Care Home: Mercers

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What the care home does well The service offers opportunities for the people using the service to engage in meaning full activities and opportunity for personal and professional development. People using the service engage in work based employment opportunities and are able be supported to experience new and interesting activities. People using the service reported that staff listen to them and act upon what they say. One person using the service commented "I like art and crafts, I like things so I can do that at any time. I like watching films and listening to music. I know a lot about college and employment and in the future I may do it". People are supported as required within a risk management frame work that is enabling rather than disabling. The service strives to make continues improvements and has an effective quality assurance system in place which is based on a continuous cycle of review and improvement, seeking better outcomes for the people suing the service. Feedback and findings from the annual quality assurance system are reviewed and fed back to stakeholders and the people using the service with a clear plan of action. Information that people using the service receive ensures that they are empowered and supported to make and take positive choices in their lives. One person using the service commented, "when I moved in here I had plenty of information about the house and the people that work here. Three people came to visit me to talk to me, it was very useful to hear information and have the chance to talk to them". The assessment process used to support people moving into the service is detailed and enables their individual support plans to be tailored to meet individual needs. The service is in the process of implementing a document called "all about me". This is a person centred document and aims to put the individual at the centre of the care and support that they are receiving. The document details their individual needs and aspirations and includes other person specific information presented in a style and manner suitable to the person. One health care professional surveyed reported that "in my experience Mercers have proved to be an excellent provider. I have supported two service users who were both placed in difficult circumstances. They both have complex needs and Mercers managed their care and support in a person centred way". The service has made a number of referrals to the Deprivation of Liberty and Safeguards Team. This ensures that the service is pro active and mindful of the needs, rights and choices of the people using the service. One relative commented "I could not wish for a better care home for my X to go to. X is so well looked after its a pleasure to visit X. I have found the staff so helpful, caring, kind and always considerate in everything they say and do. Its a home from home. Wonderful place". Staff recruitment files ensure that the staff have the right checks made prior to working at the service. This protects the people using the service and ensures that are suitable to support them. Staff are suitably trained and the service has a planned training programme in place for the next financial year. What has improved since the last inspection? Improvements at the service are continuous. Redecoration of a number of the communal areas and bedrooms has occurred. The new kitchen has been fitted since that last key inspection. Recruitment of qualified competent staff continues as vacancies occur. Training continues to ensure that staff are qualified in all areas and are provided with refresher training as required. There is currently the Registered Manager and a trainee manager at the service. What the care home could do better: The service should review the documentation provided to the people who use the service to ensure that it is up to date. Areas have been identified in relation to medication management and systems that require improving. The cultural and diversity needs of the people using the service should be further explored. The fire risk assessment must be updated with the location of the Oxygen storage and cylinders in the building. Appropriate signs must be used to identify its storage. Key inspection report Care homes for adults (18-65 years) Name: Address: Mercers 14 Serpentine Walk Colchester Essex CO1 1XR     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: Louise Bushell     Date: 0 8 0 7 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 32 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 32 Information about the care home Name of care home: Address: Mercers 14 Serpentine Walk Colchester Essex CO1 1XR 01206570226 01206570226 k.kittle@tiscali.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mr Pelandapatirage Gemunu Susantha Dias,Mrs Kaushali N Kittle,Mr Gary John Kittle care home 7 Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: One person, under the age of 65 years, who requires care by reason of a learning disability to be accommodated at 16 Cowdray Avenue, Colchester Persons of either sex, aged 65 or under, who require care by reason of a learning disability (not to exceed 6 persons) The total number of service users accommodated must not exceed 7 persons Date of last inspection Brief description of the care home Mercers offers accommodation and care for up to six individuals, with learning disabilities, between the ages of 20 and 40. Registered in 2002, the home is owned by Mr P Dias and Mr and Mrs Kittle, with Mrs Kittle as Registered Manager. All three proprietors are qualified nurses. The premises consist of a two storey, detached property in a residential area within walking distance of Colchester town centre. All bedrooms are single occupancy, two of Care Homes for Adults (18-65 years) Page 4 of 32 7 Over 65 0 Brief description of the care home which are on the ground floor. One of the ground floor rooms, a recent addition off the conservatory, has en suite facilities, although none of the older rooms have such facilities. Communal facilities include a lounge, dining room and conservatory, which had been extended shortly before the inspection. Care Homes for Adults (18-65 years) Page 5 of 32 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 focus of the inspections undertaken by the Care Quality is upon outcomes for the people who use the service and their views of the service provided. The primary method of inspection used was case tracking which involved selecting a number of people and tracking the care they received through looking at their care records, discussion where possible with the people who use the service, the care staff and observation of care practices. The last key inspection took place on the 27th September 2008 followed by an Annual Service review on the 23rd July 2008. The visit was unannounced and planning for the visit included assessment of the notifications of significant events, which had been received from the service to the Care Quality Commission. We looked at the last Inspection Report and information on safeguarding and complaints since the last inspection. We also looked at the previous Annual Quality Care Homes for Adults (18-65 years) Page 6 of 32 Assurance Assessment (AQAA) and reviewed what the service has improved in the last twelve months and its plans for the next twelve months. During the visit information was gathered directly from the staff, people who use the service and relatives and or visitors to the service. The visit took place between 8:15am and 15:00pm. This enabled the inspector to directly and indirectly observe the care practices and the day to day operations of the service. A selected tour of the building was conducted during which the inspector spoke with people who use the service, staff and visitors and the manager. The fees for the service are tailored to the needs assessment of the individual. Care Homes for Adults (18-65 years) Page 7 of 32 What the care home does well: What has improved since the last inspection? Care Homes for Adults (18-65 years) Page 8 of 32 Improvements at the service are continuous. Redecoration of a number of the communal areas and bedrooms has occurred. The new kitchen has been fitted since that last key inspection. Recruitment of qualified competent staff continues as vacancies occur. Training continues to ensure that staff are qualified in all areas and are provided with refresher training as required. There is currently the Registered Manager and a trainee manager at the service. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. 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 9 of 32 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 10 of 32 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. People who use the service can be assured that their needs will be identified through an assessment process, including a visit to the service. Evidence: The service has developed a Statement of Purpose and Service Users Guide, which sets out the aims and objectives of the service, which provides information about the service and the specialist care the service offers. The guide details what the prospective and current individuals can expect and gives a clear account of the specialist services provided, quality of the accommodation, qualifications and experience of staff and how to make a complaint. Information regarding the complaints procedure is currently out of date and provides an incorrect address for the Care Quality Commission. The document is available to all people in a number of formats suitable to individual need. All new people are given a copy of the guide and the services makes one available for all to view as they wish. Feedback received on the day of the inspection from the people that use the service determined that information is readily available and that people were provided with information prior to moving into Mercers. One person using the service commented when I moved in here Care Homes for Adults (18-65 years) Page 11 of 32 Evidence: I had plenty of information about the house and the people that work here. Three people came to visit me to talk to me, it was very useful to hear information and have the chance to talk to them. Other surveys returned by people that use the service commented positively regarding moving to the service. The previous AQAA received from the service also highlights that there is a detailed assessment process and states the home has a comprehensive statement of purpose and a service user guide which highlight the needs, accommodation and support of a specific service user group. Considerable time and effort making admissions to the home person centred, with a comprehensive assessment involving all relevant parties. All new admissions have a service users plan, care management assessment and a care programme approach (CPA) care plan, which are regularly reviewed within a multi disciplinary team framework. Admissions are not made to the service until a full needs assessment has been undertaken. A skilled and trained person always completes the assessment prior to admission to the service. The assessment pro forma used by the service was detailed and identified specific areas of need. The process followed was appropriate to the policy and procedure in place. The assessment explored only number of areas of diversity included preferences and religious needs. It was evident that the service strives to seek clear information prior to admission. Both files reviewed contained assessments that had been completed by social services. One health care professional surveyed reported that in my experience Mercers have proved to be an excellent provider. I have supported two service users who were both placed in difficult circumstances. They both have complex needs and Mercers managed their care and support in a person centred way. One person who uses the service commented, the staff are very good to me since I moved in here. Each person had a statement of their individual terms and conditions and these are reviewed and adjustments made annually or as required. Contracts included information about additional charges made to people living in the home. These included details relating to the contribution for the equal share in the running costs of the service, maintenance and up keep. During the inspection evidence was seen of the involvement of specialist services seeking better outcomes for the individuals. For example one person using the service is seeking additional input from the behavioural specialist team. Care Homes for Adults (18-65 years) Page 12 of 32 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. People who use the service can be assured that their needs and choices will be met. Evidence: A total of two care plans were case tracked fully. It was established that people who use the service receive personal, social, medical and healthcare support, which is suitable to meet their needs. Personal healthcare needs including specialist health and dietary requirements are recorded in each persons care plan. One relative surveyed commented that all clients needs are met to a high standard. Excellent choice of meals, healthy foods offered. All of the surveys returned from relatives, friends, representatives and or advocates, commented that they are always kept up to date with important information, receive enough information and kept in contact with. The care plan provides information and a guide for staff to know how to support the person. It was observed that only care plans that were a current working need were in the main file for the person. Following discussion with the manager and staff of the service it was established that the other care plans, for example specific needs to Care Homes for Adults (18-65 years) Page 13 of 32 Evidence: support a person with personal hygiene tasks had been archived as there was no longer a current need to provide the support. Throughout the care planning process the need is identified in a person centred way. The care plan describes the issue or need for the person and the planned intervention and what the service can do to support this need and or issue. Goals are then identified from the need and or issue and it is highlight who has responsibility to support the person with this goal and possible obstacles and resolutions are highlighted. The two care plans that were case tracked had been reviewed fully and signed by the manager of the service and the person using the service. One person using the service stated my care plan tells staff how to support me. They are very helpful. I have signed it as I agree to it. The care plans observed that were currently in place focused on a number of behavioural and medical processes and interventions. The service is in the process of completing and putting into place a new document called all about me. This is a person centred document and tells the reader all about the persons holistic needs, including medical need. Currently the service identifies and acknowledges a person cultural and diversity needs in the assessment process and a limited amount of information is available in the persons all about me. This was discussed with the manager during feedback. The previous AQAA received does identify that service users at Mercers enjoy a full and varied lifestyle based on their age, gender, beliefs and personal abilities. They access a network of groups such as advocacy group, mens and womens groups, leisure and recreational clubs. One service user, for instance, is visited by a member of the clergy following his request. Staff receive Equal Opportunities training as part of their inductions, encompassing race, culture and diversity issues. All service users are on the Electoral Register, which has resulted in recent voting. Carers continue to maintain daily records regarding the care and activities of people living at the service. The care plan is generated from the pre admission assessment and includes guidelines, risk assessments for the management and control of a range of issues, manual handling and where appropriate behavioural support guidelines. The previous AQAA received comments risk assessments demonstrate that service users rights and choices are upheld unless it has been clearly demonstrated that to do so could result in significant harm to the service user and or others. To this end our risk assessments have sound rationales for the plans they inspire. One relative surveyed commented that the service does well in offering freedom to be out in the community. Care Homes for Adults (18-65 years) Page 14 of 32 Evidence: One person using the service commented, staff are always kind and friendly. a further person using the service commented its very nice here, just like home, living with nice people. Staff are very helpful if I need it and are very easy to talk to if there any any problems. People using the service are encouraged to contribute to the plan and all about me, as it is person centred plan and about them and their aspirations for their future. It was observed that personal support is responsive and tailored to meet the individual choices, needs and preferences. Staff were observed to respect the privacy and dignity of all people. The service listens and responds to individual choices and decisions about who delivers their personal care. People are supported and helped to be independent and can take responsibility for their personal care needs. One person using the service commented we have house meetings regularly to discuss issues and how the weeks has gone. Care Homes for Adults (18-65 years) Page 15 of 32 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 the service are provided with support to make choices about their lifestyle and to develop their life skills. Evidence: People who use the service are supported to enjoy a full and stimulating lifestyle with a variety of options to choose from. Staff members were able to report that people who use the service were supported to attend various clubs, go to the theatre, cinema, swimming, employment opportunities, college and many other activities. The people who use the service have opportunities at internal meetings to voice their wishes regarding social events and all other issues they wish to discuss. The previous AQAA received also detailed information regarding participation by the people using the service and commented significant time and effort is spent in order to ensure that service users are included in care planning, house meetings and CPA forums as part of developing a person centred approach to service user care and service delivery. Staff Care Homes for Adults (18-65 years) Page 16 of 32 Evidence: demonstrate a strong commitment and dedication to incorporating service user wishes and feelings in all areas of their lives and through an effective key worker system, service users have the opportunity to discuss their views on a one to one basis with confidence that their views will be listened to. In support of this one person using the service commented I like art and crafts, I like things so I can do that at any time. I like watching films and listening to music. I know a lot about college and employment and in the future I may do it. On the day of the inspection one person confirmed that they enjoyed going out window shopping independently, whilst another person was being supported in arts and crafts. The AQAA comments individual activities programmes developed with service user involvement, including work, leisure and educational opportunities. Service user led routines rather than service led routines. Frequent and ongoing contacts with significant others. Some service users are in supported and or paid employment. Involvement and ownership in day to day house chores. Supporting service users to move out to more independent, supported living. Menus set by service users with seasonal variations. During the visit to the service one person spoke, with support from staff about their current employemnt experience and working in a cafe. Most of the people who use the service had chosen and arranged their annual holidays with the support of the staff team. The service sought the views of the people who use the service and their representatives and considered these when planning the routines of daily living and arranging activities. Routines and activities were flexible and focused around individuals changing needs and choices. Meals were well balanced and nutritional, catering for the varying choices and dietary needs of the people living at the service. Food stocks were of good quality and in appropriate quantities. The AQAA available determines that the people using the service choose menu options and are supported and provided with healthy living information and advice. One person using the service commented I plan a menu with staff and we do a baking day. We eat all healthy options. I sometimes go to the shops to get the milk and bread if we are running low. Care Homes for Adults (18-65 years) Page 17 of 32 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. People who use the service can be assured that their health and well being is maintained and thus minimising risk. Evidence: Individuals files included information of individuals health needs and how these were to be met, however the information was contained within a variety of sources such as the daily records, the assessment and the care plan. The manager stated that a number of the people who use the service have complex health issues. Whilst it was identified that holistically information was available, it was not presented on all occasions within the care plan. The delivery of personal care was individual and flexible according to changing needs and preferences. Through discussions with the manager of the service it was determined that all about me documents are being introduced to stream line the management of all health related issues for each person. Personal care and support was provided in private and by a person of the same gender where possible. Guidance and support is provided with personal hygiene tasks Care Homes for Adults (18-65 years) Page 18 of 32 Evidence: where required although where people are able to attend to their own personal hygiene needs they were encouraged to do so. External specialist support services are accessed as required. Evidence was held on the individuals file regarding outreach services. Substantial documentation was reviewed where the service had been working with a multi disciplinary team approach, engaging with appropriate agencies to ensure better outcomes for the people using the service. One health care professional surveyed commented that the service does well with communication with professionals. The service was observed to be supporting people as required and had made appropriate referrals to the Deprivation of Liberty and Safeguards team with regards to restrictions on people using the service. This was very well co ordinated and documented in the persons best interest. Medication administration records viewed at this visit as part of the inspection process. The service currently is supplied with the medication required from a local high street pharmacist. There is a service contract in place between the pharmacist and the service. The main medication was observed being stored in a kitchen cupboard style unit which was pad locked. In addition to this further medication was stored in a small metal cabinet on the office wall. It was brought to the attention of the management team that through their contracts with local pharmacists it may be possible that they can provide more secure and suitable storage cupboards for medication. This was ordered during the inspection from the local pharmacist. When medication is received by the service it is recorded in a book. This records what has been received. On occasion this book detailed the quantity received however on others this was not recorded. The Medication Administration Record (MAR) did not show the medication as stock checked, received and quantity. This was brought to the attention of the management team at the service. Due to the failure to record the accurate quantity received against the quantity prescribed and ordered on occasion it was not possible to audit the quantity available to date. This was brought to the attention of the management team, who agreed that there was not a clear audit trail in order to monitor usage of the medication and correct volumes remaining. A number of bottles and boxs were directly observed as not having a date of opening written on them. On occasion medication had not been ordered from one month to the next as stock levels did not require this, however the remaining balance had not been carried forward to the next MAR not enabling the team to complete a reliable accurate audit of medication. It was observed that one person using the service was prescribed paracetamol. The Care Homes for Adults (18-65 years) Page 19 of 32 Evidence: MAR sheet detailed simply the word paracetamol. It was not signed, dated and no instructions for administering were on the MAR. In addition to this a further nine medicines were observed on the MAR to be crossed off with no further record or signature. A number of people using the service were prescribed medication on an as and when required basis. The service had in place a number of guidelines to support staff in knowing when this as and when required medication was to be administered and under what circumstances. The service has an internal policy that all as and when required medication is only administered following an agreement with a manager at the service. It was identified that these guidelines that had been completed were located in the care planning file and that a number of as and when required guidelines had not been completed. Temperatures of the room where medication is being stored was not recorded. The issues identity during the inspection in relation to medication were discussed in full with the management team during the inspection process. The manager stated that the current level of recording is not acceptable and will be investigating the issue further. One person using the service commented I was self medicating, however I am working towards this again. Service users have access to Chiropodists, Physiotherapists, Occupational Therapists, Speech Therapists, Community Nurses as necessary. The service maintains positive contact with these health professionals and staff support Service users to attend appointments and respect confidentiality. Feedback received from a health professional determined that the care service always seek to meet peoples social and health care needs and improve their well being. During the inspection documents were seen of records where people had been supported to attend specialist clinics and relevant health professionals. A staff member commented always in response to the care service responding to meet individual needs and that the staff have the right skills to support people using the service. Care Homes for Adults (18-65 years) Page 20 of 32 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 using the service can be assured that their complaints will be listened to and that the service safeguards and protects them. Evidence: The service has an open culture, which allows people to express their views and concerns through a variety of methods. Feedback gained from one of the people who uses the service confirmed that they are aware of what to do if they are unhappy and wish or wish to make a complaint. The individual stated, if I was unhappy I would go to the office, the manager, Gary, Charlie or Carol, it would always get sorted out. The service has a clear complaints policy and procedure that was available. The previous AQAA determines that that there is a robust complaints procedure that is understood by service users. Manager has expertise in safeguarding vulnerable adults. Mercers policies and practices ensure service users monies and financial affairs are handled accurately and safely. Mercers has a prominent, well established whistle blowing policy. Staff are trained to respond effectively to physical and verbal aggression, whilst minimising the need for physical intervention. Mercers pursues thorough training and regular staff supervision to ensure that staff comply with policies and procedures in order to protect vulnerable adults. There is an open and honest dialogue between the service and service users ensuring the latter views are heard without fear of negative consequences. Care Homes for Adults (18-65 years) Page 21 of 32 Evidence: The service understood the procedure for safeguarding vulnerable adults. Training in the safeguarding and protection of vulnerable people had occurred in April 2009 and staff records showed certificates of attendance. Complaint records were well recorded with a clear audit trail of actions taken at each stage. A relative surveyed commented they provide first class care and support my X and show utmost concern to enable X to have the best quality of life. I can not think of any improvements needed. The policies and procedures relating to recruitment promotes the safety of the people who use the service through the completion of an enhanced Criminal Records Bureau (CRB) disclosures and two written references before a new staff member starts work at the service. Threes staff files were reviewed and confirmed that suitable preemployment checks had occurred prior to commencement of employment. Care Homes for Adults (18-65 years) Page 22 of 32 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. People who use the service live in a comfortable, homely environment that meets their current needs. Evidence: The service continues to be of a good standard and it is homely, clean, and safe and reflects the individuals needs by design and adaptations provided. The people who use the service are fully involved in decisions about the decoration of the service and furniture this includes individual bedrooms and all communal areas. Individuals choose to meet with families or friends in communal settings or privately. They also have access to a telephone where they can make calls. Individuals have full access to all facilities, enabling their independence to grow. One person using the service stated I chose the colours and furniture in me bedroom and I have recently had a new carpet which I chose too. The outdoor space available is of an average size and enables people to move around freely. There is an outside summer house and a large conservatory enabling people more space to move. The previous AQAA identifies that the service has a nominated care taker on site, that Care Homes for Adults (18-65 years) Page 23 of 32 Evidence: a redecoration programme is in place an that lockable storage is available to all people using the service. During the inspection it was directly observed that hazardous materials were stored appropriately and locked away. A new kitchen has been installed since that last key inspection and the manager stated that a new bathroom suite would be installed by the end of the summer. Water temperatures are being maintained within the recommended 43 degrees centigrade, which minimises the risk of people living in the home scolding themselves when washing their hands, taking a bath or shower. Records were reviewed and held on site. The laundry facilities seen were clean and tidy with appropriate equipment to launder clothing and bedding, including a commercial washing machine with a sluice programme for dealing with soiled linen. Appropriate hand-washing facilities of liquid soap and towels are situated in all en suite and bathroom facilities where staff may be required to provide assistance with personal care. Care Homes for Adults (18-65 years) Page 24 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service can be assured that they are supported by suitably competent, qualified and adequately recruited staff. Evidence: Examination of staff records, as well as discussions with the Registered Manager and staff, gave evidence that care staff were qualified and competent. Records showed that all required pre employment checks had been undertaken and documentation was collected to ensure the protection of the people using the service. Staff were employed in sufficient numbers to meet the needs of the service users and were well trained with access to induction and regular on going development opportunities. People who use the service appear to have confidence in the staff who care for them. Rotas show well thought out and creative ways of making sure that the service is staffed efficiently, with particular attention given to busy times of the day and changing needs of the people who use the service. Accurate job descriptions and specifications clearly define the roles and responsibilities of staff. There are consistently enough staff available to meet the needs of the people using the service, with more staff being available at peak times of activity. The staffing structure is based around delivering outcomes for individuals and is not led by staff requirements. One relative surveyed commented in response to what the service does well, staff are Care Homes for Adults (18-65 years) Page 25 of 32 Evidence: friendly and helpful. The examination of staff records showed that care staff received regular formal support and supervision. The service puts a high level of importance on training and staff report that they are supported through training to meet the individual needs of people in a person centred way. There is a structured training plan in place and the forth coming training includes, medication, epilepsy awareness, makaton, autism awareness, equality and diversity and diabetes management. The previous AQAA states in relation to what the service does well, regular clinical supervision and staff appraisals. Monthly team meetings. Up to date staff training relevant to the the service users needs. Flexible responding to off duty annual leave requests. Flexible working hours to meet the needs of particular service users. Diverse staff team with a balance of skills, knowledge and experience. Clearly defined staff roles and responsibilities. Consistency of staff attendance, approach and attitude. Service users involved in staff interview process. Effective recruitment and vetting procedure. All full time staff have obtained and or are obtaining NVQ levels II, III or IV. All new staff meet Sector Skills Council induction standards. All staff receive copies of Codes of Conduct and Practice (GSCC). All staff have a minimum three month probation period. New staff receive LDaFF training. One person using the service commented the management team are really good, the people are friendly and helpful. If there is a problem you can always get help. In addition to this a further person using the service was directly observed laughing and joking in a relaxed manner with a staff member. Care Homes for Adults (18-65 years) Page 26 of 32 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. People using the service can be assured that the manager is qualified to run the service and that systems in place are suitable in order to keep them safe at all times. Evidence: The Registered Manager has the required qualification and experience, is competent to run the service and meets its stated aims and objectives. The manager is able to describe a clear vision of the service based on the organisations values and corporate priorities. The manager communicates a clear sense of direction, is able to evidence a sound understanding and application of best practice operational systems. The previous AQAA received from the service also determines that they are planning to make continued improvements to the service in the best interest of the people using the service. The manager ensures that staff follow the policies and procedures of the service. Practice and performance are discussed during supervision, staff training and team meetings. There is evidence that the ethos of the home is open and transparent. The views of both people who use the service and staff are listened to, and valued. The Care Homes for Adults (18-65 years) Page 27 of 32 Evidence: AQAA contains good information that is fully supported by appropriate evidence. The service demonstrates a high level of self-awareness and recognises the areas that it still needs to improve, and has clearly detailed the innovative ways in which they are planning to do this. The service has efficient systems to ensure effective safeguarding and management of money and valuables, including record keeping. People are supported to manage their own money where possible. Those who do not currently have the skills are encouraged and supported to develop to become as independent as possible. They have access to their records whenever they wish. Record keeping is of a good standard. Records are kept securely and staff are aware of the requirements of the Data Protection Act. The service has a comprehensive range of policies and procedures to promote and protect residents and employees health and safety. There is full and clearly written recording of all safety checks and accidents. The manager, senior team, and staff at all levels have a good understanding of risk assessment processes which is underpinned by promoting independence, choice and autonomy. These principles are taken into account in all aspects of the running of the service. The manager ensures that all staff are trained in health and safety matters. Individual training records reflect this and regular updates are planned ahead. Health and safety is well managed. It was observed that the service stores Oxygen for an individual, as per the care plan. Suitable signage and risk assessments are required in order to ensure safe use, storage and identification in the fire risk assessment. One person using the service commented the management team are really good. A relative surveyed commented I could not wish for a better care home for my X to go to. X is so well looked after its a pleasure to visit X. I have found the staff so helpful, caring, kind and always considerate in everything they say and do. Its a home from home. Wonderful place. The manager obtains feedback from service users, relatives and day centre to ascertain if service delivery is being met and how improvements can be made through questionnaires and informal discussions. The quality assurance feedback was detailed and provided a clear plan of action. This plan of action was fed back to the stake holders and the people suing the service. The service uses this vital feedback as a method of continual improvement. One person using the service commented that the staff and the manager are very good, and kind to me. Care Homes for Adults (18-65 years) Page 28 of 32 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 29 of 32 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 1 19 13 Temperatures must be recored where medication is stored. To ensure that the medication is stored as specified by the manufacturers instructions. 31/08/2009 2 19 17 Medication administration records must be accurate and reflective of the prescribed medication. In order to ensure that people using the service receive all their medication as prescribed. 31/08/2009 3 42 13 Signs must be in use for the safe storage of Oxygen. To ensure that the hazardous chemical is adequately stored and systems are in place to guide the relevant authorities to its location in the event of an emergency. 15/09/2009 Care Homes for Adults (18-65 years) Page 30 of 32 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 4 42 13 The fire risk assessment must show where oxygen is stored and in what quantities. To ensure that the relevant authorities aware of the chemicals location in the event of an emergency. 22/09/2009 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 2 3 4 5 6 7 8 2 6 6 19 19 19 19 19 The information provided to people using the service should be reviewed. The service should explore further the cultural and diversity needs of the people using the service. The service should further develop person centred approaches and systems. Records maintained should accruatly reflect stcock received in to the service. A balance of any medication remaining from one month to the next should be carried forward. All as and when medication should have additional guidelines in place. Handwritten entries should be double signed. Bottles and boxs and tubes should have a date of opening on them. Care Homes for Adults (18-65 years) Page 31 of 32 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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