If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact June Humphreys CPC1 Capital Park Fulbourn Cambridge Cambridgeshire CB21 5XE Care Homes for Adults (18-65 years) Page 11 of 29 01223771300 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 12 of 29 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 13 of 29 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 service users can expect to make an informed choice about the suitability of the home and whether or not it is able to meet their needs. Evidence: The home had a Statement of Purpose and Service User Guide that reflected the aims and objectives of the service and informed prospective service users of the services and facilities offered at the Meadows. It has been updated since the last inspection, and whilst is informative about the service it is not produced in a user friendly format i.e. there is no pictures of the home or symbols within the guide, and prospective service users would require assistance in reading the current document. There has been no new admissions to the home since 2008, but recently a vacancy has arisen and the bedroom has been prepared for a possible admission. The assessment format seen, would allow for a prospective service users needs to be assessed. The assessment form would usually be accompanied by the assessors own notes.The service also requests a detailed assessment from the social worker/care manager who is referring the person. Any new service user would be provided with several opportunities to visit the home, this would assist in making an informed choice about where to live. A contract would then be Care Homes for Adults (18-65 years) Page 14 of 29 Evidence: drawn up between the home and the service user. The contract includes the terms and conditions within the home. Once again the contract would also benefit from being produced in a pictorial format to enable service users to easily understand their rights and responsibilities. Care Homes for Adults (18-65 years) Page 15 of 29 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. Service users benefit from personalized care plans that enable them to undertake activities, both personal and social in the way they chose. Evidence: Care plans are in place for all current residents. Two care plans were looked at as part of this inspection. Examples viewed contained sufficient information of each individual persons needs; including agreed strategies for dealing with particular issues such as behaviour management, mobility, personal care, food likes and dislikes, activities etc. The care plans were accessible to staff and residents, and enabled new staff to work with service users with ease. Risk assessments to meet individuals changing needs were regularly updated. Helpful suggestions as to how certain known difficult situations might be handled to minimize risk were recorded. The risks, which could apply to the one service user who is able to leave the home unaccompanied to visit the local college, were seen to have been carefully assessed. Care Homes for Adults (18-65 years) Page 16 of 29 Evidence: Service users are consulted with regard to the running of the home through talking to their keyworker, and recording seen on daily notes. There is still a need to improve on the recording of service users meetings to demonstrate that regular consultation is happening within the home. The minutes of these meetings would also benefit from being completed in a suitable format that included pictures and symbols. Observations during the inspection and feedback from health care professionals confirmed that staff had a good understanding of residents needs and preferences. Comments included the home provides an excellent service and supports people with complex physical and emotional needs. The meadows provides a consistent and professional approach to caring for the people in their care. With dedication and determination the persons health and social needs have improved considerably. Care Homes for Adults (18-65 years) Page 17 of 29 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 living at the Meadows can expect to be supported so as to enjoy a lifestyle that meets their wishes and needs. Evidence: All the service users have individually planned social activity both inside the home, and within the community which were well recorded as part of their care plans. Staff spoken with confirmed that the home routinely offered people the opportunities to access the community and participate in chosen leisure activities both individually and as a group. Examples given included shopping, lunch or coffee outings, picnics in the warmer weather, going to the cinema and bowling. Access to transport occurs with the use of the homes onsite transport. Records seen confirmed that the home had worked hard since the last inspection to improve the standard of their care plans, and recording of activities. Care Homes for Adults (18-65 years) Page 18 of 29 Evidence: The manager stated in the AQQA that Staff support service users to maintain family links and friendships inside and outside the home. Service users are supported to take part in peer and appropriate activities. Menus were available and the home has a four-week rolling seasonal menu, which appeared well balanced. Records are maintained of food consumed and offered. the service users had returned from holiday on the day of inspection, and were having a take away for tea. They had agreed to have fish and chips because it was Friday and this was in keeping with the menu. Care Homes for Adults (18-65 years) Page 19 of 29 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. Service users health and personal care needs, including the management of medication, were met by a staff team that showed a caring approach, treating people with sensitivity, dignity and respect. Evidence: Service users have an individual health section within the care plans that give a comprehensive overview of their general health and acts as an indicator to changing health needs. since the last inspection recording has improved, and all health care needs had been reviewed. Several relatives spoken with said that staff provided the right level of support and assistance required, and were caring and sensitive when supporting people. comments received were The staff are very caring, and always try to help. Another person said there commitment to caring for the people at home is excellent, nothing is too much trouble. Two service users medication was case tracked as part of the inspection and found to be accurate. Since the last inspection the manager has changed the way in which medication is stored in the home. Medication is stored in each persons bedroom in a locked cabinet. Medication is administered to each service user on an individual basis. An auditing process is in place that is regularly completed by the manager. Care Homes for Adults (18-65 years) Page 20 of 29 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. Practices in the home ensure that service users concerns are listened to and addressed. Evidence: The CQC has not received any complaints in the last year about the home, and records viewed at the inspection showed that the home had also not received any formal complaints. The homes complaints procedure was noted to be readily available, and a relative who provided feedback confirmed that they were aware of the homes complaints procedure. The document would again be far more accessible to service users if available in a pictorial format. All service users that were able to express a view about the service said that they spoke to their key worker about anything they were unhappy about. Again with regard to relatives they were positive that complaints or concerns would be dealt with effectively. One person said the manager is happy to listen to any concerns, and they are usually sorted out quickly. Another person said if I was unhappy about the care and support provided I would say, and I feel confident the manager would deal with it. Policies and procedures relating to safeguarding were in place, with appropriate guidelines for staff to follow should a complaint of abuse be made or they observe an incident of abuse taking place. The manager has attended comprehensive training, and ensures new staff are trained as part of induction. All staff are updated of any changes in policies and procedures, and staff spoken to were aware of what to do if they observe a concern. Care Homes for Adults (18-65 years) Page 21 of 29 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. yes Evidence: The home presents as a light, modern and cheerful place to live. The quality and standard of furnishings and decoration is good. All of the requirements made at the last inspection in relation to repairs required within the home have been completed. All bedrooms are for single use, except one room which is shared. Bedrooms seen were clean, well equipped and individual in appearance. The home has a lounge, which is large enough to accommodate everyone. There are comfortable chairs and a large television. The dining area is adjacent, and this allows a real opportunity for different people to do different things i.e. several people were watching T.V whilst two other people were playing a game with staff at the table. Care Homes for Adults (18-65 years) Page 22 of 29 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. Service users receive support from staff who are trained, skilled and sufficient in numbers to meet their needs. Evidence: The staff member on duty advised that the manager provides good support. He works with us as part of the team, and when he is not on duty we can always phone him for advise. All newly appointed staff have a detailed and well-structured induction programme, which ensures that they are confident of policies and procedures in the home. More experienced staff work along side new staff to assist in them getting to know the service users. The training records seen demonstrated that mandatory training i.e. manual handling, medication and safeguarding and are given priority. The service supports staff to complete a range of qualifications, including N.V.Q. One member of staff was in the process of completing there learning disability degree. Staff recruitment files were not available to be looked at on the day of inspection as the manager is the only person who has access to these documents. At the last inspection in 2008 two sets of recruitment records were seen and they contained all the appropriate security and identity checks including Criminal Records Bureau checks and two up to date references. The staff rota inspected showed that two staff were on duty during the day shifts, and one staff at night on waking duty, which is considered sufficient.The level of staffing in Care Homes for Adults (18-65 years) Page 23 of 29 Evidence: the home is adequate as there are currently five Service Users instead of six. This may need to be reviewed dependent on the the needs of the new person admitted. Since the last inspection formal supervision of staff has improved. The manager stated in the AQAA Service users are involved in various aspects of staff recruitment and selection. Training is designed to address assessed needs and personal development. Staff are clear about their roles and work to well designed rotas, which enable them to be available for service users when needed. Staff are supported throughout by personal supervision meetings. Information received from surveys, and comments made in discussion with relatives and professionals were very positive. comments made were The staff provides service users with individual support, and promote good health. I find the care given at the Meadows extremely good. They are always professional in their approach. They always contact me and let me know whats happening Care Homes for Adults (18-65 years) Page 24 of 29 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. Service users can be assured that their health, safety and welfare is promoted and protected. Evidence: The owner/manager is very experienced in the care of people with a learning disability and stated in the completed AQAA The home has an open Ethos, everyone is valued, respected and listened to. The home is never complacent and continues to strive towards improving the service. Records relating to health and safety and the maintenance of equipment were in order. These included electrical and gas safety certificates and fire safety and system checks. All the requirements and recommendations made at the last inspection relating to improvements and repairs to the home had been completed. Observation on the day was that the home was safe and well maintained. The Service supports people in the management of personal allowances and savings. At the last inspection the record keeping was unsatisfactory. Following on from the inspection requested information was provided by the manager relating to service users Care Homes for Adults (18-65 years) Page 25 of 29 Evidence: expenditure which demonstrated that the overall financial management of service users money was not a concern. Three service users cash transaction records were inspected at this inspection, and all were correct. Feedback from service users and staff about the registered manager was positive with comments received about them being approachable, supportive and always on hand for advice. Supervision and team meetings have improved, and there was also evidence of the completion of essential paperwork, but the rota demonstrated that the manager still continues work on shift, which limits management time available,and it would be of benefit if the care staffing levels were reviewed once the home is fully occupied with six service users. Care Homes for Adults (18-65 years) Page 26 of 29 Are there any outstanding requirements from the last inspection? Yes  No  Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No Standard Regulation Requirement Timescale for action 1 20 13 The registered manager will make arrangements for the safe storage of medication 31/01/2009 To ensure medication that is adminstered to service users is stored at the appropriate temperature as recommended by the manufacturers. 2 34 19 schedule 2 The registered 31/12/2006 provider/manager must ensure that criminal records checks are undertaken on all new staff employed in the home. Care Homes for Adults (18-65 years) Page 27 of 29 Requirements and recommendations from this inspection Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No Standard Regulation Description Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set No Standard Regulation Description Timescale for action 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 1 Service user guide /statement of purpose would benefit people who are interested in looking at the service if it was produced in a pictorial format with pictures of the home. The complaints procedure would benefit from being produced in a user friendly format. 2 22 Care Homes for Adults (18-65 years) Page 28 of 29 Helpline: Telephone: 03000 616161 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) 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. 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